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Introduction There are many options available to patients who are placed on constant positive airway pressure (CPAP) for obstructive sleep apnea. Despite the success of CPAP in correcting apnea, a significant number of patients have difficulty with the therapy. A large number of those patients who have difficulty stop therapy and are often labeled as "CPAP Failure". Non-sleep specialists may view CPAP therapy as a singular course of treatment, but there are many ways CPAP may be ordered for a patient. Each patient experiences a unique set of options that constitute a unique order set. Methods In order to demonstrate the magnitude of the possible options, estimates of the number of unique order sets were calculated. The author chose individual order options and the number of selections possible within each option. The calculated sets included a "Generous, Limited and Minimal" number of selections for each option. Calculations were done separately for standard CPAP and for auto-adjusting CPAP. Additional calculations were performed using the number of commercially available masks in the United States. Results The maximum number of unique order sets was seen using a standard CPAP combined with commercially available masks: 49,152 unique order sets. The fewest number of unique order sets were seen with the auto-adjusting CPAP and the "Minimal" selections: 288 unique order sets. Discussion There are a large number of unique CPAP orders that a patient may experience. CPAP treatment is not a singular or simple therapy. When evaluating obstructive sleep apnea patients with histories of CPAP failure or prior difficulty with CPAP, paying close attention to the patient's treatment experiences may help explain a significant number of those patients' CPAP therapy problems.

Robert G Hooper The Sleep Center, Scottsdale, AZ, USA Study objectives: Periodic limb movements (PLMs) are routinely measured during polysomnogram (PSG) testing. During the early years of sleep testing, physical movements were identified and over time, consensus ultimately led to the current definitions of movement disorders including criteria used to measure PLMs on PSG testing. There has been considerable debate about the clinical importance of the PLMs measured during PSG testing. Over the last decade, the author has observed significant variations in the actual visible physical movements observed with a PLM event. This report is the result of work to quantify the amount of movement and the frequency of movements observed among individuals who have PLMs. Methods/principal findings: Consecutive PSGs performed in a suburban sleep center for an initial diagnosis of a sleep disorder were retrospectively reviewed to identify those with measured PLMs. Of 646 studies on patients >18 years, 460 met criteria for inclusion. Visual assessment of movements was carried out on all of those with PLM events measured using American Academy of Sleep Medicine guidelines. The movements were quantified based on the number of extremities observed to move. PLMs were observed in 237 of the 460 studies that met inclusion criteria (52%). As expected, the PLMs occurred more frequently in older individuals. PLMs occurred with equal frequency in both sexes. Apnea occurred with equal frequency in those with and without observed physical movements. Of those with PLMs, 62% (147) demonstrated observable physical movements. Significant movements involving three or four extremities occurred in 16% of individuals with PLMs. No physical movements were observed in 38%. Conclusion: In this uncontrolled, nonrandom, observational series, visual physical movements with a PLM event identify a unique subset of individuals with PLMs. The presence of any visual movements or more pronounced visual movements involving multiple extremities may represent markers for PLM disorder, for clinically significant PLMs with other disorders, or for other clinical conditions or physiologic variables. Keywords: periodic limb movements, periodic limb movement disorder, polysomnogram, sleep movements, periodic limb movement index, leg movements, PLM

Variations in environmental physicochemical parameters result in corresponding changes in seawater rare earth element (REE) distributions. For an archive to be utilized in paleoceanographic and paleoenvironmental reconstructions, it should record these variations. Therefore, an archive's proxy potentiality should be assessed analogous to modern oceanic settings. Articulated brachiopods of several shallow water localities ( The mean REE SN pattern of shallow-water brachiopods is significantly different from that of their deep-water counterparts, with lower enrichments in LREEs and MREEs, and depletion in HREEs. Depth exercises a major control on the LREE and MREE fractionation with a milder one on HREE fractionation. The Ce/Ce* anomaly is not affected by either of these parameters in shallow-water settings, but in deep settings the depth effect dominates. Due to the importance of depth on REE fractionation in the shells from shallow settings, their LREE SN to HREE SN ratios (L:H) were divided into six discrete intervals for the bathymetric sensor. The bathymetric sensor was applied to some fossils and whole rock in order to estimate their paleodepths. The evaluation was successful in placing the Permian Gyanyima, the Pennsylvanian Naco, Boggy and the Silurian Chicotte, Becscie and Jupiter Formations in shallow depths (

