Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is prevalent in the UK. Reported survival is lower than in countries with comparable healthcare systems; a better understanding of outcome determinants may identify areas for improvement. METHODS: An analysis of 9109 OHCA attended in East of England between 1 January 2015 and 31 July 2017. Univariate descriptives and multivariable analysis were used to understand the determinants of survival for non-traumatic cardiac arrest (NTCA) and traumatic cardiac arrest (TCA). Two Utstein outcome variables were used: survival to hospital admission and hospital discharge. RESULTS: The incidence of OHCA was 55.1 per 100 000 population/year. The overall survival to hospital admission was 27.6% (95% CI 26.7% to 28.6%) and the overall survival to discharge was 7.9% (95% CI 7.3% to 8.5%). Survival to hospital admission and survival to hospital discharge were both greater in the NTCA group compared with the TCA group: 27.9% vs 19.3% p=0.001, and 8.0% vs 3.8% p=0.012 respectively.Determinants of NTCA and TCA survival were different, and varied according to the outcome examined. In NTCA, bystander cardiopulmonary resuscitation (CPR) was associated with survival at discharge but not at admission, and the likelihood of bystander CPR was dependent on geographical socioeconomic status. An air ambulance was associated with increased survival to both hospital admission and discharge in NTCA, but only with survival to admission in TCA. CONCLUSION: NTCA and TCA are clinically distinct entities with different predictors for outcome-future OHCA reports should aim to separate arrest aetiologies. Determinants of survival to hospital admission and discharge differ in a way that likely reflects the determinants of neurological injury. Bystander CPR public engagement may be best focused in more deprived areas

Molecular Gas in Spiral Galaxies

In this review, I highlight a number of recent surveys of molecular gas in nearby spiral galaxies. Through such surveys, more complete observations of the distribution and kinematics of molecular gas have become available for galaxies with a wider range of properties (e.g., brightness, Hubble type, strength of spiral or bar structure). These studies show the promise of both interferometers and single-dish telescopes in advancing our general understanding of molecular gas in spiral galaxies. In particular, I highlight the contributions of the recent BIMA Survey of Nearby Galaxies (SONG).Comment: 8 pages, 1 figure. To appear in the proceedings of the 4th Cologne-Bonn-Zermatt-Symposium, "The Dense Interstellar Medium in Galaxies", which was held in Zermatt, Switzerland in September 200

Diversification of a single ancestral gene into a successful toxin superfamily in highly venomous Australian funnel-web spiders

Background: Spiders have evolved pharmacologically complex venoms that serve to rapidly subdue prey and deter predators. The major toxic factors in most spider venoms are small, disulfide-rich peptides. While there is abundant evidence that snake venoms evolved by recruitment of genes encoding normal body proteins followed by extensive gene duplication accompanied by explosive structural and functional diversification, the evolutionary trajectory of spider-venom peptides is less clear. Results: Here we present evidence of a spider-toxin superfamily encoding a high degree of sequence and functional diversity that has evolved via accelerated duplication and diversification of a single ancestral gene. The peptides within this toxin superfamily are translated as prepropeptides that are posttranslationally processed to yield the mature toxin. The N-terminal signal sequence, as well as the protease recognition site at the junction of the propeptide and mature toxin are conserved, whereas the remainder of the propeptide and mature toxin sequences are variable. All toxin transcripts within this superfamily exhibit a striking cysteine codon bias. We show that different pharmacological classes of toxins within this peptide superfamily evolved under different evolutionary selection pressures. Conclusions: Overall, this study reinforces the hypothesis that spiders use a combinatorial peptide library strategy to evolve a complex cocktail of peptide toxins that target neuronal receptors and ion channels in prey and predators. We show that the ω-hexatoxins that target insect voltage-gated calcium channels evolved under the influence of positive Darwinian selection in an episodic fashion, whereas the κ-hexatoxins that target insect calcium-activated potassium channels appear to be under negative selection. A majority of the diversifying sites in the ω-hexatoxins are concentrated on the molecular surface of the toxins, thereby facilitating neofunctionalisation leading to new toxin pharmacology. © 2014 Pineda et al.; licensee BioMed Central Ltd

Perspective-taking in deriving implicatures: The listener's perspective is important too

