Out-of-Hospital Cardiac Arrest in the 1990s: A Population-Based Study in the Maastricht Area on Incidence, Characteristics and Survival

AbstractObjectives. We sought to describe the incidence, characteristics and survival of out-of-hospital sudden cardiac arrest (SCA) in the Maastricht area of The Netherlands.Background. Incidence and survival rates of out-of-hospital SCA in different communities are often based on the number of victims resuscitated by the emergency medical services. Our population-based study in the Maastricht area allows information on all victims of witnessed and unwitnessed SCA occurring outside the hospital.Methods. Incidence, patient characteristics and survival rates were determined by prospectively collecting information on all cases of SCA occurring in the age group 20 to 75 years between January 1, 1991 and December 31, 1994. Survival rates were related to the site of the event (at home vs. outside the home) and the presence or absence of a witness and rhythm at the time of the resuscitation attempt in out-of-hospital SCA.Results. Five hundred fifteen patients were included (72% men, 28% women). In 44% of men and 53% of women, SCA was most likely the first manifestation of heart disease. In patients known to have had a previous myocardial infarction (MI), the mean interval between the MI and SCA was 6.5 years, with >50% having a left ventricular ejection fraction >30%. The mean yearly incidence of SCA was 1 in 1,000 inhabitants. Of all deaths in the age groups studied, 18.5% were sudden. Nearly 80% of SCAs occurred at home. In 60% of all cases of SCA a witness was present. Cardiac resuscitation, which was attempted in 51% of all subjects, resulted overall in 32 (6%) of 515 patients being discharged alive from the hospital. Survival rates for witnessed SCA were 8% (16 of 208 subjects) at home and 18% (15 of 85 subjects) outside the home (95% confidence interval 1% to 18.8%).Conclusions. The majority of victims of SCA cannot be identified before the event. Sudden cardiac arrest usually occurs at home, and the survival of those with a witnessed SCA at home was low compared with that outside the home, indicating the necessity of optimizing out-of-hospital resuscitation, especially in the at-home situation

Identification of nine new susceptibility loci for endometrial cancer

Endometrial cancer is the most commonly diagnosed cancer of the female reproductive tract in developed countries. Through genome-wide association studies (GWAS), we have previously identified eight risk loci for endometrial cancer. Here, we present an expanded meta-analysis of 12,906 endometrial cancer cases and 108,979 controls (including new genotype data for 5624 cases) and identify nine novel genome-wide significant loci, including a locus on 12q24.12 previously identified by meta-GWAS of endometrial and colorectal cancer. At five loci, expression quantitative trait locus (eQTL) analyses identify candidate causal genes; risk alleles at two of these loci associate with decreased expression of genes, which encode negative regulators of oncogenic signal transduction proteins (SH2B3 (12q24.12) and NF1 (17q11.2)). In summary, this study has doubled the number of known endometrial cancer risk loci and revealed candidate causal genes for future study

Development and use of performance composite scores in dispatch teams

Teams perform a variety of functions within organizations and should therefore be evaluated on multiple criteria. This paper argues for the use of a single value. We review the literature on team performance composites and briefly describe two approaches to developing evaluative performance composites in an academic setting by combining performance indicator data: A qualitative approach for performance feedback as well as an empirical approach for research purposes

Developing a high-fidelity simulation lab: Challenges and lessons learned

With a decade of experience, the Middle Tennessee State University (MTSU) NASA FOCUS (Flight Operations Center- Unified Simulation) lab is a vital part of the educational experience for senior aerospace students. The NASA FOCUS Lab is a highfidelity simulation of a flight dispatch center in a collegiate setting. Students are trained in specific positions in the lab and must operate within a complex team environment to run the virtual airline within their shift. The purpose of the lab is to provide a learning platform for students to practice the requisite teamwork skills necessary to effectively work in airline operations. Designing effective simulation experiences and providing adequate performance feedback is complex. This paper discusses some of the challenges we encountered and lessons learned through a ten-year span of operation and refinement. By presenting this information, it may help future researchers in the design and development of high-fidelity simulation labs

Involvement, Tate and me

The involvement construct has been explored in relation to products, services and leisure but not in an art museum context. The purpose of this paper is to address this theoretical gap by drawing on the marketing and leisure literature to understand members’ consumption of Tate using the involvement construct. Tate, a portfolio of four art museums in the UK has more than 90,000 members that receive a benefits package in return for a membership fee. Data were collected using an interpretive, qualitative approach. 59 face to face semi-structured interviews were conducted with Tate Members during spring 2008. The narratives expose the complexity in exploring the involvement construct and the analysis revealed six new involvement characteristics: 1) Centrality and Pleasure; 2) Desire to Learn; 3) Escapism: Spirituality and Creativity; 4) Sense of Belonging and Prestige; 5) Physical; and 6) Drivers of Involvement. These are discussed in the context of previous studies into museum consumption, services and leisure involvement literature. The authors discuss how these findings may be transferred to other settings and the managerial implications for marketers and membership managers are considered

Role of mustelids in the life-cycle of ixodid ticks and transmission cycles of four tick-borne pathogens

Background: Elucidating which wildlife species significantly contribute to the maintenance of Ixodes ricinus populations and the enzootic cycles of the pathogens they transmit is imperative in understanding the driving forces behind the emergence of tick-borne diseases. Here, we aimed to quantify the relative contribution of four mustelid species in the life-cycles of I. ricinus and Borrelia burgdorferi (sensu lato) in forested areas and to investigate their role in the transmission of other tick-borne pathogens. Road-killed badgers, pine martens, stone martens and polecats were collected in Belgium and the Netherlands. Their organs and feeding ticks were tested for the presence of tick-borne pathogens. Results: Ixodes hexagonus and I. ricinus were found on half of the screened animals (n = 637). Pine martens had the highest I. ricinus burden, whereas polecats had the highest I. hexagonus burden. We detected DNA from B. burgdorferi (s.l.) and Anaplasma phagocytophilum in organs of all four mustelid species (n = 789), and Neoehrlichia mikurensis DNA was detected in all species, except badgers. DNA from B. miyamotoi was not detected in any of the investigated mustelids. From the 15 larvae of I. ricinus feeding on pine martens (n = 44), only one was positive for B. miyamotoi DNA, and all tested negative for B. burgdorferi (s.l.), N. mikurensis and A. phagocytophilum. The two feeding larvae from the investigated polecats (n = 364) and stone martens (n = 39) were negative for all four pathogens. The infection rate of N. mikurensis was higher in feeding nymphs collected from mustelids compared to questing nymphs, but not for B. burgdorferi (s.l.), B. miyamotoi or A. phagocytophilum. Conclusions: Although all stages of I. ricinus can be found on badgers, polecats, pine and stone martens, their relative contribution to the life-cycle of I. ricinus in forested areas is less than 1%. Consequently, the relative contribution of mustelids to the enzootic cycles of I. ricinus-borne pathogens is negligible, despite the presence of these pathogens in organs and feeding ticks. Interestingly, all four mustelid species carried all stages of I. hexagonus, potentially maintaining enzootic cycles of this tick species apart from the cycle involving hedgehogs as main host species