EuReCa ONE—27 Nations, ONE Europe, ONE Registry A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

AbstractIntroductionThe aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.MethodsThis was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.ResultsData on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.ConclusionThe results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe.EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events

Credit cycles and macroprudential policies in emerging market economies

Research background: Excessive credit expansions have an important role in the generation and amplification of business cycles in emerging market (EM) economies. Macroprudential policies can be beneficial in restraining excessive credit growth and safeguarding financial stability. Despite recent theoretical advances in understanding of the benefits of macroprudential policies, empirical evidence on their effect on the credit cycle is still scarce. Purpose of the article: This paper studies the effectiveness of macroprudential measures in the sample of major EM economies focusing on the broad credit measure and using an empirical framework which aims to alleviate several concerns in the previous literature. We examine the effectiveness of four categories of measures which are granular enough to provide relevant policy perspectives, whilst mitigating data sparsity issues. By exploiting both time-series and cross-country variation in the tightness of macroprudential regulation in the construction of policy variables we also mitigate some of the common reverse causality concerns. Methods: We use panel data and employ several (fixed effect, bias corrected LSDV and dynamic interactive fixed effect) estimators to ensure that the results are not sensitive with respect to the estimation method while, together with our construction of the policy variables, alleviating other endogeneity concerns. Findings & value added: We uncover the heterogeneity in the effects of macroprudential measures on the credit cycle. While measures related to bank capital and credit activity are found to be effective in leaning-against the credit cycle, the measures targeting bank liquidity and FX exposures fail to have statistically significant effect. Our results provide the rationale for mixed evidence in the empirical literature studying the effectiveness of the broadly defined macroprudential measures. From the policy perspective, our findings provide evidence that the measures which address excessive credit expansion and strengthen the resilience of the financial system are effective in the EM economies

Fractal boundary value problems for integral and differential equations with local fractional operators

In the present paper we investigate the fractal boundary value problems for the Fredholm and Volterra integral equations, heat conduction and wave equations by using the local fractional decomposition method. The operator is described by the local fractional operators. The four illustrative examples are given to elaborate the accuracy and reliability of the obtained results

Regenerating the NC code in order to improve the surface quality

© 2017, Strojarski Facultet. All rights reserved. The paper presents the research results of the impact of variable machining parameters: feed and spindle speed on surface roughness of Aluminium alloy 6005-T6, at CNC in the up and down milling with tools of different dimensions and different materials (Ø6 HSS, Ø6 VHM and Ø10 VHM). The properties and classification of Aluminium alloys are cited. The definition of surface roughness at end milling is given and parameters that affect it are specified. It was concluded that the feed is the parameter that has the most influence on surface roughens, while the lowest roughness is achieved by up milling. Correlation equations have provided good prediction of surface roughness in the case of machining of VHM by cutter Ø10. The results of the experiment will serve as an input into the model for control of input parameters of the machining process by regeneration of NC code for the purpose of quality improvement of machined surface

A Risk Stratification Model for Cardiovascular Complications during the 3-Month Period after Major Elective Vascular Surgery

Introduction. The Revised Cardiac Risk Index (RCRI) is an extensively used simple risk stratification tool advocated by the European Society of Cardiology and European Society of Anesthesiology (ESC/ESA). Purpose. The aim of this study was to find the best model for predicting 3-month cardiovascular complications in elective major vascular surgical patients using preoperative clinical assessment, calculation of the RCRI and Vascular Physiological and Operative Severity Score for the enumeration of mortality and morbidity (V-POSSUM) scores, and the preoperative levels of N-terminal brain natriuretic peptide (NT pro-BNP), high-sensitivity troponin I (hs TnI), and high-sensitivity C-reactive protein (hs CRP). Materials and Methods. We included 122 participants in a prospective, single-center, observational study. The levels of NT pro-BNP, hs CRP, and hs TnI were measured 48 hours prior to surgery. During the perioperative period and 90 days after surgery the following adverse cardiac events were recorded: myocardial infarction, arrhythmias, pulmonary edema, acute decompensated heart failure, and cardiac arrest. Results. During the first 3 months after surgery 29 participants (23.8%) had 50 cardiac complications. There was a statistically significant difference in the RCRI score between participants with and without cardiac complications. ROC analysis showed that a combination of RCRI with hs TnI has good discriminatory power (AUC 0.909, p<0,001). By adding NT pro-BNP concentrations to the RCRI+hs TnI+V-POSSSUM combination we obtained the model with the best predictive power for 3-month cardiac complications (AUC 0.963, p<0,001). Conclusion. We need to improve preoperative risk assessment in participants scheduled for major vascular surgery by combining their clinical scores with biomarkers. Therefore, it is possible to identify patients at risk of cardiovascular complications who need adequate preoperative diagnosis and treatment

Crise sanitaire : quelles opportunités pour la recherche clinique sur le médicament ?

International audienceLa pandémie de coronavirus disease-19 (COVID-19) a conduit au déploiement d’un effort de recherche académique et industriel sans précédent dont on peut regretter le caractère parfois redondant ainsi que le manque de pilotage tant national qu’international. Pourtant, force est de constater qu’à l’occasion de cette crise, les procédures réglementaires ont été adaptées de même que certains freins dans l’organisation de la recherche clinique ont pu être en partie levés pour contribuer au déploiement d’essais au plus près des patients et faciliter les modalités de suivi et de contrôle. La digitalisation de certains processus et la décentralisation de certaines activités ont pu être mises en œuvre sous couvert d’une mobilisation des autorités et de l’ensemble des acteurs institutionnels, académiques ou industriels. Si outre-manche, l’optimisation des ressources, au travers d’un essai de plateforme unique, a permis de montrer ou d’infirmer l’efficacité de nombreux traitements, en France la crise sanitaire a mis en lumière la fragilité de l’organisation de la recherche clinique, notamment un déficit de coordination et de financement, des difficultés dans la mise en œuvre des études ou encore une certaine frilosité concernant le partage des données. Cependant, la crise a aussi révélé les capacités d’adaptation des différents acteurs et permis l’amélioration de plusieurs processus utiles au déploiement de l’innovation thérapeutique. Gageons que les leçons tirées à l’occasion de cette crise permettront une meilleure efficacité en cas de nouvelle pandémie et surtout que les progrès obtenus continueront de s’appliquer à l’ensemble des activités de recherche clinique futures

Health crisis: What opportunities for clinical drug research?

International audienceThe COVID-19 pandemic led to the deployment of an unprecedented academic and industrial research effort, the sometimes redundant nature of which is regrettable, as is the lack of both national and international management. However, it must be noted that during this crisis, regulatory procedures were adapted and certain obstacles in the organisation of clinical research were partly removed to contribute to the deployment of trials as close as possible to patients and to facilitate monitoring and control procedures. The digitisation of certain processes and the decentralisation of certain activities were implemented under the cover of a mobilisation of the authorities and all institutional, academic and industrial players. While in the UK, the optimisation of resources through a single platform trial has made it possible to demonstrate or invalidate the efficacy of many treatments, in France the health crisis has highlighted the fragility of the organisation of clinical research, in particular a lack of coordination and funding, difficulties in implementing studies and a certain reluctance to share data. However, the crisis has also revealed the adaptability of the various stakeholders and has led to the improvement of several processes useful for the deployment of therapeutic innovation. Let us hope that the lessons learned during this crisis will allow for greater efficiency in the event of a new pandemic and, above all, that the progress made will continue to apply to all future clinical research activities