Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type.

INTRODUCTION: The incidence of deep venous thrombosis (DVT) related to a central venous catheter varies considerably in ICUs depending on the population included. The aim of this study was to determine subclavian central venous catheter (SCVC)-related DVT risk factors in severely traumatized patients with regard to two kinds of polyurethane catheters. METHODS: Critically ill trauma patients needing a SCVC for their usual care were prospectively included in an observational study. Depending on the month of inclusion, patients received one of the two available products in the emergency unit: either an aromatic polyurethane SCVC or an aliphatic polyurethane SCVC. Patients were screened weekly by ultrasound for SCVC-related DVT. Potential risk factors were collected, including history-related, trauma-related and SCVC-related characteristics. RESULTS: A total of 186 patients were included with a median Injury Severity Sore of 30 and a high rate of severe brain injuries (21% of high intracranial pressure). Incidence of SCVC-related DVT was 37% (95% confidence interval: 26 to 40) in patients or 20/1,000 catheter-days. SCVC-related DVT occurred within 8 days in 65% of cases. There was no significant difference in DVT rates between the aromatic polyurethane and aliphatic polyurethane SCVC groups (38% vs. 36%). SCVC-related DVT independent risk factors were age>30 years, intracranial hypertension, massive transfusion (>10 packed red blood cell units), SCVC tip position in the internal jugular or in the innominate vein, and ipsilateral jugular catheter. CONCLUSION: SCVC-related DVT concerned one-third of these severely traumatized patients and was mostly clinically silent. Incidence did not depend on the type of polyurethane but was related to age>30 years, intracranial hypertension or misplacement of the SCVC. Further studies are needed to assess the cost-effectiveness of routine screening in these patients in whom thromboprophylaxis may be hazardous.

The search for worlds like our own.

The direct detection of Earth-like exoplanets orbiting nearby stars and the characterization of such planets-particularly, their evolution, their atmospheres, and their ability to host life-constitute a significant problem. The quest for other worlds as abodes of life has been one of mankind's great questions for several millennia. For instance, as stated by Epicurus approximately 300 BC: "Other worlds, with plants and other living things, some of them similar and some of them different from ours, must exist." Demokritos from Abdera (460-370 BC), the man who invented the concept of indivisible small parts-atoms-also held the belief that other worlds exist around the stars and that some of these worlds may be inhabited by life-forms. The idea of the plurality of worlds and of life on them has since been held by scientists like Johannes Kepler and William Herschel, among many others. Here, one must also mention Giordano Bruno. Born in 1548, Bruno studied in France and came into contact with the teachings of Nicolas Copernicus. He wrote the book De l'Infinito, Universo e Mondi in 1584, in which he claimed that the Universe was infinite, that it contained an infinite amount of worlds like Earth, and that these worlds were inhabited by intelligent beings. At the time, this was extremely controversial, and eventually Bruno was arrested by the church and burned at the stake in Rome in 1600, as a heretic, for promoting this and other equally confrontational issues (though it is unclear exactly which idea was the one that ultimately brought him to his end). In all the aforementioned cases, the opinions and results were arrived at through reasoning-not by experiment. We have only recently acquired the technological capability to observe planets orbiting stars other than 6 our Sun; acquisition of this capability has been a remarkable feat of our time. We show in this introduction to the Habitability Primer that mankind is at the dawning of an age when, by way of the scientific method and 21(st)-century technology, we will be able to answer this fascinating controversial issue that has persisted for at least 2500 years.

Origin and formation of planetary systems.

To estimate the occurrence of terrestrial exoplanets and maximize the chance of finding them, it is crucial to understand the formation of planetary systems in general and that of terrestrial planets in particular. We show that a reliable formation theory should not only explain the formation of the Solar System, with small terrestrial planets within a few AU and gas giants farther out, but also the newly discovered exoplanetary systems with close-in giant planets. Regarding the presently known exoplanets, we stress that our current knowledge is strongly biased by the sensitivity limits of current detection techniques (mainly the radial velocity method). With time and improved detection methods, the diversity of planets and orbits in exoplanetary systems will definitely increase and help to constrain the formation theory further. In this work, we review the latest state of planetary formation in relation to the origin and evolution of habitable terrestrial planets.

Dynamical habitability of planetary systems.

The problem of the stability of planetary systems, a question that concerns only multiplanetary systems that host at least two planets, is discussed. The problem of mean motion resonances is addressed prior to discussion of the dynamical structure of the more than 350 known planets. The difference with regard to our own Solar System with eight planets on low eccentricity is evident in that 60% of the known extrasolar planets have orbits with eccentricity e > 0.2. We theoretically highlight the studies concerning possible terrestrial planets in systems with a Jupiter-like planet. We emphasize that an orbit of a particular nature only will keep a planet within the habitable zone around a host star with respect to the semimajor axis and its eccentricity. In addition, some results are given for individual systems (e.g., Gl777A) with regard to the stability of orbits within habitable zones. We also review what is known about the orbits of planets in double-star systems around only one component (e.g., gamma Cephei) and around both stars (e.g., eclipsing binaries).

Co-evolution of atmospheres, life, and climate.

After Earth's origin, our host star, the Sun, was shining 20-25% less brightly than today. Without greenhouse-like conditions to warm the atmosphere, our early planet would have been an ice ball, and life may never have evolved. But life did evolve, which indicates that greenhouse gases must have been present on early Earth to warm the planet. Evidence from the geological record indicates an abundance of the greenhouse gas CO(2). CH(4) was probably present as well; and, in this regard, methanogenic bacteria, which belong to a diverse group of anaerobic prokaryotes that ferment CO(2) plus H(2) to CH(4), may have contributed to modification of the early atmosphere. Molecular oxygen was not present, as is indicated by the study of rocks from that era, which contain iron carbonate rather than iron oxide. Multicellular organisms originated as cells within colonies that became increasingly specialized. The development of photosynthesis allowed the Sun's energy to be harvested directly by life-forms. The resultant oxygen accumulated in the atmosphere and formed the ozone layer in the upper atmosphere. Aided by the absorption of harmful UV radiation in the ozone layer, life colonized Earth's surface. Our own planet is a very good example of how life-forms modified the atmosphere over the planets' lifetime. We show that these facts have to be taken into account when we discover and characterize atmospheres of Earth-like exoplanets. If life has originated and evolved on a planet, then it should be expected that a strong co-evolution occurred between life and the atmosphere, the result of which is the planet's climate.

Origin and evolution of life on terrestrial planets.

The ultimate goal of terrestrial planet-finding missions is not only to discover terrestrial exoplanets inside the habitable zone (HZ) of their host stars but also to address the major question as to whether life may have evolved on a habitable Earth-like exoplanet outside our Solar System. We note that the chemical evolution that finally led to the origin of life on Earth must be studied if we hope to understand the principles of how life might evolve on other terrestrial planets in the Universe. This is not just an anthropocentric point of view: the basic ingredients of terrestrial life, that is, reduced carbon-based molecules and liquid H(2)O, have very specific properties. We discuss the origin of life from the chemical evolution of its precursors to the earliest life-forms and the biological implications of the stellar radiation and energetic particle environments. Likewise, the study of the biological evolution that has generated the various life-forms on Earth provides clues toward the understanding of the interconnectedness of life with its environment.

Deciphering spectral fingerprints of habitable exoplanets.

We discuss how to read a planet's spectrum to assess its habitability and search for the signatures of a biosphere. After a decade rich in giant exoplanet detections, observation techniques have advanced to a level where we now have the capability to find planets of less than 10 Earth masses (M(Earth)) (so-called "super Earths"), which may be habitable. How can we characterize those planets and assess whether they are habitable? This new field of exoplanet search has shown an extraordinary capacity to combine research in astrophysics, chemistry, biology, and geophysics into a new and exciting interdisciplinary approach to understanding our place in the Universe. The results of a first-generation mission will most likely generate an amazing scope of diverse planets that will set planet formation, evolution, and our planet into an overall context.

Geophysical and atmospheric evolution of habitable planets.

The evolution of Earth-like habitable planets is a complex process that depends on the geodynamical and geophysical environments. In particular, it is necessary that plate tectonics remain active over billions of years. These geophysically active environments are strongly coupled to a planet's host star parameters, such as mass, luminosity and activity, orbit location of the habitable zone, and the planet's initial water inventory. Depending on the host star's radiation and particle flux evolution, the composition in the thermosphere, and the availability of an active magnetic dynamo, the atmospheres of Earth-like planets within their habitable zones are differently affected due to thermal and nonthermal escape processes. For some planets, strong atmospheric escape could even effect the stability of the atmosphere.

Stellar aspects of habitability--characterizing target stars for terrestrial planet-finding missions.

We present and discuss the criteria for selecting potential target stars suitable for the search for Earth-like planets, with a special emphasis on the stellar aspects of habitability. Missions that search for terrestrial exoplanets will explore the presence and habitability of Earth-like exoplanets around several hundred nearby stars, mainly F, G, K, and M stars. The evaluation of the list of potential target systems is essential in order to develop mission concepts for a search for terrestrial exoplanets. Using the Darwin All Sky Star Catalogue (DASSC), we discuss the selection criteria, configuration-dependent subcatalogues, and the implication of stellar activity for habitability.

