Advances for Treating in-Hospital Cardiac Arrest: Safety and Effectiveness of a New Automatic External Cardioverter-Defibrillator

OBJECTIVES: The purpose of this study was to prospectively analyze the performance and safety of a new programmable, fully automatic external cardioverter-defibrillator (AECD) in a European multicenter trial. BACKGROUND Although, the response time to cardiac arrest (CA) is a major determinant of mortality and morbidity, in-hospital strategies have not significantly changed during the last 30 years. METHODS: Patients (n = 117) at risk of CA in monitored wards (n = 51) and patients undergoing electrophysiologic testing or implantable cardioverter-defibrillator (ICD) implantation (n = 66) were enrolled. The accuracy of the automatic response of the device to any change of rhythm (lasting >1 s and >4 beats) was confirmed by reviewing the simultaneously recorded Holter data and the programmed parameters. RESULTS: During 1,240 h, 1,988 episodes of rhythm changes were documented. A total of 115 episodes lasted > or =10 s or needed treatment (pacing, n = 32; ICD, n = 51; AECD, n = 35) for termination. The device detected ventricular tachyarrhythmias with a sensitivity of 100% and specificity of 97.6% (true negatives, n = 1,454; true positives, n = 499; false positives, n = 35; false negatives, n = 0). The false positives were all caused by T-wave oversensing during ventricular pacing. There were no complications or adverse events. The mean response time was 14.4 s for those episodes needing a full charge of the capacitor. CONCLUSIONS: This new AECD is safe and effective in detecting, monitoring, and treating spontaneous arrhythmias. This fully automatic device shortens the response time to treatment, and it is likely that it will significantly improve the outcome of patients with in-hospital CA

Marketing The Non-Profit Organizations,"The Jordan Museum as a case study"

The aim of this paper is to analyse the existing concepts of marketing and the difficulties of applying general marketing techniques in the Jordan Museum and highlighting the strengths, weakness, threats and opportunities that are facing the museum. The paper offers marketing suggestions that may influence and assist the Jordan museum to enhance its marketing structure. The gained information for the research was obtained byusing articles, books, case studies, interviews. This method is used to gain Varity of information, points of views, and attitudes. The questions deducted in the interviews focused on whether if the Museum in question is placed on the well-known tourist trail. Another focus was upon the tools & techniques should be used in marketing. The paper also investigated if there is any marketing plan considered and whether the museums in Jordan has been discussed or even mentioned in any of the international tourism or cultural conference’s Which Jordan is invited to. The result showed that The Jordan Museum lacks any marketing innovation and having no clear marketing plan. The museum can overcome this by reconsidering its priorities enclosing new marketing techniques.  Key Words: Museums, Marketing mix, Nonprofit Organization DOI: 10.7176/JTHS/40-0

Cyclosporine-A therapy-induced multiple bilateral breast and accessory axillary breast fibroadenomas: a case report

<p>Abstract</p> <p>Introduction</p> <p>Breast adenoma is common. However, in the setting of post-transplantation immune suppression it may be expressed differently.</p> <p>Case presentation</p> <p>A 35-year-old Sudanese woman, with a history of renal transplantation two and half years prior to presentation, was on a single immune suppression therapy in the form of cyclosporine-A since the transplantation. During a regular follow-up visit, she was noticed to have gingival hypertrophy and bilateral breast and axillary swellings. She underwent successful surgical resection of the bilateral fibroadenomas.</p> <p>Conclusions</p> <p>Cyclosporine-A therapy post renal transplantation is associated with an increased incidence of benign breast changes as fibroadenoma. Regular follow-up and appropriate selection of immunosuppressant therapy are essential in the post transplantation management of these patients.</p

The global impact of tobacco control policies on smokeless tobacco use: a systematic review

BACKGROUND: Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use. METHODS: In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946). FINDINGS: 14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%). INTERPRETATION: Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use. FUNDING: UK National Institute for Health Research

Whole Earth Telescope observations of the hot helium atmosphere pulsating white dwarf EC 20058-5234

We present the analysis of a total of 177h of high-quality optical time-series photometry of the helium atmosphere pulsating white dwarf (DBV) EC 20058-5234. The bulk of the observations (135h) were obtained during a WET campaign (XCOV15) in July 1997 that featured coordinated observing from 4 southern observatory sites over an 8-day period. The remaining data (42h) were obtained in June 2004 at Mt John Observatory in NZ over a one-week observing period. This work significantly extends the discovery observations of this low-amplitude (few percent) pulsator by increasing the number of detected frequencies from 8 to 18, and employs a simulation procedure to confirm the reality of these frequencies to a high level of significance (1 in 1000). The nature of the observed pulsation spectrum precludes identification of unique pulsation mode properties using any clearly discernable trends. However, we have used a global modelling procedure employing genetic algorithm techniques to identify the n, l values of 8 pulsation modes, and thereby obtain asteroseismic measurements of several model parameters, including the stellar mass (0.55 M_sun) and T_eff (~28200 K). These values are consistent with those derived from published spectral fitting: T_eff ~ 28400 K and log g ~ 7.86. We also present persuasive evidence from apparent rotational mode splitting for two of the modes that indicates this compact object is a relatively rapid rotator with a period of 2h. In direct analogy with the corresponding properties of the hydrogen (DAV) atmosphere pulsators, the stable low-amplitude pulsation behaviour of EC 20058 is entirely consistent with its inferred effective temperature, which indicates it is close to the blue edge of the DBV instability strip. (abridged)Comment: 19 pages, 8 figures, 5 tables, MNRAS accepte