Robert G Hooper The Sleep Center, PC, Scottsdale, AZ,USA Study objectives: The relationship between obstructive sleep apnea (OSA) and body weight is not clearly established. In order to describe the relationship of weight and OSA severity seen in a suburban sleep center, an observational review was performed of initial diagnostic polysomnograms (PSGs) ordered on patients with American Academy of Sleep Medicine (AASM) symptomatic indications. Methodology/principle findings: Initial, full-night diagnostic or initial split-night (diagnostic portion) PSGs performed for any indication on patients >18 years old were retrospectively reviewed for a two year period. All studies were performed following AASM guidelines. PSG data were reviewed for the presence and severity of apnea (no OSA – apnea hypopnea index (AHI) 60). Data were reviewed from 629 PSGs (37% females and 63% males) of which 450 met the criteria for apnea. Studies were classified by apnea severity (196 mild, 103 moderate, 91 severe apnea and 60 with very severe apnea) and weight (body mass index (BMI)). Of those with apnea, and BMIs 30. Conclusion/significance: The profile of this nonrandom series, tested because they were suspected of having a disorder of sleep, provides guidelines for physicians in their approach to symptomatic patients. Individuals with a normal BMI can have apnea, including severe apnea. Severe obesity (BMI >40) is almost always associated with apnea when symptoms are present. Obesity increases the severity of the diagnosed apnea. Excessive weight should be an indication for testing, but normal weight should not exclude individuals with appropriate symptoms. Obesity, while a major contributing factor to severity, is not the etiological cause of OSA in the majority of these patients. Keywords: apnea, nonobese apnea, apnea severity, etiology of apnea, obesity

A soil geochemical study in northern California was done to investigate the role that weathering and transport play in the regional distribution and mobility of geogenic Cr and Ni, which are both potentially toxic and carcinogenic. These elements are enriched in ultramafic rocks (primarily serpentinite) and the soils derived from them (1700–10,000 mg Cr per kg soil and 1300–3900 mg Ni per kg soil) in the Coast Range ophiolite. Chromium and Ni have been transported eastward from the Coast Range into the western Sacramento Valley and as a result, valley soil is enriched in Cr (80–1420 mg kg−1) and Ni (65–224 mg kg−1) compared to median values of U.S. soils of 50 and 15 mg kg−1, respectively. Nickel in ultramafic source rocks and soils is present in serpentine minerals (lizardite, antigorite, and chrysotile) and is more easily weathered compared to Cr, which primarily resides in highly refractory chromite ([Mg,Fe2+][Cr3+,Al,Fe3+]2O4). Although the majority of Cr and Ni in soils are in refractory chromite and serpentine minerals, the etching and dissolution of these minerals, presence of Cr- and Ni-enriched clay minerals and development of nanocrystalline Fe (hydr)oxides is evidence that a significant fractions of these elements have been transferred to potentially more labile phases.

Anticlines along the western margin of the South Viking Graben in the Brae area of the U.K. North Sea form the structural components of large structural and stratigraphic traps within Upper Jurassic Brae Formation submarine fan deposits. Various interpretations of the origin of these anticlines and their attendant inboard synclines at the graben boundary have been previously published, with both gravity-driven processes and inversion being invoked. Based on regional interpretation of 3-D seismic data sets and analysis of thickness variations in uppermost Jurassic and Cretaceous sequences in numerous wells, it is concluded that gravity-driven processes were more important than inversion. Differential compaction of mudstone-rich slope deposits laterally adjacent to coarse clastic submarine fan reservoirs has resulted in the field reservoirs now being at slightly higher elevations than the finer grained deposits along the length of the anticlines. Compaction of the very thick sandstone- and mudstone-dominated successions in the basin center has also been greater than that of the more conglomeratic successions adjacent to the basin margin, where sequences are underpinned by the slope of the footwall, resulting in over-steepened slopes toward the basin on the outboard side of the anticlines. Movement of Permian salt that underlies the Jurassic (and Triassic) in the basin has also had significant broad effects on the Upper Jurassic structures, creating depressions and underpinning some anticlines. Continued slow subsidence of the basin-fill down the main graben boundary fault system in the under-filled rift during the latest Jurassic and Early Cretaceous, above changes in footwall slope (from eroded slope to graben-boundary fault, or, in the case of East Brae, across a plunging basement nose) is considered to be the primary cause of the anticlines and their inboard synclines. Reversal of movement along the main boundary fault, causing inversion of the graben-margin sequences, is considered unlikely as the primary mechanism for anticline formation. Additional movement down the graben-boundary fault system in the early Maastrichtian may have slightly tightened the anticlines. Final minor fault movement along the graben margin occurred in the mid Eocene, but this is unlikely to have significantly affected the Brae structures. Some of the anticlines provide evidence of the presence of the underlying thick reservoir sequences (due to differential compaction over conglomeratic sections), but not all positive structural features contain coarse clastic sediments.

