The Study Protocol for the LINC (LUCAS in Cardiac Arrest) Study: a study comparing conventional adult out-of-hospital cardiopulmonary resuscitation with a concept with mechanical chest compressions and simultaneous defibrillation

BACKGROUND: The LUCAS™ device delivers mechanical chest compressions that have been shown in experimental studies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end tidal CO(2,) compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot studies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual CPR. There remains evidence from small case series that the device can be potentially beneficial compared with manual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and safety of mechanical chest compressions with the LUCAS™ device whilst allowing defibrillation during on-going CPR, and comparing the results with those of conventional resuscitation. METHODS/DESIGN: This article describes the design and protocol of the LINC-study which is a randomised controlled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at ClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1). RESULTS: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety aspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR. CONCLUSION: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR and specifically to the efficacy and safety of the LUCAS™ device when used in association with defibrillation during on-going CPR

More Bucks for the Bang: New Space Solutions, Impact Tourism and one Unique Science & Engineering Opportunity at T-6 Months and Counting

For now, the Planetary Defense Conference Exercise 2021's incoming fictitious(!) asteroid, 2021 PDC, seems headed for impact on October 20th, 2021, exactly 6 months after its discovery. Today (April 26th, 2021), the impact probability is 5%, in a steep rise from 1 in 2500 upon discovery six days ago. We all know how these things end. Or do we? Unless somebody kicked off another headline-grabbing media scare or wants to keep civil defense very idle very soon, chances are that it will hit (note: this is an exercise!). Taking stock, it is barely 6 months to impact, a steadily rising likelihood that it will actually happen, and a huge uncertainty of possible impact energies: First estimates range from 1.2 MtTNT to 13 GtTNT, and this is not even the worst-worst case: a 700 m diameter massive NiFe asteroid (covered by a thin veneer of Ryugu-black rubble to match size and brightness) would come in at 70 GtTNT. In down to Earth terms, this could be all between smashing fireworks over some remote area of the globe and a 7.5 km crater downtown somewhere. Considering the deliberate and sedate ways of development of interplanetary missions it seems we can only stand and stare until we know well enough where to tell people to pack up all that can be moved at all and save themselves. But then, it could just as well be a smaller bright rock. The best estimate is 120 m diameter from optical observation alone, by 13% standard albedo. NASA's upcoming DART mission to binary asteroid (65803) Didymos is designed to hit such a small target, its moonlet Dimorphos. The Deep Impact mission's impactor in 2005 successfully guided itself to the brightest spot on comet 9P/Tempel 1, a relatively small feature on the 6 km nucleus. And 'space' has changed: By the end of this decade, one satellite communication network plans to have launched over 11000 satellites at a pace of 60 per launch every other week. This level of series production is comparable in numbers to the most prolific commercial airliners. Launch vehicle production has not simply increased correspondingly - they can be reused, although in a trade for performance. Optical and radio astronomy as well as planetary radar have made great strides in the past decade, and so has the design and production capability for everyday 'high-tech' products. 60 years ago, spaceflight was invented from scratch within two years, and there are recent examples of fastpaced space projects as well as a drive towards 'responsive space'. It seems it is not quite yet time to abandon all hope. We present what could be done and what is too close to call once thinking is shoved out of the box by a clear and present danger, to show where a little more preparedness or routine would come in handy - or become decisive. And if we fail, let's stand and stare safely and well instrumented anywhere on Earth together in the greatest adventure of science

