Background:
The organisation of trauma care in Scandinavia has several similarities, including trauma registries, but so far there are limited amount of research on efficiency and outcome. Data and ...results from trauma outcome studies like the US MTOS are not fully applicable to the Scandinavian trauma population.
Aims:
To reveal the feasibility of using data from existing trauma registries of major hospitals in Scandinavia, for a minimal common dataset, in a joint, prospective Scandinavian MTOS.
Material and Methods:
We collected data points, data point definitions, and inclusion/exclusion criteria, from the major trauma registries of the Swedish trauma registry standard, three university hospitals in Denmark, one university hospital in Finland, and the Norwegian National Trauma Registry. The collected material was compared to reveal common data points, inclusion criteria, and the compatibility of data point definitions.
Results:
The median number of data points was 147 (range 71–257; interquartile range = 90–205). Most registries lacked precise data definition catalogues. Only 16 data points could be considered as common, of which just a few were core trauma data. Four data points had the same data category options but were not considered having the same data point definitions. The inclusion criteria were not uniform.
Conclusions:
Trauma registries in Scandinavia have few common core data and data point definitions. There were data points for calculating the Trauma and Injury Severity Score (TRISS) but the inclusion criteria varied too much to ensure a valid comparison. A consensus process for a joint trauma core data set will be initiated by the Scandinavian Networking Group for Trauma and Emergency Management (SCANTEM) to increase research on trauma efficiency and outcome.
Planck intermediate results Adam, R; Ade, P A R; Alves, M I R ...
Astronomy and astrophysics (Berlin),
12/2016, Volume:
596
Journal Article
Peer reviewed
Open access
Recent models for the large-scale Galactic magnetic fields in the literature have been largely constrained by synchrotron emission and Faraday rotation measures. We use three different but ...representative models to compare their predicted polarized synchrotron and dust emission with that measured by the Planck satellite. We first update these models to match the Planck synchrotron products using a common model for the cosmic-ray leptons. We discuss the impact on this analysis of the ongoing problems of component separation in the Planck microwave bands and of the uncertain cosmic-ray spectrum. In particular, the inferred degree of ordering in the magnetic fields is sensitive to these systematic uncertainties, and we further show the importance of considering the expected variations in the observables in addition to their mean morphology. We then compare the resulting simulated emission to the observed dust polarization and find that the dust predictions do not match the morphology in the Planck data but underpredict the dust polarization away from the plane. We modify one of the models to roughly match both observables at high latitudes by increasing the field ordering in the thin disc near the observer. Though this specific analysis is dependent on the component separation issues, we present the improved model as a proof of concept for how these studies can be advanced in future using complementary information from ongoing and planned observational projects.
Objective:To identify predictors of radiographic progression in a 2-year randomised, double-blind, clinical study (CIMESTRA) of patients with early rheumatoid arthritis (RA).Methods:Patients with ...early RA (n = 130) were treated with methotrexate, intra-articular betamethasone and ciclosporin/placebo-ciclosporin. Baseline magnetic resonance imaging (MRI) of the wrist (wrist-only group, n = 130) or MRI of wrist and metacarpophalangeal (MCP) joints (wrist+MCP group, n = 89) (OMERACT RAMRIS), x-ray examination of hands, wrists and forefeet (Sharp/van der Heijde Score (TSS)), Disease Activity Score (DAS28), anti-cyclic citrullinated peptide antibodies (anti-CCP), HLA-DRB1-shared epitope (SE) and smoking status were assessed. Multiple regression analysis was performed with delta-TSS (0–2 years) as dependent variable and baseline DAS28, TSS, MRI bone oedema score, MRI synovitis score, MRI erosion score, anti-CCP, smoking, SE, age and gender as explanatory variables.Results:Baseline values: median DAS28 5.6 (range 2.4–8.0); anti-CCP positive 61%; radiographic erosions 56%. At 2 years: DAS28 2.0 (0.5–5.7), in DAS remission: 56%, radiographic progression 26% (wrist+MCP group, similar for wrist-only group). MRI bone oedema score was the only independent predictor of delta-TSS (wrist+MCP group: coefficient = 0.75 (95% CI 0.55 to 0.94), p<0.001; wrist-only group: coefficient = 0.59 (95% CI 0.40 to 0.77), p<0.001). Bone oedema score explained 41% of the variation in the progression of TSS (wrist+MCP group), 25% in wrist-only group (Pearson’s r = 0.64 and r = 0.50, respectively). Results were confirmed by sensitivity analyses.Conclusion:In a randomised controlled trial aiming at remission in patients with early RA, baseline RAMRIS MRI bone oedema score of MCP and wrist joints (and of wrist only) was the strongest independent predictor of radiographic progression in hands, wrists and forefeet after 2 years. MRI synovitis score, MRI erosion score, DAS28, anti-CCP, SE, smoking, age and gender were not independent risk factors.Trial registration number:NCT00209859.