Objectives: Physical and psychological symptoms of individuals with chronic whiplash-associated disorders (WAD) are modulated by successful treatment with cervical radiofrequency neurotomy (cRFN). However, not all individuals respond to cRFN, and it is unknown which clinical features predict successful response to cRFN.Methods: This prospective cohort study investigated 53 individuals with chronic WAD (36 female, 17 male mean age = 44.7 ± 10.9 (SD) years) who underwent cRFN. Predictor variables measured at baseline (prior to RFN) included self-reported pain (VAS), disability (NDI), post-traumatic stress symptoms (PDS), pain catastrophizing (PCS), and measures of sensory hypersensitivity (pressure and cold pain thresholds). The outcome measure was perceived Global Rating of Change (where scores ≥ 4 were classified as a successful response) 3 months post-cRFN.Results: Univariate logistic regression demonstrated that lower levels of disability and pain catastrophizing were associated with successful response of cRFN (both P < 0.05). Multivariable logistic regression demonstrated that low levels of pain catastrophizing and disability remained significant predictors of a successful response to cRFN (both P < 0.05).Conclusions: Low levels of pain catastrophizing and disability independently predicted a successful response to cRFN in patients with chronic WAD.

The post-Jurassic bathymetric and subsidence history of the Mid-Norwegian Atlantic margin (More and Voring basins) has been investigated using the technique of 3D-flexural backstripping. Eleven mapped horizons from seabed to the Base Cretaceous have been sequentially backstripped to produce a suite of palaeobathymetry and palaeostructure maps for all horizons at all time stages. Backstripping has incorporated thermal subsidence in response to (1) an initial rift event at c . 140 Ma and (2) a subsequent rift-to-break-up event in the latest Cretaceous/early Tertiary. Transient dynamic uplift of the margin during the Paleocene is also incorporated, having a particular impact on palaeobathymetric predictions at this time. In an exploration context, the palaeobathymetric maps were used predictively to investigate sediment dispersal and deposition through time; the subsurface palaeostructure maps were used for maturation modelling and identification of hydrocarbon-migration pathways, while all of the maps contribute to an understanding of hydrocarbon-trap development through time. The backstripped maps yield considerable information on the regional structural evolution of the margin. After regionally distributed extension of both the More and Voring basins during the Late Jurassic/Early Cretaceous, map restorations of the two basins show contrasting structural histories. There is no younger fault-controlled overprint on the More Basin, whereas the inner Voring Basin was extended again in the mid-Cretaceous and the outer Voring Basin was extended in the latest Cretaceous/Paleocene. Three-dimensional backstripping also confirms an active compressional origin, rather than a wholly passive loading origin, for the post-break-up Tertiary domes located along the margin. This is the first time that a temporal analysis of the domes9 formation has been possible in 3D map form rather than 2D section form. The technique of 3D flexural backstripping has wide application to the study of rifts and continental margins elsewhere.

This study conducted a cost-effectiveness analysis of Delaware's CREST Outreach Center, a work release therapeutic community (TC) and aftercare program for criminal offenders. Treatment effectiveness was assessed using the number of days reincarcerated during an 18-month, post-release follow-up period. The 6-month CREST program cost $1937 for the average participant, and led to ∼30 fewer days incarcerated (29% less) than the average participant in a standard work release program. This implies that the CREST program reduced incarceration for criminal offenders at an average cost of $65 per day. The additional investment of $935 per client to provide aftercare services led to 49 fewer days incarcerated (43% less) than CREST work release-only participants. This suggests that by adding an aftercare component to the CREST work release program, a day of incarceration is avoided at an average cost of $19 per day. These findings have implications for future investments in post-release substance abuse treatment for criminal offenders. However, the results must be interpreted with caution given potential selection bias in the groups that participated in the CREST work release and aftercare programs. Selection bias and the policy implications of this research are noted and discussed.

Seasonal changes in the lipid and lipid soluble components of gonads of green sea urchin (Strongylocentrotus droebachiensis) were investigated. The lipid content was highest in the spring while it was lowest in the winter. The composition of nonpolar and polar lipid classes of sea urchin gonads were not affected qualitatively, but there were significant (P

The Niger Delta has a distinctive structural and stratigraphic zonation. Regional and counter-regional growth faults, developed in an outer-shelf and upper-slope setting, are linked, via a translational zone containing shale diapirs, to a contractional zone defined by a fold-thrust belt that developed in a toe-of-slope setting. Structural and depositional systems have migrated with the progradation of the delta. A paleo fold belt is buried under the modern upper/middle slope. The structural system in this paleo fold belt is complex and comprises a series of en echelon thrust-cored folds and associated ponded slope-basins, shale diapirs, and extensional growth faults. Analysis of the growth sections filling the ponded slope-basins provides a record of how this accommodation was created and subsequently filled and how the individual structural elements interact to create and modify the available space. The depositional systems initially exploit primary accommodation on the slope created by structural movement—the synchronous growth of the fold, the extensional faults and the shale diapir. As the pond is progressively filled, the previously deposited strata modify the accommodation and subsequent depositional systems compensate accordingly.

