Study objective Survival after out-of-hospital cardiac arrest depends on the links in the chain of survival. The Utstein elements are designed to assess these links and provide the basis for ...comparing outcomes within and across communities. We assess whether these measures sufficiently predict survival and explain outcome differences. Methods We used an observational, prospective data collection, case-series of adult persons with nontraumatic out-of-hospital cardiac arrest from December 1, 2005, through March 1, 2007, from the multisite, population-based Resuscitation Outcomes Consortium Epistry–Cardiac Arrest. We used logistic regression, receiver operating curves, and measures of variance to estimate the extent to which the Utstein elements predicted survival to hospital discharge and explained outcome variability overall and between 7 Resuscitation Outcomes Consortium sites. Analyses were conducted for all emergency medical services–treated cardiac arrests and for the subset of bystander-witnessed patient arrests because of presumed cardiac cause presenting with ventricular fibrillation or ventricular tachycardia. Results Survival was 7.8% overall (n=833/10,681) and varied from 4.6% to 14.7% across Resuscitation Outcomes Consortium sites. Among bystander-witnessed ventricular fibrillation or ventricular tachycardia, survival was 22.1% overall (n=323/1459) and varied from 12.5% to 41.0% across sites. The Utstein elements collectively predicted 72% of survival variability among all arrests and 40% of survival variability among bystander-witnessed ventricular fibrillation. The Utstein elements accounted for 43.6% of the between-site survival difference among all arrests and 22.3% of the between-site difference among the bystander-witnessed ventricular fibrillation subset. Conclusion The Utstein elements predict survival but account for only a modest portion of outcome variability overall and between Resuscitation Outcomes Consortium sites. The results underscore the need for ongoing investigation to better understand characteristics that influence cardiac arrest survival.
We present observations of rapid (sub-second) optical flux variability in V404 Cyg during its 2015 June outburst. Simultaneous three-band observations with the ULTRACAM fast imager on four nights ...show steep power spectra dominated by slow variations on ∼100–1000 s time-scales. Near the peak of the outburst on June 26, a dramatic change occurs and additional, persistent sub-second optical flaring appears close in time to giant radio and X-ray flaring. The flares reach peak optical luminosities of ∼ few × 1036 erg s−1. Some are unresolved down to a time resolution of 24 ms. Whereas the fast flares are stronger in the red, the slow variations are bluer when brighter. The redder slopes, emitted power and characteristic time-scales of the fast flares can be explained as optically thin synchrotron emission from a compact jet arising on size scales ∼140–500 Gravitational radii (with a possible additional contribution by a thermal particle distribution). The origin of the slower variations is unclear. The optical continuum spectral slopes are strongly affected by dereddening uncertainties and contamination by strong Hα emission, but the variations of these slopes follow relatively stable loci as a function of flux. Cross-correlating the slow variations between the different bands shows asymmetries on all nights consistent with a small red skew (i.e. red lag). X-ray reprocessing and non-thermal emission could both contribute to these. These data reveal a complex mix of components over five decades in time-scale during the outburst.
We report the discovery by the Robotic Optical Transient Search Experiment (ROTSE-IIIb) telescope of SN 2008es, an overluminous supernova (SN) at z = 0.205 with a peak visual magnitude of -22.2. We ...present multiwavelength follow-up observations with the Swift satellite and several ground-based optical telescopes. The ROTSE-IIIb observations constrain the time of explosion to be 23 ± 1 rest-frame days before maximum. The linear decay of the optical light curve, and the combination of a symmetric, broad H alpha emission line profile with broad P Cygni H beta and Na I lambda 5892 profiles, are properties reminiscent of the bright Type II-L SNe 1979C and 1980K, although SN 2008es is greater than 10 times more luminous. The host galaxy is undetected in pre-supernova Sloan Digital Sky Survey images, and similar to Type II-L SN 2005ap (the most luminous SN ever observed), the host is most likely a dwarf galaxy with Mr > - 17. Swift Ultraviolet/Optical Telescope observations in combination with Palomar 60 inch photometry measure the spectral energy distribution of the SN from 200 to 800 nm to be a blackbody that cools from 14000 K at the time of the optical peak to 6400 K 65 days later. The inferred blackbody radius is in good agreement with the radius expected for the expansion speed measured from the broad lines (10000 km s-1). The bolometric luminosity at the optical peak is 2.8 X 1044 erg s-1, with a total energy radiated over the next 65 days of 5.6 X 1050 erg. The exceptional luminosity of SN 2008es requires an efficient conversion of kinetic energy produced from the core-collapse explosion into radiation. We favor a model in which the large peak luminosity is a consequence of the core collapse of a progenitor star with a low-mass extended hydrogen envelope and a stellar wind with a density close to the upper limit on the mass-loss rate measured from the lack of an X-ray detection by the Swift X-Ray Telescope.
