Regional cardiac resuscitation systems of care

Out-of-hospital cardiac arrest (OOHCA) is a common public health problem, with large and important regional variations in outcomes. Survival rates vary widely among patients treated with OOHCA by emergency medical services (EMS), or among patients transported to the hospital after return of spontaneous circulation. Most regions lack a well-coordinated approach to post–cardiac arrest care. Effective hospital-based interventions for OOHCA exist but are used infrequently. Increased volume of patients or procedures of individual providers and hospitals is associated with better outcomes for several other clinical disorders. Regional systems of cardiac resuscitation include a process for identification of patients with OOHCA, standard field and hospital care protocols for patients with OOHCA, monitoring of care processes and outcome, and periodic review and feedback of these quality improvement data to identify problems and implement solutions. Similar systems have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. Many more people could survive OOHCA if regional systems of cardiac resuscitation were implemented and maintained. The time has come to do so wherever feasible

A Search for the Most Massive Galaxies. III. Global and Central Structure

We used the Advanced Camera for Surveys on board the Hubble Space Telescope to obtain high resolution i-band images of the centers of 23 single galaxies, which were selected because they have SDSS velocity dispersions larger than 350 km/s. The surface brightness profiles of the most luminous of these objects (M_i<-24) have well-resolved `cores' on scales of 150-1000 pc, and share similar properties to BCGs. The total luminosity of the galaxy is a better predictor of the core size than is the velocity dispersion. The correlations of luminosity and velocity dispersion with core size agree with those seen in previous studies of galaxy cores. Because of high velocity dispersions, our sample of galaxies can be expected to harbor the most massive black holes, and thus have large cores with large amounts of mass ejection. The mass-deficits inferred from core-Sersic fits to the surface-brightness profiles are approximately double the black-hole masses inferred from the M_bh-sigma relation and the same as those inferred from the M_bh-L relation. The less luminous galaxies (M_i>-23) tend to have steeper `power-law' inner profiles, higher-ellipticity, diskier isophotes, and bulge-to-total ratios of order 0.5 -- all of which suggest that they are `fast-rotators' and rotational motions could have contaminated the velocity dispersion estimate. There are obvious dust features within about 300 pc of the center in about 35% of the sample, predominantly in power-law rather than core galaxies.Comment: 27 Pages, 22 Figures, 2 Tables, Accepted for Publication in MNRA

Grist: Grid-based Data Mining for Astronomy

The Grist project is developing a grid-technology based system as a research environment for astronomy with massive and complex datasets. This knowledge extraction system will consist of a library of distributed grid services controlled by a work ow system, compliant with standards emerging from the grid computing, web services, and virtual observatory communities. This new technology is being used to find high redshift quasars, study peculiar variable objects, search for transients in real time, and fit SDSS QSO spectra to measure black hole masses. Grist services are also a component of the "hyperatlas" project to serve high-resolution multi-wavelength imagery over the Internet. In support of these science and outreach objectives, the Grist framework will provide the enabling fabric to tie together distributed grid services in the areas of data access, federation, mining, subsetting, source extraction, image mosaicking, statistics, and visualization

Measuring single cell divisions in human tissues from multi-region sequencing data

Both normal tissue development and cancer growth are driven by a branching process of cell division and mutation accumulation that leads to intra-tissue genetic heterogeneity. However, quantifying somatic evolution in humans remains challenging. Here, we show that multi-sample genomic data from a single time point of normal and cancer tissues contains information on single-cell divisions. We present a new theoretical framework that, applied to whole-genome sequencing data of healthy tissue and cancer, allows inferring the mutation rate and the cell survival/death rate per division. On average, we found that cells accumulate 1.14 mutations per cell division in healthy haematopoiesis and 1.37 mutations per division in brain development. In both tissues, cell survival was maximal during early development. Analysis of 131 biopsies from 16 tumours showed 4 to 100 times increased mutation rates compared to healthy development and substantial inter-patient variation of cell survival/death rates

Street Connectivity is Negatively Associated with Physical Activity in Canadian Youth

Street connectivity, defined as how well streets connect to one and other and the density of intersections, is positively associated with active transportation in adults. Our objective was to study the relation between street connectivity and physical activity in youth. Study participants consisted of 8,535 students in grades 6–10 from 180 schools across Canada who completed the 2006 Health Behaviour in School-aged Children (HBSC) survey. Street connectivity was measured in a 5 km circular buffer around these schools using established geographic information system measures. Physical activity performed outside of school hours was assessed by questionnaire, and multi-level regression analyses were used to estimate associations with street connectivity after controlling for several covariates. Compared to students living in the highest street connectivity quartile, those in the second (relative risk = 1.22, 95% confidence interval = 1.10–1.35), third (1.25, 1.13–1.37), and fourth (1.21, 1.09–1.34) quartiles were more likely to be physically active outside of school. In conclusion, youth in neighbourhoods with the most highly connected streets reported less physical activity outside of school than youth from neighbourhoods with less connected streets. Relationships between street connectivity and physical activity reported in this national study are in the opposite direction to those previously observed for active transportation in adult populations

F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging-Assisted Management of Patients With Severe Left Ventricular Dysfunction and Suspected Coronary Disease A Randomized, Controlled Trial (PARR-2)

