Aetiology of resuscitated out-of-hospital cardiac arrest treated at hospital

Introduction: Precipitating aetiology of out-of-hospital cardiac arrest (OHCA), as confirmed by diagnostic testing or autopsy, provides important insights into burden of OHCA and has potential implications for improving OHCA survivorship. This study aimed to describe the aetiology of nontraumatic resuscitated OHCAs treated at hospital within a local health network according to available documentation, and to investigate dierences in outcome between aetiologies. Methods: Observational retrospective cohort study of consecutive OHCA treated at hospital within a local health network between 2011–2016. Cases without sustained ROSC ( 20 minutes), unverified cardiac arrest, and retrievals to external acute care facilities were excluded. A single aetiology was determined from the hospital medical record and available autopsy results. Survival to hospital discharge was compared between adjudicated aetiologies. Results: In the 314 included cases, distribution of precipitating aetiology was 53% cardiac, 18% respiratory, 3% neurological, 6% toxicological, 9% other, and 11% unknown. A presumed cardiac pre-hospital diagnosis was assigned in 235 (84%) cases, 20% of which were incorrect after exclusion of unknown cases. Rates of survival to hospital discharge varied significantly across aetiologies: cardiac 64%, respiratory 21%, neurological 0%, toxicological 58%, other 32% (p < 0.001). A two-fold dierence in survival was observed between cardiac and non-cardiac aetiologies (64% versus 29%, excluding unknown, p < 0.001). Conclusions: Non-cardiac aetiologies represented a substantial burden of resuscitated OHCA treated at hospital within a local health network and were associated with poor outcome. The results confirmed that true aetiology was not evident on initial examination in 1 in 5 cases with a pre-hospital cardiac diagnosis.M.R. Wittwer, C. Zeitz, J.F. Beltrame, M.A. Arstal

Cardiologists appropriately exclude resuscitated out-of-hospital cardiac arrests from emergency coronary angiography

Objective: Emergency coronary angiography after resuscitated out-of-hospital cardiac arrest as a selective or non-selective diagnostic procedurewith orwithout intervention continues to be the subject of debate. This study sought to determine if cardiologists reliably select patients using clinical judgement for emergency coronary angiography without missing acutely ischemic cases requiring revascularization. Methods: Presenting clinical details and ECGs (within 2 hours) from 52 consecutive out-of-hospital cardiac arrest patients who underwent non-selective coronary angiography were compiled retrospectively. Three out-of-hospital cardiac arrestexperienced interventional cardiologists, blinded to patient outcome, independently determined working diagnosis, and decision for emergency coronary angiography using clinical judgement. Sensitivity of the cardiologists’ decision was assessed with respect to the outcome of acute revascularization. Inter-rater differences, consensus in clinical assessment, and influence of working diagnosis were also investigated. Results: Sensitivity of individual cardiologist’s decision for emergency coronary angiography with respect to acute revascularization was very high (adjusted overall sensitivity = 95.8%, 95% CI = 89–100, cardiologist range = 93%–100%), and perfect for the consensus of 2 or more cardiologists (100%, 95% CI = 79.4–100). There was no statistical difference in the sensitivity of this decision between cardiologists (P < 0.05), and inter-rater agreement was moderate (78% overall agreement, Κ = 0.56). Conclusions: Experienced cardiologists recommend emergency coronary angiography in all resuscitated out-of-hospital cardiac arrest requiring acute revascularization and appropriately excluded one-third of patients. Rather than advocating a non-selective, or conversely, a restrictive strategy with respect to coronary angiography after out-of-hospital cardiac arrest, the findings support an individualized approach by a multidisciplinary emergency team that includes experienced cardiologists. The results should be confirmed in a larger prospective study.Melanie R.Wittwer, Chris Zeitz, Sunny Wu, Kumaril Mishra, Sharmalar Rajendran, John F. Beltrame, Margaret A. Arstal

Simulating maize yield in sub-tropical conditions of southern Brazil using Glam model

The objective of this work was to evaluate the feasibility of simulating maize yield in a sub‑tropical region of southern Brazil using the general large area model (Glam). A 16‑year time series of daily weather data were used. The model was adjusted and tested as an alternative for simulating maize yield at small and large spatial scales. Simulated and observed grain yields were highly correlated (r above 0.8; p<0.01) at large scales (greater than 100,000 km2), with variable and mostly lower correlations (r from 0.65 to 0.87; p<0.1) at small spatial scales (lower than 10,000 km2). Large area models can contribute to monitoring or forecasting regional patterns of variability in maize production in the region, providing a basis for agricultural decision making, and Glam‑Maize is one of the alternatives

Projected WIMP sensitivity of the LUX-ZEPLIN dark matter experiment

LUX-ZEPLIN (LZ) is a next-generation dark matter direct detection experiment that will operate 4850 feet underground at the Sanford Underground Research Facility (SURF) in Lead, South Dakota, USA. Using a two-phase xenon detector with an active mass of 7 tonnes, LZ will search primarily for low-energy interactions with weakly interacting massive particles (WIMPs), which are hypothesized to make up the dark matter in our galactic halo. In this paper, the projected WIMP sensitivity of LZ is presented based on the latest background estimates and simulations of the detector. For a 1000 live day run using a 5.6-tonne fiducial mass, LZ is projected to exclude at 90% confidence level spin-independent WIMP-nucleon cross sections above 1.4 × 10-48cm2 for a 40 GeV/c2 mass WIMP. Additionally, a 5σ discovery potential is projected, reaching cross sections below the exclusion limits of recent experiments. For spin-dependent WIMP-neutron(-proton) scattering, a sensitivity of 2.3 × 10−43 cm2 (7.1 × 10−42 cm2) for a 40 GeV/c2 mass WIMP is expected. With underground installation well underway, LZ is on track for commissioning at SURF in 2020

The GASP-WEBT monitoring of 3C 454.3 during the 2008 optical-to-radio and γ-ray outburst

Since 2001, the radio quasar 3C 454.3 has undergone a period of high optical activity, culminating in the brightest optical state ever observed, during the 2004-2005 outburst. The Whole Earth Blazar Telescope (WEBT) consortium has carried out several multifrequency campaigns to follow the source behaviour. The GLAST-AGILE Support Program (GASP) was born from the WEBT to provide long-term continuous optical-to-radio monitoring of a sample of gamma-loud blazars, during the operation of the AGILE and GLAST (now known as Fermi GST) gamma-ray satellites. The main aim is to shed light on the mechanisms producing the high-energy radiation, through correlation analysis with the low-energy emission. Thus, since 2008 the monitoring task on 3C 454.3 passed from the WEBT to the GASP, while both AGILE and Fermi detected strong gamma-ray emission from the source. We present the main results obtained by the GASP at optical, mm, and radio frequencies in the 2008-2009 season, and compare them with the WEBT results from previous years. An optical outburst was observed to peak in mid July 2008, when Fermi detected the brightest gamma-ray levels. A contemporaneous mm outburst maintained its brightness for a longer time, until the cm emission also reached the maximum levels. The behaviour compared in the three bands suggests that the variable relative brightness of the different-frequency outbursts may be due to the changing orientation of a curved inhomogeneous jet. The optical light curve is very well sampled during the entire season, which is also well covered by the various AGILE and Fermi observing periods. The relevant cross-correlation studies will be very important in constraining high-energy emission models