To investigate changes in clinical (physical and psychological) features of individuals with chronic whiplash-associated disorder who had previously undergone cervical radiofrequency neurotomy at the time point when the effects of radiofrequency neurotomy had dissipated and pain returned.Prospective cohort observational trial of consecutive patients.Tertiary spinal intervention centre in Calgary, Alberta, Canada.A total of 53 consecutive individuals with chronic whiplash-associated disorder.Individuals underwent radiofrequency neurotomy and were assessed before radiofrequency neurotomy, at 1 and 3 months postprocedure, and then after the return of pain (approximately 10 months postprocedure).Quantitative sensory tests (pressure; thermal pain thresholds; brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement; craniocervical flexion test) were measured. Self-reported disability, psychological distress, pain catastrophization, and posttraumatic stress disorder symptoms also were measured.Upon the return of pain after radiofrequency neurotomy, levels of disability increased (P.0001), and were no different to those before radiofrequency neurotomy (P = .99). There also was a significant deterioration in quantitative sensory testing measures and reduced cervical range of motion after the return of pain (all P.05); all approaching values were recorded before radiofrequency neurotomy (P.22). There were no significant changes in pressure hyperalgesia (P.054) or craniocervical flexion test performance (P.07) after the return of pain. Psychological distress and pain catastrophizing increased significantly after the return of pain (P.01), and again were no different than measures taken prior to radiofrequency neurotomy (P.13). However, there was no difference in number or severity of posttraumatic stress symptoms after the return of pain (P.30).Physical and psychological features of chronic whiplash-associated disorder are modulated dynamically with cervical radiofrequency neurotomy. These findings indicate that peripheral nociception is involved in the manifestations of chronic whiplash-associated disorder in this cohort of individuals.

A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. The results support the effectiveness of a multistage therapeutic community model for drug-involved offenders, and the importance of a work release transitional therapeutic community as a component of this model.

This study aims to determine if cervical medial branch radiofrequency neurotomy reduces psychophysical indicators of augmented central pain processing and improves motor function in individuals with chronic whiplash symptoms.Prospective observational study of consecutive patients with healthy control comparison.Tertiary spinal intervention centre in Calgary, Alberta, Canada.Fifty-three individuals with chronic whiplash associated disorder symptoms (Grade 2); 30 healthy controls.Measures were made at four time points: two prior to radiofrequency neurotomy, and 1- and 3-months post-radiofrequency neurotomy. Measures included: comprehensive quantitative sensory testing (including brachial plexus provocation test), nociceptive flexion reflex, and motor function (cervical range of movement, superficial neck flexor activity during the craniocervical flexion test). Self-report pain and disability measures were also collected. One-way repeated measures analysis of variance and Friedman's tests were performed to investigate the effect of time on the earlier measures. Differences between the whiplash and healthy control groups were investigated with two-tailed independent samples t-test or Mann-Whitney tests.Following cervical radiofrequency neurotomy, there were significant early (within 1 month) and sustained (3 months) improvements in pain, disability, local and widespread hyperalgesia to pressure and thermal stimuli, nociceptive flexor reflex threshold, and brachial plexus provocation test responses as well as increased neck range of motion (all P 0.0001). A nonsignificant trend for reduced muscle activity with the craniocervical flexion test (P 0.13) was measured.Attenuation of psychophysical measures of augmented central pain processing and improved cervical movement imply that these processes are maintained by peripheral nociceptive input.

The endangered red-cockaded woodpecker ( Picoides borealis ) satisfies its nutrient requirements by capturing arthropods from live pine trees. Age of pine stands has been used as a guide for providing suitable habitat for the species, however, little is known about the relationship of arthropods to age of pines. The relationship on longleaf pines ( Pinus palustris ) 22–127 years old was examined in winter. Arthropod biomass m −2 on the bole, live limbs and dead limbs was related to tree age, radial growth 6–10 years before sampling and ambient temperature. Arthropod biomass m −2 declined with increasing tree age on the lower, mid- and upper bole; increased with tree age on dead limbs; and increased with tree age on live limbs until 80 years when it declined with increasing age. Slower growing trees had higher arthropod biomass m −2 for a given age than faster growing trees. Total arthropod biomass for the whole tree increased with tree age up to 86 years, when it declined with increasing tree age. However, the older the tree, the greater the arthropod biomass on dead limbs.

