Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion

<p>Abstract</p> <p>Background</p> <p>Ventilator-induced lung injury (VILI) is a recognized complication of mechanical ventilation. Although the specific mechanism by which mechanical ventilation causes lung injury remains an active area of study, the application of positive end expiratory pressure (PEEP) reduces its severity. We have previously reported that VILI is spatially heterogeneous with the most severe injury in the dorsal-caudal lung. This regional injury heterogeneity was abolished by the application of PEEP = 8 cm H₂O. We hypothesized that the spatial distribution of lung injury correlates with areas in which cyclical airway collapse and recruitment occurs.</p> <p>Methods</p> <p>To test this hypothesis, rabbits were mechanically ventilated in the supine posture, and regional ventilation distribution was measured under four conditions: tidal volumes (V_T) of 6 and 12 ml/kg with PEEP levels of 0 and 8 cm H₂O.</p> <p>Results</p> <p>We found that relative ventilation was sequentially redistributed towards dorsal-caudal lung with increasing tidal volume. This sequential ventilation redistribution was abolished with the addition of PEEP.</p> <p>Conclusions</p> <p>These results suggest that cyclical airway collapse and recruitment is regionally heterogeneous and spatially correlated with areas most susceptible to VILI.</p

Constraints on the salinity–oxygen isotope relationship in the central tropical Pacific Ocean

Uncertainties surround the relationship between salinity and the stable isotopic composition of seawater, largely due to a dearth of modern seawater isotope data. Here we report 191 new, paired measurements of salinity and seawater oxygen isotopes (δ¹⁸O_sw) taken from the central tropical Pacific in May 2012, from the surface to 4600 m depth. We observe significant correlations between δ¹⁸O_sw and salinity across the study region, with slopes ranging from 0.23 to 0.31‰/psu for the mixed layer, and 0.35–0.42‰/psu for waters between the mixed layer and 500 m depth. When considering δ¹⁸O_sw–salinity across averages of individual water masses in the region, slopes range from 0.21 to 0.40‰/psu, albeit with appreciable scatter. Surface salinity and δ¹⁸O_sw data corresponding to the North Equatorial Countercurrent are significantly higher than previously observed, which we attribute to a weak westerly current and dry conditions in the region during the May 2012 cruise. Subsurface (80–500 m) salinity values from 2012 are significantly lower than corresponding values from pre-existing regional data, highlighting a different latitudinal sampling distribution, while subsurface δ¹⁸O_sw is not significantly different. Thus, in May 2012, δ¹⁸O_sw in this region could not be used to distinguish between subsurface water masses of different salinities. Unlike other regions where the surface ‘freshwater endmember’ is close to the δ¹⁸O value of regional precipitation, the freshwater endmember implied by our dataset (− 10.38‰) is consistent with a strong evaporative influence. Paired δ¹⁸O–δD values of precipitation and surface seawaters have similar slopes (5.0, 5.1), and relatively low intercepts (1.4, 0.8) indicating isotopic variability in both reservoirs is also partly controlled by evaporation

Paleocene to Pliocene low-latitude, high-elevation basins of southern Tibet: implications for tectonic models of India-Asia collision, Cenozoic climate, and geochemical weathering

The elevation history of the Tibetan Plateau promises insight into the mechanisms and dynamics that develop and sustain high topography over tens of millions of years. We present the first nearly continuous Cenozoic elevation history from two sedimentary basins on the southern Tibetan Plateau within the latest Cretaceous to Eocene Gangdese arc. Oxygen-isotope and Δ47 clumped-isotope compositions of nonmarine carbonates allow us to constrain carbonate formation temperature and reconstruct the paleoprecipitation record of the Eocene to Pliocene Oiyug Basin and Paleocene to Eocene Penbo Basin. We exploit the systematic decrease of surface temperature and meteoric water δ18O values with elevation to derive paleoelevation estimates for these basins. Minimally altered and unaltered pedogenic and lacustrine carbonates from the Oiyug Basin yield Δ47, CDES (relative to the carbon dioxide equilibrium scale [CDES]) values of 0.625‰ to 0.755‰, which correspond to temperatures of 1−30 °C using a Δ47 thermometer for low-temperature carbonates. Similarly, the Penbo Basin yielded Δ47, CDES values of 0.701‰ to 0.726‰, corresponding to temperatures of 6−12 °C. The apparent evidence for survival of primary clumped-isotope values in the face of substantial burial and heating is an important result for the field of carbonate clumped-isotope thermometry. Our paleoelevation estimates for the Eocene to Pliocene Oiyug Basin (∼6.5−4.1 km) support previous evidence that high elevations were attained in southern Tibet by at least ca. 30 Ma. Stable-isotope results allow for the possibility of significant topographic subsidence during the Miocene as a result of regional extension. In the Penbo Basin, our paleoelevation estimates for the Paleocene to Eocene Nianbo Formation (4.4 +1.3/−1.7 km) and Eocene Pana Formation (4.1 +1.2/−1.6 km) extend the altitude record of the southern Tibetan Plateau to pre−India-Asia collision. These results support the “Lhasaplano” model of an Andean-type continental margin tectonic system. The rise of the Himalayas and Tibet is often invoked to understand isotopic proxies for global chemical weathering in the Cenozoic and has constrained the debate on the nature of CO2−climate−weathering feedbacks. The nature of the Tibetan paleoelevations from pre- to postcollision, as presented here, indicates that high relief at low latitude prevailed on the Asian margin much earlier than previously thought. Thus, high topography alone at low latitude is not sufficient to account for the Cenozoic weathering proxy record