Rymdstrålningens effekt på solsegel

As the average temperature on Earth keeps rising and becoming a greater threat to life on Earth, several methods has been proposed to mitigate the effects of elevated temperatures or to lower the Earth's average temperature drastically. One suggestion is a solar sail shade that blocks a portion of the incoming sunlight. There are several difficulties to overcome for such a mission and a demonstrator has been proposed to show the feasibility of solar sail shading.This paper is a study of the space radiations interaction with solar sail membrane, in literature and with calculations of the radiation environment with the aim to investigate the feasibility of the demonstrator.The findings of this paper is that there is not enough to show that the mission will be successful, however it is feasible. The major difficulties are the temperature dependence and the still unknown reaction that thin material, the solar sail membrane, has with the space environment. The core interaction for a solar sail membrane is of an energy level range that has not been relevant in other fields, protons with energy less than 10 keV specifically, thus there is a lack of knowledge in the desired energy range.Med Jordens ökande medeltemperatur har flera nationer på Jorden presenterat metoder för att reducera medeltemperaturen.Ett förslag är att skicka flera solsegel mellan Jorden och Solen för att blockera en del av det inkommande ljuset. Det finns flera utmaningar med detta förslag. För att undersöka om solsegel är en möjlig lösning så har en så kallad ”demonstrator” skapats. Syftet med ”demonstratorn” är att undersöka om lösningen är genomförbar.För att undersöka huruvida det är möjligt att fullgöra ”demonstratorns” uppdrag har rymdstrålningens interaktion med solseglets membran undersökts med hjälp av litteratur samt beräkningar.Slutsatsen är att det behövs mer information för att visa huruvida "demonstratorn" kommer klara det tänkta uppdraget. Den samlade informationen tyder än så länge på att uppdraget går att genomföra. Bland de större svårigheterna finns dels temperaturberoendet på väte-reaktionerna dels att reaktionen mellan solsegel och rymdstrålningen fortfarande är relativt okänd. Den aktuella interaktionen på solseglet ligger inom ett intervall av energinivåer som tidigare inte varit relevanta att undersöka. Detta gäller exempelvis protoner med energinivåer som understiger 10 keV. Därför saknas idag kunskap effekterna på solseglet inom de aktuella energinivåerna

Rymdstrålningens effekt på solsegel

As the average temperature on Earth keeps rising and becoming a greater threat to life on Earth, several methods has been proposed to mitigate the effects of elevated temperatures or to lower the Earth's average temperature drastically. One suggestion is a solar sail shade that blocks a portion of the incoming sunlight. There are several difficulties to overcome for such a mission and a demonstrator has been proposed to show the feasibility of solar sail shading.This paper is a study of the space radiations interaction with solar sail membrane, in literature and with calculations of the radiation environment with the aim to investigate the feasibility of the demonstrator.The findings of this paper is that there is not enough to show that the mission will be successful, however it is feasible. The major difficulties are the temperature dependence and the still unknown reaction that thin material, the solar sail membrane, has with the space environment. The core interaction for a solar sail membrane is of an energy level range that has not been relevant in other fields, protons with energy less than 10 keV specifically, thus there is a lack of knowledge in the desired energy range.Med Jordens ökande medeltemperatur har flera nationer på Jorden presenterat metoder för att reducera medeltemperaturen.Ett förslag är att skicka flera solsegel mellan Jorden och Solen för att blockera en del av det inkommande ljuset. Det finns flera utmaningar med detta förslag. För att undersöka om solsegel är en möjlig lösning så har en så kallad ”demonstrator” skapats. Syftet med ”demonstratorn” är att undersöka om lösningen är genomförbar.För att undersöka huruvida det är möjligt att fullgöra ”demonstratorns” uppdrag har rymdstrålningens interaktion med solseglets membran undersökts med hjälp av litteratur samt beräkningar.Slutsatsen är att det behövs mer information för att visa huruvida "demonstratorn" kommer klara det tänkta uppdraget. Den samlade informationen tyder än så länge på att uppdraget går att genomföra. Bland de större svårigheterna finns dels temperaturberoendet på väte-reaktionerna dels att reaktionen mellan solsegel och rymdstrålningen fortfarande är relativt okänd. Den aktuella interaktionen på solseglet ligger inom ett intervall av energinivåer som tidigare inte varit relevanta att undersöka. Detta gäller exempelvis protoner med energinivåer som understiger 10 keV. Därför saknas idag kunskap effekterna på solseglet inom de aktuella energinivåerna

Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms

OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated

More Bucks for the Bang: New Space Solutions, Impact Tourism and One Unique Science & Engineering Opportunity at T-6 Months and Counting

No abstract available

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable