Effects of melting, subduction-related metasomatism, and sub-solidus equilibration on the distribution of water contents in the mantle beneath the Rio Grande Rift

The distribution of water in the upper mantle plays a crucial role in the Earth's deep water cycle, magmatism, and plate tectonics. To better constrain how these large-scale geochemical systems operate, peridotite and pyroxenite mantle xenoliths from Kilbourne Hole (KH) and Rio Puerco (RP) along the Rio Grande Rift (NM, USA) were analyzed for water, and major and trace element contents. These xenoliths sample a lithosphere whose composition was influenced by subduction and rifting, and can be used to examine the effects of melting, metasomatism, and sub-solidus equilibration on the behavior of water. The first result is that in KH xenoliths, olivines underwent negligible H loss during xenolith ascent, i.e. preserved their mantle water contents. These olivine water contents are used to calculate mantle viscosities of 0.5–184 · 1021 Pa·s. These viscosity values are more than 40 times higher than those of the asthenosphere and show that KH peridotites represent samples from the lithosphere. The preservation of olivine water contents is exceptional for off-cratonic xenoliths, and the KH peridotites provide the first estimate of the average concentration of water in Phanerozoic continental mantle lithosphere at 81 ± 30 ppm H2O. The mantle lithosphere beneath the Rio Grande rift is nevertheless heterogeneous with water contents ranging from <0.5 to 120 ppm H2O in peridotites and from 227 to 400 ppm H2O in pyroxenites. A composite KH xenolith of a harzburgite cross-cut by a clinopyroxenite vein shows this heterogeneity at the cm scale. The second contribution of this study stems from the majority of the KH peridotites and two of the RP peridotites having major and trace elements that can be explained by partial melting without any need to invoke metasomatic processes. This allows to show that, prior to modelling the water content variation of each peridotite mineral during melting, a correction for sub-solidus equilibration has to be applied to the water contents of the minerals. Sub-solidus equilibration also provides an explanation for the discrepancy between the clinopyroxene/orthopyroxene ratio of water contents in natural peridotites worldwide and in laboratory experiments on water partitioning in peridotite minerals. Finally, the cryptically metasomatized peridotites, rare at KH and abundant at RP, as well as the pyroxenites, permit to decipher the origin and water contents of the metasomatic melts that affected the continental lithosphere beneath the Rio Grande Rift. Trace element modelling of the metasomatized KH and RP peridotites are consistent with metasomatism via melts that are of subduction origin. Melts in equilibrium with peridotites contain more water at RP (∼1 wt.% H2O) than at KH (∼0.5 wt.% H2O), although this did not result in a more water-rich mantle lithosphere at RP. Rio Puerco lies within the northern Rio Grande rift, proposed to have been affected by a flat slab subduction, which may explain the more hydrous and extensive metasomatism compared to the south, where KH is located

The use of social services by community-dwelling older persons who are at risk of institutionalization: a survey

The use of community-based social services additionally to regular home help services to support older persons at risk of institutionalization was studied. Structured interviews were held with 292 persons, who specifically pointed out that they prefer to remain independently at home. Bivariate and multivariate logistic regression models were developed to study the association between social service use and personal, health-related and wellbeing characteristics. 195 respondents indicated that they made use of at least one social service (68%). Only three services (individual care, social-cultural activities and restaurant facilities), out of nine, were used regularly. Those who lived in a sheltered environment or were supported by informal caregivers or who visited day care had a significantly higher probability of using these services. More attention should be given to the nature and accessibility of community-based social services in order to have distinctive added value in enabling older persons to age in place

A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

<p>Abstract</p> <p>Background</p> <p>Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively). Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity. The 2007 ACC/AHA guidelines for UA/NSTEMI do not identify patients at low risk for adverse cardiac events who can be safely discharged without provocative testing. As a result large numbers of low risk patients are triaged to chest pain observation units and undergo provocative testing, at significant cost to the healthcare system. Clinical decision rules use clinical findings (history, physical exam, test results) to suggest a diagnostic or therapeutic course of action. Currently no methodologically robust clinical decision rule identifies patients safe for early discharge.</p> <p>Methods/design</p> <p>The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i) apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii) determine the inter-observer reliability of the clinical information; iii) determine the statistical association between the clinical findings and the composite outcome; and iv) use multivariable analysis to derive a highly sensitive clinical decision rule to guide triage decisions.</p> <p>Discussion</p> <p>The study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments.</p