Theories of meaning propose that listeners understand a speaker's implicit meaning thanks to mutually assumed norms of conversation that take into account what the speaker has said, as well as contextual factors, including what the speaker knows. Emerging psycholinguistic research shows that listeners derive a particular kind of implicit meaning, quantity implicatures, when their speaker is knowledgeable about the situation but tend to not derive it otherwise. In this article we focus on if and how listeners use the knowledge that is available only to themselves, i.e., the listener's perspective, while deriving implicatures. To do so, we explore the derivation of ad hoc quantity implicature in situations where the speaker does or does not have full knowledge, while, in the latter case, the listener has two types of privileged knowledge. Two versions of a study with neurotypical English-speaking adults show that listeners are influenced by their own perspective while deriving implicatures, depending on the type of knowledge available to them. We discuss the implications of these findings for models of pragmatic interpretative strategies

Social Transmission of Avoidance Behavior under Situational Change in Learned and Unlearned Rats

BACKGROUND: Rats receive information from other conspecifics by observation or other types of social interaction. Such social interaction may contribute to the effective adaptation to changes of environment such as situational switching. Learning to avoid dangerous places or objects rapidly occurs with even a single conditioning session, and the conditioned memory tends to be sustained over long periods. The avoidance is important for adaptation, but the details of the conditions under which the social transmission of avoidance is formed are unknown. We demonstrate that the previous experience of avoidance learning is important for the formation of behaviors for social transmission of avoidance and that the experienced rats adapt to a change of situation determined by the presence or absence of aversive stimuli. We systematically investigated social influence on avoidance behavior using a passive avoidance test in a light/dark two-compartment apparatus. METHODOLOGY/PRINCIPAL FINDINGS: Rats were divided into two groups, one receiving foot shocks and another with no aversive experience in a dark compartment. Experienced and inexperienced rats were further divided into subjects and partners. In Experiment 1, each subject experienced (1) interaction with an experienced partner, (2) interaction with an inexperienced partner, or (3) no interaction. In Experiment 2, each subject experienced interaction with a partner that received a shock. The entering latency to a light compartment was measured. The avoidance behavior of experienced rats was inhibited by interaction with inexperienced or experienced partners in a safely-changed situation. The avoidance of experienced rats was reinstated in a dangerously-changed situation by interaction with shocked rats. In contrast, the inexperienced rats were not affected by any social circumstances. CONCLUSIONS/SIGNIFICANCE: These results suggest that transmitted information among rats can be updated under a situational change and that the previous experience is crucial for social enhancement and inhibition of avoidance behavior in rats

Is the pharmacy profession innovative enough?: meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique

Background Community pharmacies are ideally located as a source of support for people with chronic conditions. Yet, we have limited insight into what innovative pharmacy services would support this consumer group to manage their condition/s. The aim of this study was to identify what innovations people with chronic conditions and their carers want from their ideal community pharmacy, and compare with what pharmacists and pharmacy support staff think consumers want. Methods We elicited ideas using the nominal group technique. Participants included people with chronic conditions, unpaid carers, pharmacists and pharmacy support staff, in four regions of Australia. Themes were identified via thematic analysis using the constant comparison method. Results Fifteen consumer/carer, four pharmacist and two pharmacy support staff groups were conducted. Two overarching themes were identified: extended scope of practice for the pharmacist and new or improved pharmacy services. The most innovative role for Australian pharmacists was medication continuance, within a limited time-frame. Consumers and carers wanted improved access to pharmacists, but this did not necessarily align with a faster or automated dispensing service. Other ideas included streamlined access to prescriptions via medication reminders, electronic prescriptions and a chronic illness card. Conclusions This study provides further support for extending the pharmacist’s role in medication continuance, particularly as it represents the consumer’s voice. How this is done, or the methods used, needs to optimise patient safety. A range of innovative strategies were proposed and Australian community pharmacies should advocate for and implement innovative approaches to improve access and ensure continuity of care

Conventional Radiology for Postmortem Imaging

This book offers a comprehensive overview of the forensic and radiological aspects of pathological findings, focusing on the most relevant medico-legal issues, such as virtual autopsy (virtopsy), anthropometric identification, post-mortem decomposition features and the latest radiological applications used in forensic investigations. Forensic medicine and radiology are becoming increasingly relevant in the international medical and legal field as they offer essential techniques for determining cause of death and for anthropometric identification. This is highly topical in light of public safety and economic concerns arising as a result of mass migration and international tensions. The book discusses the latest technologies applied in the forensic field, in particular computed tomography and magnetic resonance, which are continuously being updated. Radiological techniques are fundamental in rapidly providing a full description of the damage inflicted to add to witness and medical testimonies, and forensic/radiological anthropology supplies valuable evidence in cases of violence and abuse. Written by international experts, it is of interest to students and residents in forensic medicine and radiology. It also presents a new approach to forensic investigation for lawyers and police special corps as well as law enforcement agencies

Radiostereometry and new prostheses

Optimising joint reconstruction management in arthritis and bone tumour patient