A roadmap for the detection and characterization of other Earths.

The European Space Agency and other space agencies such as NASA recognize that the question with regard to life beyond Earth in general, and the associated issue of the existence and study of exoplanets in particular, is of paramount importance for the 21(st) century. The new Cosmic Vision science plan, Cosmic Vision 2015-2025, which is built around four major themes, has as its first theme: "What are the conditions for planet formation and the emergence of life?" This main theme is addressed through further questions: 1) How do gas and dust give rise to stars and planets? 2) How will the search for and study of exoplanets eventually lead to the detection of life outside Earth (biomarkers)? 3) How did life in the Solar System arise and evolve? Although ESA has busied itself with these issues since the beginning of the Darwin study in 1996, it has become abundantly clear that, as these topics have evolved, only a very large effort, addressed from the ground and from space with the utilization of different instruments and space missions, can provide the empirical results required for a complete understanding. The good news is that the problems can be addressed and solved within a not-too-distant future. In this short essay, we present the present status of a roadmap related to projects that are related to the key long-term goal of understanding and characterizing exoplanets, in particular Earth-like planets.

The far future of exoplanet direct characterization.

We describe future steps in the direct characterization of habitable exoplanets subsequent to medium and large mission projects currently underway and investigate the benefits of spectroscopic and direct imaging approaches. We show that, after third- and fourth-generation missions have been conducted over the course of the next 100 years, a significant amount of time will lapse before we will have the capability to observe directly the morphology of extrasolar organisms.

The use of bispectral index to monitor barbiturate coma in severely brain-injured patients with refractory intracranial hypertension.

BACKGROUND: Barbiturate therapy in severely traumatic brain-injured (TBI) patients is usually monitored by an electroencephalogram (EEG) with burst-suppression pattern as a target. The Bispectral Index (BIS) is derived from EEG and considers cortical silence. We sought to determine whether a BIS range could predict a specific burst-suppression pattern. METHODS: Eleven TBI patients treated with barbiturate were included prospectively. EEG was recorded daily for 1 h. Every 5 min, the number of bursts and the suppression ratio (suppression ratio from EEG [SR(EEG)]: percentage of last 60 s in cortical silence) was calculated for 1 min on the raw EEG and compared to concomitant data from the BIS-XP (BIS and suppression ratio [SR(BIS)]). The optimal level of barbiturate coma was defined as 2-5 bursts/min in the EEG. A BIS range predictive of optimal level was determined from all data and its accuracy was studied for each examination. RESULTS: Agreement between SR(EEG) and SR(BIS) was high (interclass correlation coefficient 0.94 [95% confidence interval: 0.90-0.96]). There was a significant association between SR(EEG) and BIS. Significant disagreements were observed in some examinations. The best accuracy to predict optimal pattern was obtained with a BIS range from 6 to 15. CONCLUSION: The relationship between BIS and SR(EEG) was high in TBI patients treated with barbiturates. The rate of barbiturate infusion might be decreased if BIS is <6 or increased if BIS is >15. Correspondence between BIS and suppression pattern should periodically be checked by observation of the EEG analogical signal (as displayed by BIS-XP).

Instrumental stability requirements for exoplanet detection with a nulling interferometer: variability noise as a central issue.

We revisit the nulling interferometer performances that are needed for direct detection and the spectroscopic analysis of exoplanets, e.g., with the DARWIN [European Space Agency-SCI 12 (2000)] or TPF-I [JPL Publ. 05-5, (2005)] missions. Two types of requirement are found, one concerning the mean value of the instrumental nulling function (nl(lambda)) and another regarding its stability. The stress is usually put on the former. It is stringent at short wavelengths but somewhat relaxed at longer wavelengths. The latter, which we call the variability noise condition, does not usually receive enough attention. It is required regardless of telescope size and stellar distance. The results from three nulling experiments performed in laboratories around the world are reported and compared with the requirements. All three exhibit 1/f noise that is incompatible with the performances required by the mission. As pointed out by Lay [Appl. Opt. 43, 6100-6123 (2004)], this stability problem is not fully solved by modulation techniques. Adequate solutions must be found that are likely to include servo systems using the stellar signal itself as a reference and internal metrology with high stability.

How to oxidize atmospheric CH(4)?--A challenge for the future.

Methane is an active Greenhouse effect gas whose concentration will likely increase in the future. The possible destabilisation of CH4 clathrates (hydrates) due to anthropogenic climate warming, and the resulting outgasing of methane, could lead to a major increase of the global Greenhouse effect, with dramatic consequences for Humanity. For these reasons, the study of possible countermeasures should be actively considered. Here, we suggest taking advantage of the thermodynamic instability of CH4 in air, and search for ways to oxidize it.