Deficiencies of mitochondrial enzymes cause a number of severe neurologic syndromes in pediatric patients. Isolated myopathy secondary to enzymatic deficiency only rarely has been recognized and reported in adults. Three normal-appearing patients with unexplained dyspnea on exertion, tachycardia, and fatigue were studied with progressive incremental and constant load exercise testing with hemodynamic and gas exchange measurements. Subsequently, muscle biopsies were performed and enzymatic profiles determined. Exercise testing suggested altered cellular energy metabolism. Oxygen transport and gas exchange at rest and with exercise were normal. During exercise, ventilation increased excessively for the work performed, but it was appropriate for carbon dioxide production. Cardiac outputs increased significantly (196 to 305%), heart rates reached maximum levels, and lactic acid levels increased (385 to 833%) during exercise at 25 W. Muscle morphology was normal, but mitochondrial enzyme assays demonstrated one or more deficiencies in all three patients. Mitochondrial enzymatic deficiency can be a cause of unexplained exercise symptomatology and limitation in adults. Our experience would suggest the incidence of the disorder may be greater than that previously recognized or expected. Symptoms of exercise limitation associated with dyspnea, tachycardia, or muscle fatigue should alert the clinician to a possible abnormality in cellular energy metabolism.

Stomach contents of 498 snow crabs. Chionoecetes opilio, collected between May and August 1990 with Japanese conical traps from 5 locations in Bonne Bay, Newfoundland, were examined. Food was found in 67.5% of the crabs. The main components, in descending order of their frequency of occurrence, were algae, fish, polychaetes, crustaceans, molluscs, and echinoderms. Differences were not detected between the sexes, among size groups, or between individuals with old and new carapaces. Sampling of the bottom community at the 5 locations with a Petersen grab showed differences in wet biomass and numerical abundance of potential prey. Comparisons between the ranks of food items in the stomachs and their availability in the bottom community, showed that both prey availability and food preferences are important in the field diet of Chionoecetes opilio. The food selection of the crabs examined was biased against errant burrowing polychaetes, small gastropods, amphipods, and holothurians. Sponges, Yoldia spp., ophiuroids, and small crustaceans were generally preferred and sedentary burrowing or tube-building polychaetes were eaten in proportion to availability.

Baseline data on nearshore benthic macrofauna and flora assemblages are necessary for successful environ­mental monitoring in the Arctic, where major climate and industrial changes are underway, yet to date these environments remain understudied. This study used bottom video and benthic grab samples to compare shallow benthic marine (1 – 40 m) floral and faunal distribution and composition in two nearshore locations in the Canadian Arctic with different geomorphic settings. Sachs Harbour, located on southwestern Banks Island, has a submergent soft-sediment shoreline with locally rapid coastal erosion, while Gjoa Haven, located on southeastern King William Island, has an emergent shoreline dominated by coarse ice-contact Quaternary sediments with little to no coastal erosion. Gjoa Haven’s sediment-starved, heterogeneous nearshore area contributes to a more diverse macroalgal flora than is found at Sachs Harbour, where a continuous supply of sand and mud from thermally driven coastal erosion and muddy runoff produces a more homogeneous nearshore environment. Seventy-four species (10 macroalgae, 64 macrofauna) were recorded from southwestern Banks Island and 65 species (26 macroalgae, 39 macrofauna) from southeastern King William Island. Species composition differed greatly among locations and varied significantly among substrate and depth classes for grab- and video-sampled biota at Gjoa Haven and among depth classes for bottom video biota at Sachs Harbour. Faunally barren, shallow, mobile sand sheets were the dominant habitat sampled in Sachs Harbour. Gjoa Haven’s habitats differed significantly along a depth gradient, with sand and gravel substrates covered by Fucus sp. at depths shallower than 10 m and muddy substrates with filamentous green algae, Coccotylus truncatus , and cerianthid anemones inhabiting water down to 40 m.

Because of the drugs, violence, and other aspects of prison life that militate against rehabilitation, the therapeutic community would appear to be the most appropriate form of drug abuse treatment in correctional settings. The therapeutic community is a total treatment environment isolated from the rest of the prison population. The primary clinical staff are typically former substance abusers who themselves were rehabilitated in therapeutic communities. The treatment perspective is that drug abuse is a disorder of the whole person—that the problem is the person and not the drug; that addiction is a symptom and not the essence of the disorder; and that the primary goal is to change the negative patterns of behavior, thinking, and feeling that predispose drug use. In Delaware's system of corrections-based therapeutic communities, a variety of treatment techniques are used, including behavioral, cognitive, and emotional therapies; transactional analysis; psychodrama; and branch groups. The clinical foundations and usages of these approaches are described at length, and preliminary data on their apparent efectiveness are presented.

