Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

BACKGROUND: There are conflicting data on the effects of antipsychotic medications on delirium in patients in the intensive care unit (ICU). METHODS: In a randomized, double-blind, placebo-controlled trial, we assigned patients with acute respiratory failure or shock and hypoactive or hyperactive delirium to receive intravenous boluses of haloperidol (maximum dose, 20 mg daily), ziprasidone (maximum dose, 40 mg daily), or placebo. The volume and dose of a trial drug or placebo was halved or doubled at 12-hour intervals on the basis of the presence or absence of delirium, as detected with the use of the Confusion Assessment Method for the ICU, and of side effects of the intervention. The primary end point was the number of days alive without delirium or coma during the 14-day intervention period. Secondary end points included 30-day and 90-day survival, time to freedom from mechanical ventilation, and time to ICU and hospital discharge. Safety end points included extrapyramidal symptoms and excessive sedation. RESULTS: Written informed consent was obtained from 1183 patients or their authorized representatives. Delirium developed in 566 patients (48%), of whom 89% had hypoactive delirium and 11% had hyperactive delirium. Of the 566 patients, 184 were randomly assigned to receive placebo, 192 to receive haloperidol, and 190 to receive ziprasidone. The median duration of exposure to a trial drug or placebo was 4 days (interquartile range, 3 to 7). The median number of days alive without delirium or coma was 8.5 (95% confidence interval [CI], 5.6 to 9.9) in the placebo group, 7.9 (95% CI, 4.4 to 9.6) in the haloperidol group, and 8.7 (95% CI, 5.9 to 10.0) in the ziprasidone group (P=0.26 for overall effect across trial groups). The use of haloperidol or ziprasidone, as compared with placebo, had no significant effect on the primary end point (odds ratios, 0.88 [95% CI, 0.64 to 1.21] and 1.04 [95% CI, 0.73 to 1.48], respectively). There were no significant between-group differences with respect to the secondary end points or the frequency of extrapyramidal symptoms. CONCLUSIONS: The use of haloperidol or ziprasidone, as compared with placebo, in patients with acute respiratory failure or shock and hypoactive or hyperactive delirium in the ICU did not significantly alter the duration of delirium. (Funded by the National Institutes of Health and the VA Geriatric Research Education and Clinical Center; MIND-USA ClinicalTrials.gov number, NCT01211522 .)

Tectonique et volcanisme sous-marin à l'arrière de l'arc des Nouvelles-Hébrides (Vanuatu, Pacifique sud-ouest) : résultats préliminaires de la campagne SEAPSO Leg II du N/O Jean-Charcot

L'arrière-arc des Nouvelles-Hébrides est caractérisé par deux régions structurées en horsts et grabens, au nord et au sud, encadrant une zone centrale clairement affectée par des compressions. Dans le nord, les grabens peu marqués dans la morphologie sont associés à d'importantes manifestations volcaniques récentes et actuelles. Localement, des dépôts manganèsifères témoignent d'une activité hydrothermale récente. Dans les fossés du Coriolis, les laves draguées sont de nature différente de celles des fossés nord ; en particulier, des basaltes ankaramitiques frais ont été recueillis au fond du fossé de Futuna. Ces structures et, plus spécialement, le fossé de Futuna au sud et le fossé de Vot Tande au nord, se sont mis en place sous l'effet d'une extension de direction N30° à N 40°, oblique par rapport à la direction de convergence des plaques. (Résumé d'auteur

Real and Virtual Compton Scattering off the Nucleon

A review is given of the very recent developments in the fields of real and virtual Compton scattering off the nucleon. Both real and virtual Compton scattering reactions are discussed at low outgoing photon energy where one accesses polarizabilities of the nucleon. The real Compton scattering at large momentum transfer is discussed which is asymptotically a tool to obtain information on the valence quark wave function of the nucleon. The rapid developments in deeply virtual Compton scattering and associated meson electroproduction reactions at high energy, high photon virtuality and small momentum transfer to the nucleon are discussed. A unified theoretical description of those processes has emerged over the last few years, which gives access to new, generalized parton distributions. The experimental status and perspectives in these fields are also discussed.Comment: 25 pages, 17 figure

