ULMONARY EMBOLISM IS A COMmon and serious medical condition leading to the hospitalization or death of more than 250 000 people in the United States each year. 1 It is the third leading cause of cardiovascular mortality and is estimated to result in 5% to 10% of all deaths in US hospitals. 2 Despite the potentially lethal nature of this condition, pulmonary embolism remains one of the most difficult conditions for clinicians to diagnose accurately. 3 Given the high mortality of untreated pulmonary embolism, timely accurate diagnostic tests are essential to enable the For editorial comment see p 2788.

Symptomatic CVC-associated thrombosis in patients with cancer, although significant, is less common than previously reported. In this study, the administration of warfarin 1 mg daily did not reduce the incidence of symptomatic CVC-associated thrombosis in patients with cancer. However, the low rate of symptomatic CVC-associated thrombosis means that a much larger trial is required to address this issue definitively.

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Data evaluating the safety of using weight-based dosing of low-molecular-weight heparin (LMWH) in obese patients are limited. Some manufacturers have recommended a maximum daily dose of LMWH not to be exceeded. The purpose of this study was to determine if body weight influenced the anticoagulant response to a weight-based dose of LMWH for the treatment of venous thromboembolism. Patients with serum creatinine levels <150 µmol/l receiving the LMWH , dalteparin 200 anti-Xa IU/kg based on actual body weight subcutaneously once daily for the treatment of deep vein thrombosis or pulmonary embolism, were eligible for the study. Patients received a minimum of 5 days LMWH treatment. Patients had peak anti-Xa levels (IL Test Chromogenic assay) measured 3–4 h following their day 3 injection and trough anti-Xa levels measured immediately prior to injections on day 3 and 5. No dose adjustments were made on the basis of the anti-Xa levels. Patients were a priori stratified into three weight classes: (A) within 20% of ideal body weight (IBW) (n = 13); (B) 20–40% of IBW (n = 14), and (C) greater than 40% of IBW (n = 10). The largest patient weighed 190 kg and had a body mass index of 58. Mean daily LMWH doses were 14,030, 17,646 and 23, 565 IU for groups A, B and C, respectively. Mean (SD) trough anti-Xa levels on day 3 were 0.12 (0.05) anti-Xa IU/ml for group A, 0.11 (0.03) anti-Xa IU/ml for group B and 0.11 (0.03) anti-Xa IU/ml for group C (p > 0.2). Similar trough anti-Xa levels were observed on day 5. Mean (SD) peak anti-Xa levels on day 3 were 1.01 (0.20) anti-Xa IU/ml, 0.97 (0.21) anti-Xa IU/ml and 1.12 (0.22) anti-Xa IU/ml for groups A, B and C, respectively (p > 0.2). No thromboembolic or bleeding complications occurred during LMWH therapy in any patients. These findings suggest that body mass does not appear to have an important effect on the response to LMWH up to a weight of 190 kg in patients with normal or near normal renal function.

A regional collaborative strategy for monitoring IVIG use was established. Most of the IVIG use was for labeled or appropriate indications. The majority of unlabeled use was supported by the medical literature. Strategies to optimize IVIG utilization were associated with a decrease in inappropriate IVIG use and a plateau in IVIG utilization compared to the rest of the country.

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Longevity estimates for the bocaccio rockfish (Sebastes paucispinis) using traditional techniques range from less than 20 years to approximately 50 years. Otoliths of bocaccio are difficult to age, and previous attempts to validate ages have been unsuccessful. Because otolith age suggests the bocaccio are reasonably long-lived, lead–radium dating was used in an attempt to independently age bocaccio otoliths. The measured 210Pb and 226Ra activities were among the lowest reported and resulted in poor radiometric age resolution; however, the break-and-burn technique clearly underestimated age in some cases with the longevity of the bocaccio being at least 31 years. To provide better age resolution, the bomb radiocarbon approach was applied to individual otoliths. Based on measured radiocarbon levels relative to a reference time-series, several specimens were aged at approximately 30–40 years. To evaluate these determinations, the remaining otolith of the pair was sectioned and aged blind. The result was an excellent fit to the reference time-series and a validation of the age estimates. The maximum age from growth zone counts was 37 ± 2 years, which is consistent with a reported maximum age of approximately 50 years.

Carrying assorted cargo and covered with paints of varying toxicity, lost intermodal containers may take centuries to degrade on the deep seafloor. In June 2004, scientists from Monterey Bay Aquarium Research Institute (MBARI) discovered a recently lost container during a Remotely Operated Vehicle (ROV) dive on a sediment-covered seabed at 1281 m depth in Monterey Bay National Marine Sanctuary (MBNMS). The site was revisited by ROV in March 2011. Analyses of sediment samples and high-definition video indicate that faunal assemblages on the container's exterior and the seabed within 10 m of the container differed significantly from those up to 500 m. The container surface provides hard substratum for colonization by taxa typically found in rocky habitats. However, some key taxa that dominate rocky areas were absent or rare on the container, perhaps related to its potential toxicity or limited time for colonization and growth. Ecological effects appear to be restricted to the container surface and the benthos within ∼10 m.