We report the imaging and spectroscopic localization of GRB 060218 to a low-metallicity dwarf starburst galaxy at z = 0.03345 c 0.00006. In addition to making it the second nearest gamma-ray burst ...known, optical spectroscopy reveals the earliest detection of weak, supernova-like Si II near 5720 A (60.1c), starting 1.95 days after the burst trigger. UBVRIphotometry obtained between 1 and 26 days postburst confirms the early rise of supernova light, and suggests a short time delay between the gamma-ray burst and the onset of SN 2006aj if the early appearance of a soft component in the X-ray spectrum is understood as a "shock breakout." Together, these results verify the long-hypothesized origin of soft gamma-ray bursts in the deaths of massive stars.
After the All-Sky Automated Survey for SuperNovae discovered a significant brightening of the inner region of NGC 2617, we began a ~70 day photometric and spectroscopic monitoring campaign from the ...X-ray through near-infrared (NIR) wavelengths. We report that NGC 2617 went through a dramatic outburst, during which its X-ray flux increased by over an order of magnitude followed by an increase of its optical/ultraviolet (UV) continuum flux by almost an order of magnitude. NGC 2617, classified as a Seyfert 1.8 galaxy in 2003, is now a Seyfert 1 due to the appearance of broad optical emission lines and a continuum blue bump. Such "changing look active galactic nuclei (AGNs)" are rare and provide us with important insights about AGN physics. Based on the Hbeta line width and the radius-luminosity relation, we estimate the mass of central black hole (BH) to be (4 + or - 1) x 10 super(7) M sub(middot in circle). When we cross-correlate the light curves, we find that the disk emission lags the X-rays, with the lag becoming longer as we move from the UV (2-3 days) to the NIR (6-9 days). Also, the NIR is more heavily temporally smoothed than the UV. This can largely be explained by a simple model of a thermally emitting thin disk around a BH of the estimated mass that is illuminated by the observed, variable X-ray fluxes.
The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear.
In 14 U.S. hospitals with high adherence to quality measures for the ...treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group. We hypothesized that within 30 days after enrollment the total antibiotic-days would be lower - and the percentage of patients with adverse outcomes would not be more than 4.5 percentage points higher - in the procalcitonin group than in the usual-care group.
A total of 1656 patients were included in the final analysis cohort (826 randomly assigned to the procalcitonin group and 830 to the usual-care group), of whom 782 (47.2%) were hospitalized and 984 (59.4%) received antibiotics within 30 days. The treating clinician received procalcitonin assay results for 792 of 826 patients (95.9%) in the procalcitonin group (median time from sample collection to assay result, 77 minutes) and for 18 of 830 patients (2.2%) in the usual-care group. In both groups, the procalcitonin-level tier was associated with the decision to prescribe antibiotics in the emergency department. There was no significant difference between the procalcitonin group and the usual-care group in antibiotic-days (mean, 4.2 and 4.3 days, respectively; difference, -0.05 day; 95% confidence interval CI, -0.6 to 0.5; P=0.87) or the proportion of patients with adverse outcomes (11.7% 96 patients and 13.1% 109 patients; difference, -1.5 percentage points; 95% CI, -4.6 to 1.7; P<0.001 for noninferiority) within 30 days.
The provision of procalcitonin assay results, along with instructions on their interpretation, to emergency department and hospital-based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower respiratory tract infection. (Funded by the National Institute of General Medical Sciences; ProACT ClinicalTrials.gov number, NCT02130986 .).
