Prehospital critical care for out-of-hospital cardiac arrest: An observational study examining survival and a stakeholder-focused cost analysis

© 2016 The Author(s). Background: Survival rates from out-of-hospital cardiac arrest (OHCA) remain low, despite remarkable efforts to improve care. A number of ambulance services in the United Kingdom (UK) have developed prehospital critical care teams (CCTs) which attend critically ill patients, including OHCA. However, current scientific evidence describing CCTs attending OHCA is sparse and research to date has not demonstrated clear benefits from this model of care. Methods: This prospective, observational study will describe the effect of CCTs on survival from OHCA, when compared to advanced-life-support (ALS), the current standard of prehospital care in the UK. In addition, we will describe the association between individual critical care interventions and survival, and also the costs of CCTs for OHCA. To examine the effect of CCTs on survival from OHCA, we will use routine Utstein variables data already collected in a number of UK ambulance trusts. We will use propensity score matching to adjust for imbalances between the CCT and ALS groups. The primary outcome will be survival to hospital discharge, with the secondary outcome of survival to hospital admission. We will record the critical care interventions delivered during CCT attendance at OHCA. We will describe frequencies and aim to use multiple logistic regression to examine possible associations with survival. Finally, we will undertake a stakeholder-focused cost analysis of CCTs for OHCA. This will utilise a previously published Emergency Medical Services (EMS) cost analysis toolkit and will take into account the costs incurred from use of a helicopter and the proportion of these costs currently covered by charities in the UK. Discussion: Prehospital critical care for OHCA is not universally available in many EMS. In the UK, it is variable and largely funded through public donations to charities. If this study demonstrates benefit from CCTs at an acceptable cost to the public or EMS commissioners, it will provide a rationale to increase funding and service provision. If no clinical benefit is found, the public and charities providing these services can consider concentrating their efforts on other areas of prehospital care. Trial registration: ISRCTN registry ID ISRCTN18375201

The Possibly Remnant Massive Outflow in G5.89-0.39: I - Observations and Initial MHD Simulations

We have obtained maps of the large scale outflow associated with the UCHII regionG5.89-0.39 in CO and 13CO (J=3-2), SiO (J=8-7,J=5-4), SO2 (13(2,12)-13(1,13)) and H13CO+(J=4-3). From these maps we have been able to determine the mass (3.3 M_sun), momentum (96 M_sun km/s), energy (3.5x10^{46} erg), mechanical luminosity (141 L_sun), and mass loss rate (~1x10^{-3}M_sun/yr) in the large scale outflow. The observationally derived parameters were used toguide 3D magnetohydrodynamic models of the jet entrained outflow. Through the combination of observations and simulations, we suggest that the large scale outflowmay be inclined by approximately 45 deg to the line of sight, and that the jet entraining the observed molecular outflow may have been active for as little as 1000 years, half the kinematic age of the outflow.Comment: 27 Pages, 9 Figures, Accepted to ApJ. For full (High) resolution figures, please see http://www.ism.ucalgary.ca/~pamela/papers/index.htm

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of SARS-CoV-2 genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three available genomic nomenclature systems for SARS-CoV-2 to all sequence data from the WHO European Region available during the COVID-19 pandemic until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation. We provide a comparison of the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2.Peer reviewe