Evidence of seismic slip on a large splay fault in the Hikurangi subduction zone

The Hikurangi subduction zone is capable of producing moderate to large earthquakes as well as regularly repeating slow slip events. However, it is unclear what structures host these different slip styles along the margin. Here we address whether splay faults can host seismic slip at shallow (1 m as observed in the 1947 Poverty and Tolaga Bay earthquakes

Residential mobility during pregnancy in the north of England

<p>Abstract</p> <p>Background</p> <p>Many epidemiological studies assign exposure to an individual's residence at a single time point, such as birth or death. This approach makes no allowance for migration and may result in exposure error, leading to reduced study power and biased risk estimates. Pregnancy outcomes are less susceptible to this bias, however data from North American populations indicate that pregnant women are a highly mobile group. We assessed mobility in pregnant women in the north of England using data from the Northern Congenital Abnormality Survey (NorCAS).</p> <p>Methods</p> <p>Data were extracted from NorCAS for 1985 to 2003. Eligible cases had a gestational age at delivery of ≥ 24 weeks (a viable delivery) (n = 11 559). We assessed mobility between booking appointment (average gestational age 13 weeks) and delivery for pregnancies where the address at booking appointment and delivery were known. The impacts on mobility of maternal age and area-level socio-economic indicators were explored using standard descriptive statistics. A sensitivity analysis and a small validation exercise were undertaken to assess the impact of missing data on the estimate of mobility.</p> <p>Results</p> <p>Out of 7 919 eligible cases for whom addresses at booking and delivery were known, 705 (8.9% (95% CI 8.3 - 9.5)) moved between booking and delivery; the mean and median moving distance was 9.7 and 1.4 km respectively. Movers were significantly younger (25.4 versus 27.3 years, p < 0.01) and lived in more deprived areas (index of multiple deprivation score 38.3 versus 33.7, p < 0.01) than non movers.</p> <p>Conclusion</p> <p>Mobility in the north of England (9%) is considerably lower than that reported in North America and the only other study from the UK (23%). Consistent with other studies, mobility was related to maternal age and socio-economic status, and the majority of moves were over a relatively short distance. Although this population appears relatively stable, the mobility we have observed may still introduce misclassification or error into an exposure assessment relying solely on postcode at delivery, and migration should still therefore be considered a potential source of bias in future studies.</p

Spatio-temporal trends of mortality in small areas of Southern Spain

Background: Most mortality atlases show static maps from count data aggregated over time. This procedure has several methodological problems and serious limitations for decision making in Public Health. The evaluation of health outcomes, including mortality, should be approached from a dynamic time perspective that is specific for each gender and age group. At the moment, researches in Spain do not provide a dynamic image of the population’s mortality status from a spatio-temporal point of view. The aim of this paper is to describe the spatial distribution of mortality from all causes in small areas of Andalusia (Southern Spain) and evolution over time from 1981 to 2006. Methods: A small-area ecological study was devised using the municipality as the unit for analysis. Two spatiotemporal hierarchical Bayesian models were estimated for each age group and gender. One of these was used to estimate the specific mortality rate, together with its time trends, and the other to estimate the specific rate ratio for each municipality compared with Spain as a whole. Results: More than 97% of the municipalities showed a diminishing or flat mortality trend in all gender and age groups. In 2006, over 95% of municipalities showed male and female mortality specific rates similar or significantly lower than Spanish rates for all age groups below 65. Systematically, municipalities in Western Andalusia showed significant male and female mortality excess from 1981 to 2006 only in age groups over 65. Conclusions: The study shows a dynamic geographical distribution of mortality, with a different pattern for each year, gender and age group. This information will contribute towards a reflection on the past, present and future of mortality in Andalusia.Ye