OBJECTIVE To determine the abnormalities present in endotracheal tubes removed from mechanically ventilated patients for "massive airleak." "Massive airleak" was defined as a leak that the attending physician felt was indicative of endotracheal tube defect such that extubation (and reintubation, if needed) would be indicated. DESIGN Prospective, observational study. SETTING Mixed medical-surgical intensive care unit at a community teaching hospital. PATIENTS Seventeen patients among 1,082 patients who were undergoing mechanical ventilation during the study period. INTERVENTIONS Authors were not involved in the evaluation of most airleak situations and most participating physicians were unaware of the study. All physicians involved were board certified in pulmonary, critical care, emergency medicine, or anesthesiology. Removed endotracheal tubes were grossly inspected and subjected to pneumatic stress to determine the sites of the leakage. MEASUREMENTS AND MAIN RESULTS Eighteen endotracheal tubes were examined over a 2-yr period. Of these tubes, 11 (61%) had no evidence of mechanical fault. Five (28%) tubes had defects in the tracheal cuff and two (11%) tubes had abnormalities of the pilot valve apparatus. Condensation within the pilot valve cuff was present in 14 of 18 tubes and was present in ten of 11 intact tubes. Although the study population had an equal number of orally and nasally placed endotracheal tubes, intact tubes were disproportionately oral (8/11) and tubes wtih cuff leaks were predominantly nasal (4/5) (p = .038). CONCLUSIONS A large number of endotracheal tubes removed for presumed defect are flawless. The authors speculate that tube malposition is the most likely explantation for this phenomenon. Our findings suggest that patient care might improve with more meticulous daily attention to the airway, as well as a more analytical rather than action-oriented approach to the leaking endotracheal tube.

Whether or not male snow crab (Chionoecetes opilio) undergo a terminal molt when they develop large chelae is reviewed. Evidence supporting terminal molt includes laboratory studies in which large-clawed animals failed to molt and field studies which failed to find large-clawed males with mouth parts indicating imminent molting. Both studies were poorly documented. The field studies were largely conducted during inappropriate seasons and molt status based on a questionable mouth part stage. There is also an unsubstantiated claim that large-clawed animals fail to form limb buds for limb regeneration during the next molt and an inconclusive study of the degeneration of the Y-organ. We present new data against terminal molt including capture of large-clawed males with internal carapaces indicating impending molts, capture of two large-clawed animals with mouth parts indicating active premolting, recovery of two tagged large-clawed animals which molted while at liberty, and that the largest small-clawed animals usually are not large enough to account (through growth in a single molt) for the largest of the large-clawed animals. Also, one large-clawed male reportedly molted in captivity. We conclude that the existence of a terminal molt in male snow crab is not proven.

The Coast plutonic complex in southeastern Alaska and British Columbia is bordered on the west by low- to medium-grade metamorphic rocks of the western metamorphic belt. This belt includes intensely deformed rocks underlying a prominent topographic low, the Coast Range megalineament. Structural data from the northern part of the belt near Holkham Bay, southeastern Alaska, constrain the shear sense during polyphase deformation. Tectonite fabrics within the western metamorphic belt record at least three deformational events. Variation in foliation development, fold geometry, and metamorphism indicate that deformation was heterogeneously partitioned. Four tectonic zones can be defined; the peninsular, Coast Range megalineament, coherent, and straight zones. The earliest recognized deformation resulted in folding that transposed bedding into a tectonite layering (S1) throughout the western metamorphic belt. These structures are inferred to have developed during late Cretaceous crustal thickening that resulted in moderate- to high-pressure metamorphism. Later deformation (probably early Tertiary) resulted in abundant mesoscopic and macroscopic F2 folds of S1 and development of shear bands in the Coast Range megalineament zone. The vergence and variation in plunge of F2 folds are compatible with subvertical east-side-up displacement across the Coast Range megalineament zone (uplift of the Coast plutonic complex). Shear bands indicate right-lateral strike-slip motion occurred during the waning stages of metamorphism, probably following development of F2 folds. Brittle faults parallel to the Coast Range megalineament contain subhorizontal slickensides suggesting additional strike-slip movement.

