Neurological prognostication tools in out-of-hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013.

BACKGROUND: Neurological prognostication is an essential part of post-resuscitation care in out-of-hospital cardiac arrest (OHCA). This study aims to assess the use of computed tomography (CT) and magnetic resonance imaging (MR) of the head, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) in neurological prognostication in resuscitated OHCA patients and factors associated with their use in Danish tertiary and non-tertiary centers from 2005 to 2013 and associations with outcome. METHODS: We used the Danish Cardiac Arrest Registry to identify patients ≥18 years of age admitted to intensive care units due to OHCA of presumed cardiac etiology. CT 0-20 days and MR, SSEP, and EEG ≥2-20 days post OHCA were considered related to prognostication. Incidence and factors associated with procedures were assessed by multiple Cox regression with death as competing risk. RESULTS: Use of CT, MR, EEG, and SSEP increased during the study period (CT: 51%-67%, HRCT : 1.06, CI: 1.03-1.08, MR: 2%-5%, P = .08, EEG: 6%-33%, HREEG : 1.25, CI: 1.19-1.30, SSEP: 4%-15%, HRSSEP : 1.23, CI: 1.15-1.32). EEG and SSEP were more used in tertiary centers than non-tertiary (HREEG : 1.86, CI: 1.51-2.29, HRSSEP : 4.44, CI: 2.86-6.89). Use of CT, SSEP, and EEG were associated with higher 30-day mortality, and MR was associated with lower (HRCT : 1.15, CI: 1.01-1.30, HRMR : 0.53, CI: 0.37-0.77, HRSSEP : 1.90, CI: 1.57-2.32, HREEG : 1.75, CI: 1.49-2.05). CONCLUSION: Use of neurological prognostication procedures increased during the study period. EEG and SSEP were more used in tertiary centers. CT, EEG and SSEP were associated with increased mortality.

The police, social services, and psychiatry (PSP) cooperation as a platform for dealing with concerns of radicalization.

The police, social services, and psychiatry (PSP) is a structured cooperation between the police, social services, and the psychiatric system in Denmark. The aim of PSP is to ensure that relevant information is shared and supportive measures enhanced concerning citizens at risk, and it involves PSP representatives from each sector meeting frequently. PSP is implemented nationwide by law. In recent years, dealing with radicalization and the threat of terrorism have become key issues in society. The PSP cooperation already facilitates the identification of citizens at many kinds of risk (e.g. suicide, substance abuse, social decline, mental illness), and coordinates relevant intervention and treatment. The existing PSP cooperation is, therefore, an obvious forum for identifying and handling concerns of radicalization and extremism. The new working model includes an upgrade of all local PSP groups and an implementation of a nationwide evaluation of the initiative. This is a presentation of the working model and the experiences in practice.

Seismic evidence for a cold serpentinized mantle wedge beneath Mount St Helens.

Mount St Helens is the most active volcano within the Cascade arc; however, its location is unusual because it lies 50 km west of the main axis of arc volcanism. Subduction zone thermal models indicate that the down-going slab is decoupled from the overriding mantle wedge beneath the forearc, resulting in a cold mantle wedge that is unlikely to generate melt. Consequently, the forearc location of Mount St Helens raises questions regarding the extent of the cold mantle wedge and the source region of melts that are responsible for volcanism. Here using, high-resolution active-source seismic data, we show that Mount St Helens sits atop a sharp lateral boundary in Moho reflectivity. Weak-to-absent PmP reflections to the west are attributed to serpentinite in the mantle-wedge, which requires a cold hydrated mantle wedge beneath Mount St Helens (<∼700 °C). These results suggest that the melt source region lies east towards Mount Adams.

Signaling mechanisms of neurite outgrowth induced by the cell adhesion molecules NCAM and N-cadherin.

Formation of appropriate neural circuits depends on a complex interplay between extracellular guiding cues and intracellular signaling events that result in alterations of cytoskeletal dynamics and a neurite growth response. Surface-expressed cell adhesion molecules (CAMs) interact with the surroundings via the extracellular domain and bind to the cytoskeleton via their intracellular domain. In addition, several CAMs induce signaling events via direct interactions with intracellular proteins or via interactions with cell surface receptors. Thus, CAMs are obvious candidates for transmitting extracellular guidance cues to intracellular events and thereby regulating neurite outgrowth. In this review, we focus on two CAMs, the neural cell adhesion molecule (NCAM) and N-cadherin, and their ability to mediate signaling associated with a neurite outgrowth response. In particular, we will focus on direct interaction between NCAM and N-cadherin with a number of intracellular partners, as well as on their interaction with the fibroblast growth factor receptor (FGFR).

Headspace solvent microextraction.

A hanging microliter drop of 1-octanol is shown to be an excellent preconcentration medium for headspace analysis of volatile compounds in an aqueous matrix by gas chromatography (GC) or gas chromatography/mass spectrometry (GC/MS). Model compounds benzene, toluene, ethylbenzene, and o-xylene (BTEX) are conveniently and rapidly preconcentrated in the microdrop. An internal standard, decane, is present in the organic extracting solvent, and linear calibration curves of relative peak area versus aqueous concentration are obtained for the four model compounds. Detailed kinetic studies reveal that the overall rate of mass transfer is limited by both the aqueous-phase stirring rate and the degree of convection within the organic phase. The very low vapor pressure of 1-octanol results in minimal evaporation of the microdrop during the extraction time. This system represents an inexpensive, convenient, and precise sample cleanup and preconcentration method for the determination of volatile organic compounds at trace levels.

A model for an outpatient imaging center.

U.S. federally imposed efforts to regulate joint venturing are a result of certain physician strategies to circumvent anti-kickback statutes by investing in clinics, labs, and facilities for self-referral. This article addresses the ethical debate on physician ownership, MRI as an evolving modality, the 1989 Ethics in Patient Referrals Act and the subsequently released "safe harbors," and finally, describes an existing model for physician/hospital ownership in an outpatient MRI facility.

Prognosis after the first episode of gastrointestinal bleeding or coma in cirrhosis. Survival and prognostic factors.

Hepatic encephalopathy and gastrointestinal (GI) bleeding are the most serious complications in cirrhosis. The purpose of this study was to examine survival after the first episode of GI bleeding or coma, or both, and to identify variables associated with the subsequent survival in 284 consecutive patients with cirrhosis admitted to one division of hepatology over a period of 81 months. Patients who only bled had markedly longer survival than those who only had coma, whereas those who had both bleeding and coma had by far the poorest survival, only 15% being alive 1 year later. Several other variables showed a significant association with survival. In a Cox multiple regression analysis the following four variables showed significant association with a short survival: coma and bleeding at the episode, ascites, low prothrombin index, and high serum creatinine. The prognostic index derived from the Cox model, which was validated by a split-sample testing technique, may be used to refine prognostic estimation in this subgroup of severely ill cirrhotic patients.