Towards a high precision calculation for the pion-nucleus scattering lengths

We calculate the leading isospin conserving few-nucleon contributions to pion scattering on $^2$H, $^3$He, and $^4$He. We demonstrate that the strong contributions to the pion-nucleus scattering lengths can be controlled theoretically to an accuracy of a few percent for isoscalar nuclei and of 10% for isovector nuclei. In particular, we find the $\pi$-$^3$He scattering length to be $(62 \pm 4\pm 7)\times 10^{-3} m_{\pi}^{-1}$ where the uncertainties are due to ambiguities in the $\pi$-N scattering lengths and few-nucleon effects, respectively. To establish this accuracy we need to identify a suitable power counting for pion-nucleus scattering. For this purpose we study the dependence of the two-nucleon contributions to the scattering length on the binding energy of $^2$H. Furthermore, we investigate the relative size of the leading two-, three-, and four-nucleon contributions. For the numerical evaluation of the pertinent integrals, aMonte Carlo method suitable for momentum space is devised. Our results show that in general the power counting suggested by Weinberg is capable to properly predict the relative importance of $N$-nucleon operators, however, it fails to capture the relative strength of $N$- and $(N+1)$-nucleon operators, where we find a suppression by a factor of 5 compared to the predicted factor of 50. The relevance for the extraction of the isoscalar $\pi$-N scattering length from pionic $^2$H and $^4$He is discussed. As a side result, we show that beyond the calculation of the $\pi$-$^2$H scattering length is already beyond the range of applicability of heavy pion effective field theory.Comment: 24 pages, 14 figures, 10 table

RQM description of the charge form factor of the pion and its asymptotic behavior

The pion charge and scalar form factors, $F_1(Q^2)$ and $F_0(Q^2)$, are first calculated in different forms of relativistic quantum mechanics. This is done using the solution of a mass operator that contains both confinement and one-gluon-exchange interactions. Results of calculations, based on a one-body current, are compared to experiment for the first one. As it could be expected, those point-form, and instant and front-form ones in a parallel momentum configuration fail to reproduce experiment. The other results corresponding to a perpendicular momentum configuration (instant form in the Breit frame and front form with $q^+=0$) do much better. The comparison of charge and scalar form factors shows that the spin-1/2 nature of the constituents plays an important role. Taking into account that only the last set of results represents a reasonable basis for improving the description of the charge form factor, this one is then discussed with regard to the asymptotic QCD-power-law behavior $Q^{-2}$. The contribution of two-body currents in achieving the right power law is considered while the scalar form factor, $F_0(Q^2)$, is shown to have the right power-law behavior in any case. The low-$Q^2$ behavior of the charge form factor and the pion-decay constant are also discussed.}Comment: 30 pages, 10 figure

Precision Pion-Proton Elastic Differential Cross Sections at Energies Spanning the Delta Resonance

A precision measurement of absolute pi+p and pi-p elastic differential cross sections at incident pion laboratory kinetic energies from T_pi= 141.15 to 267.3 MeV is described. Data were obtained detecting the scattered pion and recoil proton in coincidence at 12 laboratory pion angles from 55 to 155 degrees for pi+p, and six angles from 60 to 155 degrees for pi-p. Single arm measurements were also obtained for pi+p energies up to 218.1 MeV, with the scattered pi+ detected at six angles from 20 to 70 degrees. A flat-walled, super-cooled liquid hydrogen target as well as solid CH2 targets were used. The data are characterized by small uncertainties, ~1-2% statistical and ~1-1.5% normalization. The reliability of the cross section results was ensured by carrying out the measurements under a variety of experimental conditions to identify and quantify the sources of instrumental uncertainty. Our lowest and highest energy data are consistent with overlapping results from TRIUMF and LAMPF. In general, the Virginia Polytechnic Institute SM95 partial wave analysis solution describes our data well, but the older Karlsruhe-Helsinki PWA solution KH80 does not.Comment: 39 pages, 22 figures (some with quality reduced to satisfy ArXiv requirements. Contact M.M. Pavan for originals). Submitted to Physical Review

Rescattering and chiral dynamics in B\to \rho\pi decay

We examine the role of B^0(\bar B^0) \to \sigma \pi^0 \to \pi^+\pi^- \pi^0 decay in the Dalitz plot analysis of B^0 (\bar B^0) \to \rho\pi \to \pi^+\pi^-\pi^0 decays, employed to extract the CKM parameter \alpha. The \sigma \pi channel is significant because it can break the relationship between the penguin contributions in B\to\rho^0\pi^0, B\to\rho^+\pi^-, and B\to\rho^-\pi^+ decays consequent to an assumption of isospin symmetry. Its presence thus mimics the effect of isospin violation. The \sigma\pi^0 state is of definite CP, however; we demonstrate that the B\to\rho\pi analysis can be generalized to include this channel without difficulty. The \sigma or f_0(400-1200) ``meson'' is a broad I=J=0 enhancement driven by strong \pi\pi rescattering; a suitable scalar form factor is constrained by the chiral dynamics of low-energy hadron-hadron interactions - it is rather different from the relativistic Breit-Wigner form adopted in earlier B\to\sigma\pi and D\to\sigma\pi analyses. We show that the use of this scalar form factor leads to an improved theoretical understanding of the measured ratio Br(\bar B^0 \to \rho^\mp \pi^\pm) / Br(B^-\to \rho^0 \pi^-).Comment: 26 pages, 8 figs, published version. typos fixed, minor change