ObjectivesWe conducted a randomized trial to assess the effectiveness of F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-assisted management in patients with severe ventricular dysfunction and suspected coronary disease.BackgroundSuch patients may benefit from revascularization, but have significant perioperative morbidity and mortality. F-18-fluorodeoxyglucose PET can detect viable myocardium that might recover after revascularization.MethodsIncluded were patients with severe left ventricular (LV) dysfunction and suspected coronary disease being considered for revascularization, heart failure, or transplantation work-ups or in whom PET was considered potentially useful. Patients were stratified according to recent angiography or not, then randomized to management assisted by FDG PET (n = 218) or standard care (n = 212). The primary outcome was the composite of cardiac death, myocardial infarction, or recurrent hospital stay for cardiac cause, within 1 year.ResultsAt 1 year, the cumulative proportion of patients who had experienced the composite event was 30% (PET arm) versus 36% (standard arm) (relative risk 0.82, 95% confidence interval [CI] 0.59 to 1.14; p = 0.16). The hazard ratio (HR) for the composite outcome, PET versus standard care, was 0.78 (95% CI 0.58 to 1.1; p = 0.15); for patients that adhered to PET recommendations for revascularization, revascularization work-up, or neither, HR = 0.62 (95% CI 0.42 to 0.93; p = 0.019); in those without recent angiography, for cardiac death, HR = 0.4 (95% CI 0.17 to 0.96; p = 0.035).ConclusionsThis study did not demonstrate a significant reduction in cardiac events in patients with LV dysfunction and suspected coronary disease for FDG PET-assisted management versus standard care. In those who adhered to PET recommendations and in patients without recent angiography, significant benefits were observed. The utility of FDG PET is best realized in this subpopulation and when adherence to recommendations can be achieved

Galaxy And Mass Assembly (GAMA)

The GAMA survey aims to deliver 250,000 optical spectra (3--7Ang resolution) over 250 sq. degrees to spectroscopic limits of r_{AB} <19.8 and K_{AB}<17.0 mag. Complementary imaging will be provided by GALEX, VST, UKIRT, VISTA, HERSCHEL and ASKAP to comparable flux levels leading to a definitive multi-wavelength galaxy database. The data will be used to study all aspects of cosmic structures on 1kpc to 1Mpc scales spanning all environments and out to a redshift limit of z ~ 0.4. Key science drivers include the measurement of: the halo mass function via group velocity dispersions; the stellar, HI, and baryonic mass functions; galaxy component mass-size relations; the recent merger and star-formation rates by mass, types and environment. Detailed modeling of the spectra, broad SEDs, and spatial distributions should provide individual star formation histories, ages, bulge-disc decompositions and stellar bulge, stellar disc, dust disc, neutral HI gas and total dynamical masses for a significant subset of the sample (~100k) spanning both the giant and dwarf galaxy populations. The survey commenced March 2008 with 50k spectra obtained in 21 clear nights using the Anglo Australian Observatory's new multi-fibre-fed bench-mounted dual-beam spectroscopic system (AAOmega).Comment: Invited talk at IAU 254 (The Galaxy Disk in Cosmological Context, Copenhagen), 6 pages, 5 figures, high quality PDF version available at http://www.eso.org/~jliske/gama

Understanding factors associated with the translation of cardiovascular research: A multinational case study approach

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Funders of health research increasingly seek to understand how best to allocate resources in order to achieve maximum value from their funding. We built an international consortium and developed a multinational case study approach to assess benefits arising from health research. We used that to facilitate analysis of factors in the production of research that might be associated with translating research findings into wider impacts, and the complexities involved. Methods: We built on the Payback Framework and expanded its application through conducting co-ordinated case studies on the payback from cardiovascular and stroke research in Australia, Canada and the United Kingdom. We selected a stratified random sample of projects from leading medical research funders. We devised a series of innovative steps to: minimize the effect of researcher bias; rate the level of impacts identified in the case studies; and interrogate case study narratives to identify factors that correlated with achieving high or low levels of impact. Results: Twenty-nine detailed case studies produced many and diverse impacts. Over the 15 to 20 years examined, basic biomedical research has a greater impact than clinical research in terms of academic impacts such as knowledge production and research capacity building. Clinical research has greater levels of wider impact on health policies, practice, and generating health gains. There was no correlation between knowledge production and wider impacts. We identified various factors associated with high impact. Interaction between researchers and practitioners and the public is associated with achieving high academic impact and translation into wider impacts, as is basic research conducted with a clinical focus. Strategic thinking by clinical researchers, in terms of thinking through pathways by which research could potentially be translated into practice, is associated with high wider impact. Finally, we identified the complexity of factors behind research translation that can arise in a single case. Conclusions: We can systematically assess research impacts and use the findings to promote translation. Research funders can justify funding research of diverse types, but they should not assume academic impacts are proxies for wider impacts. They should encourage researchers to consider pathways towards impact and engage potential research users in research processes. © 2014 Wooding et al.; licensee BioMed Central Ltd.RAND Europe and HERG, with subsequent funding from the NHFA, the HSFC and the CIHR. This research was also partially supported by the Policy Research Programme in the English Department of Health