We present chemical abundances in a sample of luminous cool stars located within 30 pc of the Galactic center. Abundances of carbon, nitrogen, oxygen, calcium, and iron were derived from ...high-resolution infrared spectra in the H and K bands. The abundance results indicate that both O/Fe and Ca/Fe are enhanced, respectively, by averages of +0.2 and +0.3 dex, relative to either the Sun or the Milky Way disk at near-solar Fe abundances. The Galactic center stars show a nearly uniform and nearly solar iron abundance. The mean value of A(Fe)= 7.59 plus or minus 0.06 agrees well with previous work. The total range in Fe abundance among Galactic center stars, 0.16 dex, is significantly narrower than the iron abundance distributions found in the literature for the older bulge population. Our snapshot of the current-day Fe abundance within 30 pc of the Galactic center samples stars with an age less than 1 Gyr; a larger sample in time (or space) may find a wider spread In abundances.
We use a fully self-consistent evolutionary code to follow the rotational evolution of low-mass red giants, making a comprehensive attempt to assess the role of rotationally induced mixing in the ...development of abundance anomalies in giants with a range of masses and metallicities in stellar clusters and the field. We adopt a maximal mixing approach with reasonable initial conditions of angular momentum distribution and main-sequence rotation rates as a function of stellar type. Unlike most previous work, we do not focus on the determination of combinations of mixing rate and depth that reproduce the data on a particular stellar type. Instead, we concentrate on the more fundamental problem of the simultaneous reproduction of the patterns of CNO surface abundances in both Population I and Population II giants using the same physics and models. We follow and discuss the essential physics of rotational mixing in terms of the structural and angular momentum evolution along the red giant branch (RGB). A general result of all our models is that rotational mixing, although present in small amounts, is inefficient on the lower RGB independently of any inhibiting effect of k-barriers. Therefore, the lack of well-mixed stars before the luminosity of the RGB bump in globular clusters and the field does not constitute unquestionable evidence for the inhibition of mixing by k-barriers. Instead, we argue that the rapid disappearance of the RGB bump as soon as mixing is allowed to penetrate k-barriers is what actually constitutes the first solid evidence of such inhibition. Maximal mixing models with differentially rotating envelopes are able to reproduce the super(12)C/ super(13)C data on M67 giants with initial rotation rates adequate to their progenitors but fail to do so for open clusters of larger turnoff mass and for metal-poor giants in the field and globular clusters. Possible solutions are discussed. Our favored scenario is one in which the overall strength of canonical extra mixing has been underestimated by existent derivations, but which additionally needs to be coupled with a much lower efficiency for rotational mixing among the rapidly rotating open cluster giants than in the slowly rotating ones in the field and globular clusters. We hypothesize that this last requirement is provided by the interaction between convection and rotation in the envelopes of giants, in the sense that rapidly rotating stars would develop much shallower angular velocity profiles in their envelopes than do slowly rotating stars.
Eclipsing binaries (EBs) provide critical laboratories for empirically testing predictions of theoretical models of stellar structure and evolution. Pre-main-sequence (PMS) EBs are particularly ...valuable, both due to their rarity and the highly dynamic nature of PMS evolution, such that a dense grid of PMS EBs is required to properly calibrate theoretical PMS models. Analyzing multi-epoch, multi-color light curves for ~2400 candidate Orion Nebula Cluster (ONC) members from our Warm Spitzer Exploration Science Program YSOVAR, we have identified 12 stars whose light curves show eclipse features. Four of these 12 EBs are previously known. Supplementing our light curves with follow-up optical and near-infrared spectroscopy, we establish two of the candidates as likely field EBs lying behind the ONC. We confirm the remaining six candidate systems, however, as newly identified ONC PMS EBs. These systems increase the number of known PMS EBs by over 50% and include the highest mass (straighttheta super(1) Ori E, for which we provide a complete set of well-determined parameters including component masses of 2.807 and 2.797 M sub(middot in circle)) and longest-period (ISOY J053505.71-052354.1, P ~ 20 days) PMS EBs currently known. In two cases (straighttheta super(1) Ori E and ISOY J053526.88-044730.7), enough photometric and spectroscopic data exist to attempt an orbit solution and derive the system parameters. For the remaining systems, we combine our data with literature information to provide a preliminary characterization sufficient to guide follow-up investigations of these rare, benchmark systems.
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