Professional guideline versus product label selection for treatment with IV thrombolysis: an analysis from SITS registry

Introduction: Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods: We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1–3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3–5), medium efficiency (6–8) or higher efficiency (9–11). Sites were also grouped by adherence with European product label and ESO guideline: ‘label adherent’ (>95% on-label), ‘guideline adherent’ (≥5% off-label, ≥95% on-guideline) or ‘guideline non-adherent’ (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0–1. Results: A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were ‘label adherent’, 204 ‘guideline adherent’ and 337 ‘guideline non-adherent’. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all ‘label adherent’ sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion: Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion: Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years

Stable and unstable accretion in the classical T Tauri stars IM Lup and RU Lup as observed by MOST

Results of the time variability monitoring of the two classical T Tauri stars, RU Lup and IM Lup, are presented. Three photometric data sets were utilised: (1) simultaneous (same field) MOST satellite observations over four weeks in each of the years 2012 and 2013, (2) multicolour observations at the SAAO in April - May of 2013, (3) archival V-filter ASAS data for nine seasons, 2001 - 2009. They were augmented by an analysis of high-resolution, public-domain VLT-UT2 UVES spectra from the years 2000 to 2012. From the MOST observations, we infer that irregular light variations of RU Lup are caused by stochastic variability of hot spots induced by unstable accretion. In contrast, the MOST light curves of IM Lup are fairly regular and modulated with a period of about 7.19 - 7.58 d, which is in accord with ASAS observations showing a well defined 7.247+/-0.026 d periodicity. We propose that this is the rotational period of IM Lup and is due to the changing visibility of two antipodal hot spots created near the stellar magnetic poles during the stable process of accretion. Re-analysis of RU Lup high-resolution spectra with the Broadening Function approach reveals signs of a large polar cold spot, which is fairly stable over 13 years. As the star rotates, the spot-induced depression of intensity in the Broadening Function profiles changes cyclically with period 3.71058 d, which was previously found by the spectral cross-correlation method.Comment: 14 pages, 7 figures. Accepted by MNRA

All-age hospitalization rates in coal seam gas areas in Queensland, Australia, 1995–2011

Background: Unconventional natural gas development (UNGD) is expanding globally, with Australia expanding development in the form of coal seam gas (CSG). Residents and other interest groups have voiced concerns about the potential environmental and health impacts related to CSG. This paper compares objective health outcomes from three study areas in Queensland, Australia to examine potential environmentally-related health impacts. Methods: Three study areas were selected in an ecologic study design: A CSG area, a coal mining area, and a rural/agricultural area. Admitted patient data, as well as population data and additional factors, were obtained for each calendar year from 1995 through 2011 to calculate all-age hospitalization rates and age-standardized rates in each of these areas. The three areas were compared using negative binomial regression analyses (unadjusted and adjusted models) to examine increases over time of hospitalization rates grouped by primary diagnosis (19 ICD chapters), with rate ratios serving to compare the within-area regression slopes between the areas. Results: The CSG area did not have significant increases in all-cause hospitalization rates over time for all-ages compared to the coal and rural study areas in adjusted models (RR: 1.02, 95 % CI: 1.00-1.04 as compared to the coal mining area; RR: 1.01, 95 % CI: 0.99-1.04 as compared to the rural area). While the CSG area did not show significant increases in specific hospitalization rates compared to both the coal mining and rural areas for any ICD chapters in the adjusted models, the CSG area showed increases in hospitalization rates compared only to the rural area for neoplasms (RR: 1.09, 95 % CI: 1.02-1.16) and blood/immune diseases (RR: 1.14, 95 % CI: 1.02-1.27). Conclusions: This exploratory study of all-age hospitalization rates for three study areas in Queensland suggests that certain hospital admissions rates increased more quickly in the CSG study area than in other study areas, particularly the rural area, after adjusting for key sociodemographic factors. These findings are an important first step in identifying potential health impacts of CSG in the Australian context and serve to generate hypotheses for future studies

A structural decomposition-based diagnosis method for dynamic process systems using HAZID information

A novel diagnosis method is proposed in this paper that uses the results of the blended HAZID analysis extended to the dynamic case of process systems controlled by operational procedures. The algorithm is capable of finding fault root causes in process systems using nominal and observed possible faulty operational procedure execution traces. The algorithm uses the structural decomposition of the process system and its component-level dynamic HAZID (P-HAZID) tables and executes the diagnosis component-wise by first decomposing the observed execution traces, and then assembling the diagnosis results. The exact structure of the algorithm is also discussed, followed by two case studies on which its operation is demonstrated. © 2014 Elsevier Ltd

MOST photometry of the RRd Lyrae variable AQ Leo: Two radial modes, 32 combination frequencies, and beyond