Objective. Among the currently available neural interface devices, there has been a need for a penetrating electrode array with a high electrode-count and high electrode-density (the number of ...electrodes mm2) that can be used for electrophysiological studies of sub-millimeter neuroanatomical structures. We have developed such a penetrating microelectrode array with both a high electrode-density (25 electrodes mm2) and high electrode-count (up to 96 electrodes) for small nervous system structures, based on the existing Utah Slanted Electrode Array (USEA). Such high electrode-density arrays are expected to provide greater access to nerve fibers than the conventionally spaced USEA especially in small diameter nerves. Approach. One concern for such high density microelectrode arrays is that they may cause a nerve crush-type injury upon implantation. We evaluated this possibility during acute (<10 h) in vivo experiments with electrode arrays implanted into small diameter peripheral nerves of anesthetized rats (sciatic nerve) and cats (pudendal nerve). Main results. Successful intrafascicular implantation and viable nerve function was demonstrated via microstimulation, single-unit recordings and histological analysis. Measurements of the electrode impedances and quantified electrode dimensions demonstrated fabrication quality. The results of these experiments show that such high density neural interfaces can be implanted acutely into neural tissue without causing a complete nerve crush injury, while mediating intrafascicular access to fibers in small diameter peripheral nerves. Significance. This new penetrating microelectrode array has characteristics un-matched by other neural interface devices currently available for peripheral nervous system neurophysiological research.
The Baltic Sea, located in northern Europe, is a semi-enclosed, shallow and tideless sea with seasonal sea-ice cover in its northern sub-basins. Its long water residence time contributes to oxygen ...depletion in the bottom water of its southern sub-basins. In this study, recently performed scenario simulations for the Baltic Sea including marine biogeochemistry were analysed and compared with earlier published projections. Specifically, dynamical downscaling using a regionally coupled atmosphere–ocean climate model was used to regionalise four global Earth
system models. However, as the regional climate model does not include
components representing terrestrial and marine biogeochemistry, an additional catchment and a coupled physical–biogeochemical model for the
Baltic Sea were included. The scenario simulations take the impact of various global sea level rise scenarios into account. According to the projections, compared to the present climate, higher water temperatures, a shallower mixed layer with a sharper thermocline during summer, less sea-ice cover and greater mixing in the northern Baltic Sea during winter can be expected. Both the frequency and the duration of marine heat waves will increase significantly, in particular in the coastal zone of the southern Baltic Sea (except in regions with frequent upwellings). Nonetheless, due to the uncertainties in the projections regarding regional winds, the water cycle and the global sea level rise, robust and statistically significant salinity changes could not be identified. The impact of a changing climate on biogeochemical cycling is predicted to be considerable but still smaller than that of plausible nutrient input changes. Implementing the proposed Baltic Sea Action Plan, a nutrient input abatement plan for the entire catchment area, would result in a significantly improved ecological status of the Baltic Sea, including
reductions in the size of the hypoxic area also in a future climate, which
in turn would increase the resilience of the Baltic Sea against anticipated
climate change. While our findings regarding changes in heat-cycle variables mainly confirm earlier scenario simulations, they differ substantially from earlier projections of salinity and biogeochemical cycles, due to differences in experimental setups and in input scenarios for bioavailable nutrients.
