128 research outputs found
Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: Observational cohort study
Background: Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective: To describe IHCA demographics during three day/time periods - weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59) - and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods: We performed a prospectively defined analysis of NCAA data from 27 700 patients aged â„16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results: Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and nighttime (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/ time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions: IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible
Cosmological model with interactions in the dark sector
A cosmological model is proposed for the current Universe consisted of
non-interacting baryonic matter and interacting dark components. The dark
energy and dark matter are coupled through their effective barotropic indexes,
which are considered as functions of the ratio between their energy densities.
It is investigated two cases where the ratio is asymptotically stable and their
parameters are adjusted by considering best fits to Hubble function data. It is
shown that the deceleration parameter, the densities parameters, and the
luminosity distance have the correct behavior which is expected for a viable
present scenario of the Universe.Comment: 6 pages, 8 figure
Comparison of NITAG policies and working processes in selected developed countries
BACKGROUND: Vaccines are specific medicines characterized by two country-specific market access processes: (1) a recommendation by National Immunization Technical Advisory Group (NITAG), and (2) a funding policy decision. OBJECTIVES: The objective of this study was to compare and analyze NITAGs of 13 developed countries by describing vaccination committees' bodies and working processes. METHODS: Information about NITAGs bodies and working processes was searched from official sources from June 2011 to November 2012. Retrieved information was completed from relevant articles identified through a systematic literature review and by information provided by direct contact with NITAGs or parent organizations. An expert panel was also conducted to discuss, validate, and provide additional input on obtained results. RESULTS: While complete information, defined as 100%, was retrieved only for the UK, at least 80% of data was retrieved for 9 countries out of the 13 selected countries. Terms of references were identified in 7 countries, and the main mission for all NITAGs was to provide advice for National immunization programs. However, these terms of references did not fully encompass all the actual missions of the NITAGs. Decision analysis frameworks were identified for 10 out of the 13, and all NITAGs considered at least four criteria for decision-making: disease burden, efficacy/effectiveness, safety and cost-effectiveness. Advices were published by most NITAGs, but few NITAGs published meeting agendas and minutes. Only the United States had open meetings. CONCLUSIONS: This study supports previous findings about the disparities in NITAGs processes which could potentially explain the disparity in access to vaccinations and immunization programs across Europe. With NITAGs recommendations being used by policy decision makers for implementation and funding of vaccine programs, guidances should be well-informed and transparent to ensure National Immunization Programs' (NIP) credibility among the public and health care professionals
The Similarity Hypothesis in General Relativity
Self-similar models are important in general relativity and other fundamental
theories. In this paper we shall discuss the ``similarity hypothesis'', which
asserts that under a variety of physical circumstances solutions of these
theories will naturally evolve to a self-similar form. We will find there is
good evidence for this in the context of both spatially homogenous and
inhomogeneous cosmological models, although in some cases the self-similar
model is only an intermediate attractor. There are also a wide variety of
situations, including critical pheneomena, in which spherically symmetric
models tend towards self-similarity. However, this does not happen in all cases
and it is it is important to understand the prerequisites for the conjecture.Comment: to be submitted to Gen. Rel. Gra
Constraints on Dark Matter Annihilation in Clusters of Galaxies with the Fermi Large Area Telescope
Nearby clusters and groups of galaxies are potentially bright sources of
high-energy gamma-ray emission resulting from the pair-annihilation of dark
matter particles. However, no significant gamma-ray emission has been detected
so far from clusters in the first 11 months of observations with the Fermi
Large Area Telescope. We interpret this non-detection in terms of constraints
on dark matter particle properties. In particular for leptonic annihilation
final states and particle masses greater than ~200 GeV, gamma-ray emission from
inverse Compton scattering of CMB photons is expected to dominate the dark
matter annihilation signal from clusters, and our gamma-ray limits exclude
large regions of the parameter space that would give a good fit to the recent
anomalous Pamela and Fermi-LAT electron-positron measurements. We also present
constraints on the annihilation of more standard dark matter candidates, such
as the lightest neutralino of supersymmetric models. The constraints are
particularly strong when including the fact that clusters are known to contain
substructure at least on galaxy scales, increasing the expected gamma-ray flux
by a factor of ~5 over a smooth-halo assumption. We also explore the effect of
uncertainties in cluster dark matter density profiles, finding a systematic
uncertainty in the constraints of roughly a factor of two, but similar overall
conclusions. In this work, we focus on deriving limits on dark matter models; a
more general consideration of the Fermi-LAT data on clusters and clusters as
gamma-ray sources is forthcoming.Comment: accepted to JCAP, Corresponding authors: T.E. Jeltema and S. Profumo,
minor revisions to be consistent with accepted versio
Exploring the mechanisms of renoprotection against progressive glomerulosclerosis
In this review, I introduce the strategy developed by our laboratory to explore the mechanisms of renoprotection against progressive glomerulosclerosis leading to renal death. First, I describe the experimental rat model in which disturbances of vascular regeneration and glomerular hemodynamics lead to irreversible glomerulosclerosis. Second, I discuss the possible mechanisms determining the progression of glomerulosclerosis and introduce a new imaging system based on intravital confocal laser scanning microscopy. Third, I provide an in-depth review of the regulatory glomerular hemodynamics at the cellular and molecular levels while focusing on the pivotal role of Ca2+-dependent gap junctional intercellular communication in coordinating the behavior of mesangial cells. Last, I show that local delivery of renoprotective agents, in combination with diagnostic imaging of the renal microvasculature, allows the evaluation of the therapeutic effects of angiotensin II receptor and cyclooxygenase activity local blockade on the progression of glomerulosclerosis, which would otherwise lead to renal death
The On-orbit Calibrations for the Fermi Large Area Telescope
The Large Area Telescope (LAT) on--board the Fermi Gamma ray Space Telescope
began its on--orbit operations on June 23, 2008. Calibrations, defined in a
generic sense, correspond to synchronization of trigger signals, optimization
of delays for latching data, determination of detector thresholds, gains and
responses, evaluation of the perimeter of the South Atlantic Anomaly (SAA),
measurements of live time, of absolute time, and internal and spacecraft
boresight alignments. Here we describe on orbit calibration results obtained
using known astrophysical sources, galactic cosmic rays, and charge injection
into the front-end electronics of each detector. Instrument response functions
will be described in a separate publication. This paper demonstrates the
stability of calibrations and describes minor changes observed since launch.
These results have been used to calibrate the LAT datasets to be publicly
released in August 2009.Comment: 60 pages, 34 figures, submitted to Astroparticle Physic
TRY plant trait database â enhanced coverage and open access
Plant traitsâthe morphological, anatomical, physiological, biochemical and phenological characteristics of plantsâdetermine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of traitâbased plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traitsâalmost complete coverage for âplant growth formâ. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and traitâenvironmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives
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