Prognostic value of adenosine stress cardiovascular magnetic resonance in patients with low-risk chest pain

<p>Abstract</p> <p>Background</p> <p>Approximately 5% of patients with an acute coronary syndrome are discharged from the emergency room with an erroneous diagnosis of non-cardiac chest pain. Highly accurate non-invasive stress imaging is valuable for assessment of low-risk chest pain patients to prevent these errors. Adenosine stress cardiovascular magnetic resonance (AS-CMR) is an imaging modality with increasing application. The goal of this study was to evaluate the negative prognostic value of AS-CMR among low-risk acute chest pain patients.</p> <p>Methods</p> <p>We studied 103 patients, mean 56.7 ± 12.3 years of age, with chest pain and no electrocardiographic evidence of ischemia and negative cardiac biomarkers of necrosis, who were admitted to the Cardiac Decision Unit of our institution. All patients underwent AS-CMR. A negative AS-CMR was defined as absence of all the following: regional wall motion abnormalities at rest; perfusion defects during stress (adenosine) and rest; and myocardial scar on late gadolinium enhancement images. The patients were followed for a mean of 277 (range 161-462) days. The primary end point was defined as the combination of cardiac death, nonfatal acute myocardial infarction, re-hospitalization for chest pain, obstructive coronary artery disease (>50% coronary stenosis on invasive angiography) and coronary revascularization.</p> <p>Results</p> <p>In 14 patients (13.6%), AS-CMR was positive. The remaining 89 patients (86.4%), who had negative AS-CMR, were discharged. No patient with negative AS-CMR reached the primary end-point during follow-up. The negative predictive value of AS-CMR was 100%.</p> <p>Conclusion</p> <p>AS-CMR holds promise as a useful tool to rule out significant coronary artery disease in patients with low-risk chest pain. Patients with negative AS-CMR have an excellent short and mid-term prognosis.</p

Assessment of cardiac ischaemia and viability: role of cardiovascular magnetic resonance

Over the past years, cardiovascular magnetic resonance (CMR) has proven its efficacy in large clinical trials, and consequently, the assessment of function, viability, and ischaemia by CMR is now an integrated part of the diagnostic armamentarium in cardiology. By combining these CMR applications, coronary artery disease (CAD) can be detected in its early stages and this allows for interventions with the goal to reduce complications of CAD such as infarcts and subsequently chronic heart failure (CHF). As the CMR examinations are robust and reproducible and do not expose patients to radiation, they are ideally suited for repetitive studies without harm to the patients. Since CAD is a chronic disease, the option to monitor CAD regularly by CMR over many decades is highly valuable. Cardiovascular magnetic resonance also progressed recently in the setting of acute coronary syndromes. In this situation, CMR allows for important differential diagnoses. Cardiovascular magnetic resonance also delineates precisely the different tissue components in acute myocardial infarction such as necrosis, microvascular obstruction (MVO), haemorrhage, and oedema, i.e. area at risk. With these features, CMR might also become the preferred tool to investigate novel treatment strategies in clinical research. Finally, in CHF patients, the versatility of CMR to assess function, flow, perfusion, and viability and to characterize tissue is helpful to narrow the differential diagnosis and to monitor treatment

The Survival of Non-capitalism

This article explores the importance of non-capitalist space within the global political economy. The issue of how to categorise and understand space in so-called peripheral regions such as Latin America has been a contentious one. Whilst many radical analyses have focused on the dynamics of capitalism in relation to the geography of development, explaining how it has been able to survive and grow, this article makes the case for a more multi-linear theoretical framework with which to view the socio-economic landscape. This is inspired not only by the later writings of Marx but also the specific Marxian class analysis of those involved in Rethinking Marxism. Via a focus on Oaxaca in southern Mexico, this article highlights both the survival and the recreation of spaces of non-capitalism, and provides an argument for why we should consider these to be important for transformative action more broadly, whilst also discussing their potential limitations