Ultraluminous X-ray sources (ULX) are off-nuclear point sources in nearby galaxies whose X-ray luminosity exceeds the theoretical maximum for spherical infall (the Eddington limit) onto stellar-mass ...black holes. Their luminosity ranges from \(10^{40}\) erg s\(^{-1} < L_X\)(0.5 - 10 keV) \(<10^{40}\) erg s\(^{-1}\). Since higher masses imply less extreme ratios of the luminosity to the isotropic Eddington limit theoretical models have focused on black hole rather than neutron star systems. The most challenging sources to explain are those at the luminous end (\(L_X\) > \(10^{40}\) erg s\(^{-1}\)), which require black hole masses MBH >50 solar masses and/or significant departures from the standard thin disk accretion that powers bright Galactic X-ray binaries. Here we report broadband X-ray observations of the nuclear region of the galaxy M82, which contains two bright ULXs. The observations reveal pulsations of average period 1.37 s with a 2.5-day sinusoidal modulation. The pulsations result from the rotation of a magnetized neutron star, and the modulation arises from its binary orbit. The pulsed flux alone corresponds to \(L_X\)(3 - 30 keV) = \(4.9 \times 10^{39}\) erg s\(^{-1}\). The pulsating source is spatially coincident with a variable ULX which can reach \(L_X\) (0.3 - 10 keV) = \(1.8 \times 10^{40}\) erg s\(^{-1}\). This association implies a luminosity ~100 times the Eddington limit for a 1.4 solar mass object, or more than ten times brighter than any known accreting pulsar. This finding implies that neutron stars may not be rare in the ULX population, and it challenges physical models for the accretion of matter onto magnetized compact objects.
The aim of the current study was to develop a cancer vaccine formulation for treatment of human papillomavirus (HPV)-induced malignancies. Synthetic long peptides (SLPs) derived from HPV16 E6 and E7 ...oncoproteins have been used for therapeutic vaccination in clinical trials with promising results. In preclinical and clinical studies adjuvants based on mineral oils (such as incomplete Freund's adjuvant (IFA) and Montanide) are used to create a sustained release depot at the injection site. While the depot effect of mineral oils is important for induction of robust immune responses, their administration is accompanied with severe adverse and long lasting side effects. In order to develop an alternative for IFA family of adjuvants, polymeric nanoparticles (NPs) based on hydrophilic polyester (poly(d,l lactic-co-hydroxymethyl glycolic acid) (pLHMGA)) were prepared. These NPs were loaded with a synthetic long peptide (SLP) derived from HPV16 E7 oncoprotein and a toll like receptor 3 (TLR3) ligand (poly IC) by double emulsion solvent evaporation technique. The therapeutic efficacy of the nanoparticulate formulations was compared to that of HPV SLP+poly IC formulated in IFA. Encapsulation of HPV SLP antigen in NPs substantially enhanced the population of HPV-specific CD8+ T cells when combined with poly IC either co-encapsulated with the antigen or in its soluble form. The therapeutic efficacy of NPs containing poly IC in tumor eradication was equivalent to that of the IFA formulation. Importantly, administration of pLHMGA nanoparticles was not associated with adverse effects and therefore these biodegradable nanoparticles are excellent substitutes for IFA in cancer vaccines.
Summary
Background
A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) ...has no agreed‐upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e‐Delphi surveys. In this manuscript, we describe two in‐person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.
Objectives
To consider which items from a long list of candidate items to exclude and which to cluster into outcome domains.
Methods
The study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey.
Results
Forty‐one individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS‐specific quality of life, satisfaction, symptoms, pain and global assessments.
Conclusions
The HISTORIC consensus meetings I and II will be followed by further e‐Delphi rounds to finalize the core domain set, building on the work of the in‐person consensus meetings.
What's already known about this topic?
Reported outcome measure instruments for hidradenitis suppurativa (HS) are numerous and diverse, with 30 instruments recently found in 12 randomized trials.
This diverse use of instruments limits the possibility to perform evidence synthesis and may produce outcome reporting bias.
A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials.
What does this study add?
The study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators.