Imaging the disc rim and a moving close-in companion candidate in the pre-transitional disc of V1247 Orionis

This is the author accepted manuscript. The final version is available from EDP Sciences via the DOI in this record.Context. V1247 Orionis harbours a pre-transitional disc with a partially cleared gap. Earlier interferometric and polarimetric observations revealed strong asymmetries both in the gap region and in the outer disc. The presence of a companion was inferred to explain these asymmetric structures and the ongoing disc clearing. Aims. Using an extensive set of multi-wavelength and multi-epoch observations we aimed to identify the origin of the previously detected asymmetries. Methods. We observed V1247 Ori at three epochs spanning ∼ 678 days using sparse aperture masking interferometry with Keck/NIRC2 and VLT/NACO. In addition, we search for signs of accretion through VLT/SPHERE-ZIMPOL spectral differential imaging in Hα and R-band continuum. Our SMA sub-millimetre interferometry in 880 µm continuum and in the CO(3-2) line allows us to constrain the orientation and direction of rotation of the outer disc. Results. We find the L’-band emission to be dominated by static features which trace forward-scattered dust emission from the inner edge of the outer disc located to the north-east. In H- and K-band, we see evidence for a companion candidate that moved systematically by 45◦ within the first ∼345 days. The separation of the companion candidate is not well constrained, but the observed position angle change is consistent with Keplerian motion of a body located on a 6 au orbit. From the SMA CO moment map, the location of the disc rim, and the detected orbital motion, we deduced the 3-dimensional orientation of the disc. We see no indication of accretion in Hα and set upper limits for an accreting companion. Conclusions. The measured contrast of the companion candidate in H and K is consistent with an actively accreting protoplanet. Hence, we identify V1247 Ori as a unique laboratory for studying companion-disc interactions and disc clearing.We acknowledge support from an ERC Starting Grant (Grant Agreement No. 639889), STFC Rutherford Fellowship Article number, page 14 of 17 M. Willson et al.: Imaging the disc rim and companion candidate in V1247 Ori (ST/J004030/1), STFC Rutherford Grant (ST/K003445/1), Marie SklodowskaCurie CIG grant (Ref. 618910), and Philip Leverhulme Prize (PLP-2013-110). We additionally acknowledge support from NASA KPDA grants (JPL-1452321, 1474717, 1485953, 1496788). The Submillimeter Array is a joint project between the Smithsonian Astrophysical Observatory and the Academia Sinica Institute of Astronomy and Astrophysics and is funded by the Smithsonian Institution and the Academia Sinica. The authors wish to recognize and acknowledge the very significant cultural role and reverence that the summit of Mauna Kea has always had within the indigenous Hawaiian community. We are most fortunate to have the opportunity to conduct observations from this mountain.Some of the data presented herein were obtained at the W.M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W.M. Keck Foundation. J. Kluska acknowledges support from the research council of the KU Leuven under grant number C14/17/082. M. Curé and S. Kanaan acknowledge financial support from Centro de Astrofísica de Valparaiso. S. Kanaan thank the support of Fondecyt iniciacíon grant No. 11130702. T. Muto is partially supported by JSPS KAKENHI grant No. 26800106

Pulsational Mapping of Calcium Across the Surface of a White Dwarf

We constrain the distribution of calcium across the surface of the white dwarf star G29-38 by combining time series spectroscopy from Gemini-North with global time series photometry from the Whole Earth Telescope. G29-38 is actively accreting metals from a known debris disk. Since the metals sink significantly faster than they mix across the surface, any inhomogeneity in the accretion process will appear as an inhomogeneity of the metals on the surface of the star. We measure the flux amplitudes and the calcium equivalent width amplitudes for two large pulsations excited on G29-38 in 2008. The ratio of these amplitudes best fits a model for polar accretion of calcium and rules out equatorial accretion.Comment: Accepted to the Astrophysical Journal. 16 pages, 10 figures

Observations of the pulsating subdwarf B star Feige 48: Constraints on evolution and companions

Since pulsating subdwarf B (sdBV or EC14026) stars were first discovered (Kilkenny et al, 1997), observational efforts have tried to realize their potential for constraining the interior physics of extreme horizontal branch (EHB) stars. Difficulties encountered along the way include uncertain mode identifications and a lack of stable pulsation mode properties. Here we report on Feige 48, an sdBV star for which follow-up observations have been obtained spanning more than four years, which shows some stable pulsation modes. We resolve the temporal spectrum into five stable pulsation periods in the range 340 to 380 seconds with amplitudes less than 1%, and two additional periods that appear in one dataset each. The three largest amplitude periodicities are nearly equally spaced, and we explore the consequences of identifying them as a rotationally split l=1 triplet by consulting with a representative stellar model. The general stability of the pulsation amplitudes and phases allows us to use the pulsation phases to constrain the timescale of evolution for this sdBV star. Additionally, we are able to place interesting limits on any stellar or planetary companion to Feige 48.Comment: accepted for publication in MNRA