Incidence, outcomes and characteristics of rearrest after out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) results in nearly 350,000 deaths in the United States annually. Survival after OHCA is dismal, with regional estimates suggesting an overall case fatality rate of between 92% and 96%. High mortality following OHCA persists despite advances in resuscitation methodology that result in the successful resuscitation of a substantial fraction of patients (~40%). It is known that some patients experience another OHCA after resuscitation. This secondary OHCA, called rearrest, has not been extensively characterized, but it is known that rearrest correlates with poor OHCA survival prognosis after OHCA. Further understanding of rearrest may enable its prevention and development of optimal treatment strategies, potentially increasing survival after OHCA. Utilizing data from the OHCA surveillance program of the Resuscitation Outcomes Consortium, this dissertation addresses the need for further characterization of rearrest, focusing on patient, treatment, and electrocardiographic characteristics. The results of this study indicate several characteristics that distinguish cases with and without rearrest. Of these, median income and electrocardiographic characteristics derived from the QT-interval were the most robustly associated with rearrest case status. Time-to-rearrest was correlated with rearrest event number, presenting OHCA electrocardiogram rhythm, and when measured over the first 5-minutes following resuscitation in patients with rearrest, standard deviation of heart rate. While the characterization of rearrest cases was comprehensively reported with the available data in this study, limited inference could be drawn regarding the prediction and prevention of rearrest due to a lack of patient history data and a large amount of missing electrocardiographic data. Still, this study lays down a clear path to future research, indicating promising directions for further filling in the knowledge gaps necessary to increase survival after OHCA. The public health significance of this work is rooted in the identification and characterization of an important determinant of a major source of mortality in the developed world, OHCA. The findings of this study provide a novel basis for further investigations aiming to save some of the hundreds of thousands of lives that are claimed by OHCA each year, potentially through public health interventions executed through emergency medical services

Pion and proton showers in the CALICE scintillator-steel analogue hadron calorimeter

Showers produced by positive hadrons in the highly granular CALICE scintillator-steel analogue hadron calorimeter were studied. The experimental data were collected at CERN and FNAL for single particles with initial momenta from 10 to 80 GeV/c. The calorimeter response and resolution and spatial characteristics of shower development for proton- and pion-induced showers for test beam data and simulations using Geant4 version 9.6 are compared.Comment: 26 pages, 16 figures, JINST style, changes in the author list, typos corrected, new section added, figures regrouped. Accepted for publication in JINS

A new path to first light for the Magdalena Ridge Observatory Interferometer

The Magdalena Ridge Observatory Interferometer (MROI) was the most ambitious infrared interferometric facility conceived of in 2003 when funding began. Today, despite having suffered some financial short-falls, it is still one of the most ambitious interferometric imaging facilities ever designed. With an innovative approach to attaining the original goal of fringe tracking to H = 14$^{th}$ magnitude via completely redesigned mobile telescopes, and a unique approach to the beam train and delay lines, the MROI will be able to image faint and complex objects with milliarcsecond resolutions for a fraction of the cost of giant telescopes or space-based facilities. The design goals of MROI have been optimized for studying stellar astrophysical processes such as mass loss and mass transfer, the formation and evolution of YSOs and their disks, and the environs of nearby AGN. The global needs for Space Situational Awareness (SSA) have moved to the forefront in many communities as Space becomes a more integral part of a national security portfolio. These needs drive imaging capabilities ultimately to a few tens of centimeter resolution at geosynchronous orbits. Any array capable of producing images on faint and complex geosynchronous objects in just a few hours will be outstanding not only as an astrophysical tool, but also for these types of SSA missions. With the recent infusion of new funding from the Air Force Research Lab (AFRL) in Albuquerque, NM, MROI will be able to attain first light, first fringes, and demonstrate bootstrapping with three telescopes by 2020. MROI’s current status along with a sketch of our activities over the coming 5 years will be presented, as well as clear opportunities to collaborate on various aspects of the facility as it comes online. Further funding is actively being sought to accelerate the capability of the array for interferometric imaging on a short time-scale so as to achieve the original goals of this ambitious facility.AFRL (Cooperative Agreement FA9453-15-2-0086 titled “Amplitude Interferometer Research for Geosynchronous Earth Orbit (GEO) Space Situational Awareness (SSA)”), Congressional Delegation of the State of New Mexico, Science and Technology Facilities CouncilThis is the author accepted manuscript. The final version is available from SPIE via http://dx.doi.org/10.1117/12.223391