Two consensus meetings, in Europe and North America, considered potential HS core domains, within a nominal group theory structure.
Seven potential core domains were put forward to the subsequent e‐Delphi: disease course, physical signs, HS‐specific quality of life, satisfaction, symptoms, pain and global assessments.
What are the clinical implications of this work?
The development of a COS is particularly timely for HS and should substantially improve future HS trial design.
Plain language summary available online
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An important new development within the European ENSEMBLES project has been to explore performance-based weighting of regional climate models (RCMs). Until now, although no weighting has been applied ...in multi-RCM analyses, one could claim that an assumption of 'equal weight' was implicitly adopted. At the same time, different RCMs generate different results, e.g. for various types of extremes, and these results need to be combined when using the full RCM ensemble. The process of constructing, assigning and combining metrics of model performance is not straightforward. Rather, there is a considerable degree of subjectivity both in the choice of metrics and on how these may be combined into weights. We explore the applicability of combining a set of 6 specifically designed RCM performance metrics to produce one aggregated model weight with the purpose of combining climate change information from the range of RCMs used within ENSEMBLES. These metrics capture aspects of model performance in reproducing large-scale circulation patterns, meso-scale signals, daily temperature and precipitation distributions and extremes, trends and the annual cycle. We examine different aggregation procedures that generate different inter-model spreads of weights. The use of model weights is sensitive to the aggregation procedure and shows different sensitivities to the selected metrics. Generally, however, we do not find compelling evidence of an improved description of mean climate states using performance-based weights in comparison to the use of equal weights. We suggest that model weighting adds another level of uncertainty to the generation of ensemble-based climate projections, which should be suitably explored, although our results indicate that this uncertainty remains relatively small for the weighting procedures examined.
Late Miocene to mid‐Pleistocene sedimentary proxy records reveal that northwest Australia underwent an abrupt transition from dry to humid climate conditions at 5.5 million years (Ma), likely ...receiving year‐round rainfall, but after ~3.3 Ma, climate shifted toward an increasingly seasonal precipitation regime. The progressive constriction of the Indonesian Throughflow likely decreased continental humidity and transferred control of northwest Australian climate from the Pacific to the Indian Ocean, leading to drier conditions punctuated by monsoonal precipitation. The northwest dust pathway and fully established seasonal and orbitally controlled precipitation were in place by ~2.4 Ma, well after the intensification of Northern Hemisphere glaciation. The transition from humid to arid conditions was driven by changes in Pacific and Indian Ocean circulation and regional atmospheric moisture transport, influenced by the emerging Maritime Continent. We conclude that the Maritime Continent is the switchboard modulating teleconnections between tropical and high‐latitude climate systems.
Key Points
Northwestern shelf sediments record major shifts in Australian climate at 5.5, 3.3, and 2.4 Ma
We interpret NGR‐derived proxies as changes in terrestrial climate from annually to seasonally wet
Neogene Australian climate is defined by the progressive restriction of ITF by the Maritime Continent
Plain Language Summary
Australia is the most arid habitable continent on earth, however its climate is capable of dramatic change with seasonal monsoon rains in the otherwise arid northwest. We analyzed natural gamma radiation in a recently drilled borehole (IODP Expedition 356 Site U1463) off NW Australia to examine long‐term climate changes over the last 6 million years. Based on variations in potassium, thorium and uranium, as well as common clay minerals, we show that the NW continent was more humid during the Pliocene period, between ~5.5 and 3.3 million years ago (Humid Interval), and became arid by the early Pleistocene, ~2.4 million years ago (Arid Interval). We attribute the Humid Interval to an expansion of warm surface waters in the western Pacific, supplying warm and moist air to the continent. As Australia moved north, the Maritime Continent (islands to the north) emerged, restricting the flow of warm surface currents from the Pacific (Indonesian Throughflow), resulting in drier conditions on land. The Arid Interval ushered in a modern‐like Australian climate, with seasonal rainfall and dust storms, and a more modern Indian Ocean circulation. Our results show that the Maritime Continent is an important control on both Australian climate and Indian Ocean circulation.
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