Highly precise and nearly uninterrupted optical photometry of the RR Lyrae star AQ Leo was obtained with the MOST (Microvariability & Oscillations of STars) satellite over 34.4 days in February-March 2005. AQ Leo was the first known double-mode RR Lyrae pulsator (RRd star). Three decades after its discovery, MOST observations have revealed that AQ Leo oscillates with at least 42 frequencies, of which 32 are linear combinations (up to the sixth order) of the radial fundamental mode and its first overtone. Evidence for period changes of these modes is found in the data. The other intrinsic frequencies may represent an additional nonradial pulsation mode and its harmonics (plus linear combinations) which warrant theoretical modeling. The unprecedented number of frequencies detected with amplitudes down to millimag precision also presents an opportunity to test nonlinear theories of mode growth and saturation in RR Lyrae pulsators.Comment: accepted for publication in MNRAS; revision v2 : broken references have been fixe

Quantifying the Impoverishing Effects of Purchasing Medicines: A Cross-Country Comparison of the Affordability of Medicines in the Developing World

Laurens Niëns and colleagues estimate the impoverishing effects of four medicines in 16 low- and middle-income countries using the impoverishment method as a metric of affordability and show that medicine purchases could impoverish large numbers of people

Environmental change impacts on the C- and N-cycle of European forests: a model comparison study [Discussion paper]

Forests are important components of the greenhouse gas balance of Europe. There is considerable uncertainty about how predicted changes to climate and nitrogen deposition will perturb the carbon and nitrogen cycles of European forests and thereby alter forest growth, carbon sequestration and N2O emission. The present study aimed to quantify the carbon and nitrogen balance, including the exchange of greenhouse gases, of European forests over the period 2010–2030, with a particular emphasis on the spatial variability of change. The analysis was carried out for two tree species: European beech and Scots pine. For this purpose, four different dynamic models were used: BASFOR, DailyDayCent, INTEGRATOR and Landscape-DNDC. These models span a range from semi-empirical to complex mechanistic. Comparison of these models allowed assessment of the extent to which model predictions depended on differences in model inputs and structure. We found a European average carbon sink of 0.160 ± 0.020 kgC m−2 yr−1 (pine) and 0.138 ± 0.062 kgC m−2 yr−1 (beech) and N2O source of 0.285 ± 0.125 kgN ha−1 yr−1 (pine) and 0.575 ± 0.105 kgN ha−1 yr−1 (beech). The European average greenhouse gas potential of the carbon source was 18 (pine) and 8 (beech) times that of the N2O source. Carbon sequestration was larger in the trees than in the soil. Carbon sequestration and forest growth were largest in central Europe and lowest in northern Sweden and Finland, N. Poland and S. Spain. No single driver was found to dominate change across Europe. Forests were found to be most sensitive to change in environmental drivers where the drivers were limiting growth, where changes were particularly large or where changes acted in concert. The models disagreed as to which environmental changes were most significant for the geographical variation in forest growth and as to which tree species showed the largest rate of carbon sequestration. Pine and beech forests were found to have differing sensitivities to environmental change, in particular the response to changes in nitrogen and precipitation, with beech forest more vulnerable to drought. There was considerable uncertainty about the geographical location of N2O emissions. Two of the models BASFOR and LandscapeDNDC had largest emissions in central Europe where nitrogen deposition and soil nitrogen were largest whereas the two other models identified different regions with large N2O emission. N2O emissions were found to be larger from beech than pine forests and were found to be particularly sensitive to forest growth

Understanding Degassing Pathways Along the 1886 Tarawera (New Zealand) Volcanic Fissure by Combining Soil and Lake CO₂ Fluxes

CO₂ flux measurements are often used to monitor volcanic systems, understand the cause of volcanic unrest, and map sub-surface structures. Currently, such measurements are incomplete at Tarawera (New Zealand), which erupted with little warning in 1886 and produced a ∼17 km long fissure. We combine new soil CO₂ flux and C isotope measurements of Tarawera with previous data from Rotomahana and Waimangu (regions also along the 1886 fissure) to fingerprint the CO₂ source, understand the current pathways for degassing, quantify the CO₂ released along the entire fissure, and provide a baseline survey. The total CO₂ emissions from the fissure are 1227 t⋅d⁻¹ (742–3398 t⋅d⁻¹ 90 % confidence interval), similar to other regions in the Taupō Volcanic Zone. The CO₂ flux from Waimangu and Rotomahana is far higher than from Tarawera (>549 vs. ∼4 t⋅d⁻¹ CO₂), likely influenced by a shallow silicic body at depth and Okataina caldera rim faults increasing permeability at the southern end of the fissure. Highly localized regions of elevated CO2 flux occur along the fissure and are likely caused by cross-cutting faults that focus the flow. One of these areas occurs on Tarawera, which is emitting ∼1 t⋅d⁻¹ CO₂ with a δ¹³CO₂ of −5.5 ± 0.5 ‰, and comparison with previous observations shows that activity is declining over time. This region highlights the spatial and temporal complexity of degassing pathways at volcanoes and that sub-surface structures exert a primary control on the magnitude of CO₂ flux in comparison to the surface mechanism (i.e., CO₂ released through the soil or lake surface)