characterized and used as starting materials in experimental studies. The untreated samples were prepared for ATEM analysis by suspension of mg quantities in distilled water and dispersion onto a TEM grid with a carbon-film substrate. Larger quantities of GL, BB, MH and F were disaggregated by shaking in 2% K2CO 3 solutions for up to 8 h. SH could not be disaggregated by this method; it was ground in a bail mill containing a 1 M KCI solution for 3 d. The illites were then washed in distilled water and treated for the removal of carbonates (acetate buffer procedure), organic matter (H202 procedure) and iron oxide coatings (citratedithionite procedure) using the methods of Kittrick and Hope (1963), which are based on the work of Jackson (1956) and Mehra and Jackson (1960). These treatments were modified in that Na salts were replaced by their K equivalents to avoid Na contamination in the interlayer site. The samples were then saturated with K § using 1 M KC1 solution, followed by washing in distilled water to remove excess salt; size-separated to retain the 0.2-5 Ixm size fraction by gravity settling

The content of total and free amino acids (FAA) in green sea urchin (Strongylocentrotus droebachiensis) gonads varied with the season and feeding on an artificial diet. Glycine was the dominant amino acid in each season contributing 12.9-16.6% to the total amino acid (TAA) content, peaking in the spring. In the FAA profile, glycine accounted for 30.3-61.4% in different seasons. A grain-based artificial diet had noticeable effects on the total and FAA compositions of S. droebachiensis. Although, glycine was the dominant amino acid in the TAA profile during early harvesting, tyrosine in gonads became more dominant on week 9 of feeding. Furthermore, glycine was the dominant amino acid in the FAA pool after feeding the artificial diet. The total FAA content in the gonads increased significantly (P

Subgreenschist to amphibolite facies metavolcanic rocks found along the western flank of the Coast Plutonic Complex (western metamorphic belt) between Berners Bay and Endicott Arm, southeastern Alaska, are divided into three distinct sequences on the basis of age and the nature of interbedded metasedimentary rocks. These sequences crop out in linear belts, from west to east: the Gravina belt of Jurassic-Cretaceous age, the western Taku terrane of Permian to Triassic age, and the eastern Taku-Yukon-Tanana terrane of largely unknown age. Major, minor, trace element, and relict phenocryst chemistry are used to locate boundaries between the sequences and to provide clues to their origin. Variations in large ion lithophile element (LILE) and high field strength element (HFSE) abundances indicate that Gravina and eastern Taku magmas were derived through subduction-related processes. Pyroxene phenocryst compositions, LILE, light rare earth element, and HFSE enrichments in Gravina belt rocks are suggestive of high-K calc-alkaline to shoshonitic magmatism. Amphibolite facies metavolcanic rocks in the eastern Taku terrane are inferred to be island arc tholeiites. Western Taku metavolcanic rocks show little or no evidence of subduction-related genesis and resemble within-plate, possibly plume-related, basaltic magmas. Tectonic settings and magma sources inferred from metabasalt geochemistry and the associated stratigraphy of the three sequences are compatible with derivation of all the volcanic rocks in the western metamorphic belt and the Wrangellia terrane from a single Permian to Cretaceous arc complex. Initiation of arc tholeiite volcanism in the eastern Taku terrane possibly occurred during or prior to the Permian. Correlation of western Taku and Wrangellia rocks suggests a Triassic link between the Alexander and at least part of the Taku terrane, and nonsubduction-related basaltic volcanism prior to the Late Jurassic. Later rifting and/or changes in subduction geometry may have resulted in eruption of Gravina arc lavas into a marine basin, possibly floored by western Taku-Wrangellia rocks.

Interpretation of recently acquired high-resolution three-dimensional seismic data has been combined with two-dimensional cross-section restorations and new insights into salt tectonics derived from scaled physical and numerical models. This prompted a reevaluation of the development of salt-related structures in our areas of interest in the U.K. Southern Gas Basin. Salt-related structures in the overburden comprise a series of broadly northwest-trending grabens and associated salt diapirs and walls. These structures are considered to be caused by thin-skinned gravity-driven deformation that triggered and controlled the growth of grabens and diapirs and the later inversion of selected grabens. Additional structures were created by bending and by vertical movements associated with extensionally driven diapiric collapse. The development of the overburden structure was not driven by salt movement; salt structures developed as a simple "reaction" to the thin-skinned extension and subsequent contraction of the overburden.

The Pine Mountain terrane, the southernmost basement massif in the southern Appalachians, comprises a Grenville age basement complex and Paleozoic(?) cover sequence, now exposed in a complex window within the Piedmont terrane. The window is framed at its eastern end by three faults, all of demonstrably different ages.

Two kinds of crystalline thrust sheets form in the internides of mountain chains. Type C megathrust sheets are internally brittle slabs of intact crust (composite basement) that detach within the thermally softened ductile-brittle transition (DBT) and, once formed, behave as thin-skinned thrust sheets. Type F thrust sheets are fold-related lobe-shaped thrust sheets that form below or within the DBT by attenuation of the common limb between antiforms and synforms in passive- or flexural-flow folding; transport is controlled by ductile flow. Type C megathrust sheets form by continent-continent or arc-continent collision accompanying A-subduction; Type F sheets form via A- or B-subduction below the DBT. Both result in crustal thickening. Individual Type C megathrusts are very strong (compared to large foreland sheets), with maximum size and displacement attained where crystalline thrusts ramp into weak zones in platform sedimentary rocks. Here crustal thickness may be duplicated, but α (basal detachment) and β (surface slope) angles remain constant (and near zero) because of slab geometry. Coefficient of internal friction along the base of nascent Type C megathrust sheets would be low (

Previous literature documents Atlantic Silverside, Menidia menidia, as occurring from the southern Gulf of St. Lawrence to northeastern Florida. Beach seining in St. George’s Bay, Newfoundland, revealed the presence of this species in coastal waters of southwestern Newfoundland. This is the first documented report of M. menidia in Newfoundland waters. This report extends the range of this species north of the Laurentian Channel, a significant biogeographic barrier to small coastal fishes. All M. menidia collected were young-of-the-year, less than 90 mm SL (Standard Length). These fish may be representative of a larger relict population originating from the Mid-Hypsithermal Interval (7000 years ago) that spawn in St. George’s Bay and migrate offshore for winter. Alternatively, these M. menidia may be survivors of a more southern spawning population carried northward by ocean currents.

Short treatment courses of ACS have been shown to be of no demonstrable value in the treatment of ARDS. We gave two patients with persistant ARDS a trial of ACS after they demonstrated pulmonary uptake of 67 Ga. Brief initial improvement disappeared with tapering of the ACS. A sustained course of ACS led to resolution of the ARDS in both patients. In all, ten patietits with established ARDS were treated with sustained ACS over an 18-month period. The eight additional patients had uninterrupted courses of therapeutic ACS for greater than 21 days. The patients averaged 12 days of greater than 40 mg a day. At the time of treatment, all patients had established ARDS, meeting for at least 72 hours, criteria for the diagnosis of ARDS. A sustained course of ACS may be effective in the treatment of selected patients with established ARDS. Controlled studies of established ARDS are indicated to define the characteristics of these patients and their management. (Chest 1990; 97:138-43)

The southern Appalachian Pine Mountain window exposes 1.1 Ga Grenvillian basement and its metasedimentary Paleozoic(?) cover through the allochthonous Inner Piedmont. The issue of whether the crustal block inside the window was either transported above the master Appalachian (late Alleghanian) decollement or is an autochthonous block that was overridden by the decollement has been debated for some time. New detrital zircon geochronologic data from the cover rocks inside the window suggest this crustal block was derived from Gondwana but docked with Laurentia before the Alleghanian event. Reprocessed deep seismic reflection data from west-central Georgia (pr- and poststack noise reduction, amplitude variation analysis, and prestack depth migration) indicate that a significant band of subhorizontal reflections occurs almost continuously beneath the window collinear with the originally recognized decollement reflections north of the window. A marked variation in the decollement image, from strong and coherent north of the window to more diffuse directly beneath the window, is likely a partial consequence of the different geology between the Inner Piedmont and the window. The more diffuse image beneath the window may also result from imaging problems related to changes in topography and fold of cover (i.e., signal-to-noise ratio). Two alternative tectonic models for the Pine Mountain window can partially account for the observed variation in the decollement reflectivity. (1) The Pine Mountain block could be truncated below by a relatively smooth continuation of the decollement. The window would thus expose an allochthonous basement duplex or hors-block thrust upward from the south along the Late Proterozoic rifted continental margin. (2) The window represents localized exhumation of autochthonous basement and cover along a zone of distributed intrabasement shearing directly beneath the window. Either model is viable if only reflector geometry is considered; model (1) is favored if both geometry and kinematics of Blue Ridge–Piedmont thrust sheet emplacement are incorporated. In either model, the southern margin of the window merges to the west with the Iapetan early Alleghanian Central Piedmont suture, which juxtaposes North American–affinity Piedmont rocks to the north and exotic Panafrican rocks of the Carolina (Avalon) terrane to the south. Immediately south of the window, this suture dips southward and merges in the lower crust with the late Alleghanian suture joining the Appalachians with Gondwana.