Testing Hadronic Interaction Models using a Highly Granular Silicon-Tungsten Calorimeter

A detailed study of hadronic interactions is presented using data recorded with the highly granular CALICE silicon-tungsten electromagnetic calorimeter. Approximately 350,000 selected negatively charged pion events at energies between 2 and 10 GeV have been studied. The predictions of several physics models available within the Geant4 simulation tool kit are compared to this data. A reasonable overall description of the data is observed; the Monte Carlo predictions are within 20% of the data, and for many observables much closer. The largest quantitative discrepancies are found in the longitudinal and transverse distributions of reconstructed energy.Comment: 28 pages, 24 figures, accepted for publication in NIM

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Interview no. 1019

Mr. Salcido remembers a hard childhood that forced him to work at an early age so he could help his family economically; these hardships led him to enlist in the Bracero Program in 1964; he worked in Colorado cleaning sugar beet fields; additionally, he describes the hiring process, the contracting center in Chihuahua, Chihuahua, México, the difficulties he endured there, and the train trip to the México-United States border in cattle cars; furthermore, he explains how the reception center in El Paso, Texas worked, the disinfection procedures they endured and the signing of his contract; he continues to recount the bad treatment they received, and how he felt that they were treated as animals; moreover, he narrates the daily activities on the farm, how the work was performed, their housing, and the food they ate; he discusses the good relationship he had with other braceros and the activities they did during weekends; in addition, he recalls the types of contracts he had, their lengths, and the way ranchers treated him; he states the benefits of having been a bracero, what the term bracero means to him and why he has fond memories of the experience

Is the writing on the skull?

No abstract availabl

Regional cerebral saturation in post-cardiac arrest patients is doomed… or is it just a near death experience?

One of the most challenging aspects in the treatment of a post-cardiac arrest patient is the assessment of the extent of brain damage, and its concomitant prognosis. Clinicians are continuously confronted with the optimistic expectations of relatives. Parameters that provide early prognostic information are highly desirable in the post-cardiac arrest setting since they would facilitate communication with relatives and would allow better triage of economically burdensome therapies. Reliable, practical measures of intra- and post-arrest neurologic function have potential to guide treatment geared toward reducing neurological damage and providing a basis for accurate prognostication. A persistent candidate measure to fill this role is cerebral oxygen saturation (rSO2) monitoring, as assessed by near-infrared spectroscopy (NIRS) technology. It has been mainly used and studied in the perioperative cardiac surgery and paediatric intensive care setting. [...

Monitor the quality of cardiopulmonary resuscitation in 2020.

PURPOSE OF REVIEW: The current review will give an overview of different possibilities to monitor quality of cardiopulmonary resuscitation (CPR) from a physiologic and a process point of view and how these two approaches can/should overlap. RECENT FINDINGS: Technology is evolving fast with a lot of opportunities to improve the CPR quality. The role of smartphones and wearables are step-by-step identified as also the possibilities to perform patient tailored CPR based on physiologic parameters. The first steps have been taken, but more are to be expected. In this context, the limits of what is possible with human providers will become more and more clear. SUMMARY: To perform high-quality CPR, at first, one should optimize rate, depth and pause duration supported by process monitoring tools. Second, the evolving technological evolution gives opportunities to measure physiologic parameters in real-time which will open the way for patient-tailored CPR. The role of ultrasound, cerebral saturation and end-tidal CO2 in measuring the quality of CPR needs to be further investigated as well as the possible ways of influencing these measured parameters to improve neurological outcome and survival