Evading the CKM Hierarchy: Intrinsic Charm in B Decays

We show that the presence of intrinsic charm in the hadrons' light-cone wave functions, even at a few percent level, provides new, competitive decay mechanisms for B decays which are nominally CKM-suppressed. For example, the weak decays of the B-meson to two-body exclusive states consisting of strange plus light hadrons, such as B\to\pi K, are expected to be dominated by penguin contributions since the tree-level b\to s u\bar u decay is CKM suppressed. However, higher Fock states in the B wave function containing charm quark pairs can mediate the decay via a CKM-favored b\to s c\bar c tree-level transition. Such intrinsic charm contributions can be phenomenologically significant. Since they mimic the amplitude structure of ``charming'' penguin contributions, charming penguins need not be penguins at all.Comment: 28 pages, 6 figures, published version. References added, minor change

Influência de práticas culturais e da resistência genética na intensidade do cancro da haste e produção de soja no Cerrado

Os efeitos de práticas culturais e resistência genética na intensidade ao cancro-da-haste da soja (Diaporthe phaseolorum f.sp. meridionalis - Dpm) foram examinados na safra 1995-96 em áreas de produção comercial, que haviam sido severamente atacadas na safra anterior (1994-95). Um experimento investigou os efeitos de cultivo mínimo (MT) e do plantio direto (NT) no desenvolvimento da doença e produtividade das cultivares FT-Cristalina e FT-Seriema. Em outro experimento, semeado em plantio direto, estudou-se o efeito da densidade de plantas (8, 15, 21 e 36 plantas/m) no desenvolvimento da doença e produtividade das cvs. FT-Cristalina (suscetivel), FT- 101 (moderadamente resistente) e FT-104 (resistente). Incidência e severidade da doença foram menores em NT do que em MT. A produtividade aumentou no sistema NT (23% para ‘FT-Cristalina’ e 14% para ‘FT-Seriema’), comparada com as produtividades em MT. As curvas de progresso da doença foram melhor descritas pelos mo- delos de Gompertz e logístico. A severidade do cancro aumentou pro- porcionalmente ao aumento das densidades de plantio nas cvs. suscetível e moderadamente resistente. No final do ciclo, 100% das plantas da cv. FT-Cristalina estavam infetadas por Dpm, em todas as densidades de plantio. Níveis intermediários de doença foram observa- dos na cv. FT-101, enquanto apenas níveis muito baixos de doença ocorreram na cv. FT-104. Estabeleceu-se uma correlação negativa entre severidade de cancro-da-haste e produção. Algumas das práticas estudadas demonstraram potential para aplicação direta no controle da doença, e poderiam ser combinadas considerando-se seus efeitos aditivos.Field experiments were conducted in the 1995-96 soybean (Glycine max) growing season to evaluate the effects of cultural practices and host genetic resistance on the intensity of soybean stem canker, caused by Diaporthe phaseolorum f.sp. meridionalis (Dpm). Experiments were conducted in a commercial field severely infected in the previous (1994-95) season. In one study, minimum tillage (MT) and no-tillage (NT) cropping systems were investigated for their effects on disease development and on plant yields in cvs. FT- Cristalina (susceptible) and FT-Seriema (moderately resistant). Another study evaluated the effects of plant densities (8, 15, 21 and 36 plants/m) on disease development in cvs. FT-Cristalina, FT-101 (moderately resistant) and FT-104 (resistant). Disease incidence and severity were consistently lower in NT than in MT, and plant yields were increased by 23% and 14% in the NT system for the susceptible and moderately resistant cultivars, respectively, compared to the yields in the MT system. The Gompertz and Logistic models described well the disease progress curves in all situations. For both susceptible and moderately resistant cultivars, disease severity increased proportionately to the increase in plant densities. At the end of the season, 100% of the plants of cv. FT-Cristalina were infected by Dpm, at all plant densities. Disease levels on cv. FT-101 were intermediate while only very low disease levels were recorded on cv. FT-104. There was a consistent negative correlation between stem canker severity and yield. Some practices demonstrated potential for direct application in disease control, and could be combined considering their additive effects

Direct Measurement of the Pseudoscalar Decay Constant fD+

The absolute branching fraction of $D^+ \to \mu^+ \nu$ has been directly measured by an analysis of a data sample of about 33 ${\rm pb^{-1}}$ collected around $\sqrt{s}=3.773$ GeV with the BES-II at the BEPC. At these energies, $D^-$ meson is produced in pair as $e^+e^-\to D^{+} D^{-}$. A total of $5321 \pm 149 \pm 160$ $D^-$ mesons are reconstructed from this data set. In the recoil side of the tagged $D^-$ mesons, $2.67\pm1.74$ purely leptonic decay events of $D^+ \to \mu^+ \nu$ are observed. This yields a branching fraction of $BF(D^+ \to \mu^+ \nu_{\mu}) = (0.122^{+0.111}_{-0.053}\pm 0.010)$, and a corresponding pseudoscalar decay constant $f_{D^+}=(371^{+129}_{-119}\pm 25)$ MeV.Comment: 7 pages, 8 figures, Submitted to Physics Letters B in October, 200