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  • 1
    In: JAMA, American Medical Association (AMA), Vol. 327, No. 18 ( 2022-05-10), p. 1782-
    Abstract: In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. Objective To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. Design, Setting, and Participants Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. Interventions Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). Main Outcomes and Measures The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death] ) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. Results Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21] ); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). Conclusions and Relevance In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. Trial Registration ClinicalTrials.gov Identifier: NCT02795962
    Type of Medium: Online Resource
    ISSN: 0098-7484
    RVK:
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 2
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2023-02), p. 33-44
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2276432-X
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  • 3
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2023-02), p. 45-56
    Abstract: Acute appendicitis is a common surgical emergency, and the standard approach to diagnosis and management has been codified in several practice guidelines. Adherence to these guidelines provides insight into independent surgical practice patterns and institutional resource constraints as impediments to best practice. We explored data from the recent ESTES SnapAppy observational cohort study to determine guideline compliance in contemporary practice to identify opportunities to close evidence-to-practice gaps. Methods We undertook a preplanned analysis of the ESTES SnapAppy observational cohort study, identifying, at a patient level, congruence with, or deviation from WSES Jerusalem guidelines for the diagnosis and management of acute appendicitis and the Surviving Sepsis Campaign in our cohort. Compliance was then correlated with the incidence of postoperative complications. Results Four thousand six hundred and thirteen (4613) consecutive adult and adolescent patients with acute appendicitis were followed from date of admission (November 1, 2020, and May 28, 2021) for 90 days. Patient-level compliance with guideline elements allowed patients to be grouped into those with full compliance (all 5 elements: 13%), partial compliance (1–4 elements: 87%) or noncompliance (0 elements: 0.2%). We identified an excess postoperative complication rate in patients who received noncompliant and partially compliant care, compared with those who received fully guideline-compliant care (36% and 16%, versus 7.3%, p   〈  0.001). Conclusions The observed diagnostic and treatment practices of the participating institutions displayed variability in compliance with key recommendations from existing guidelines. In general, practice was congruent with recommendations for preoperative antibiotic surgical site infection prophylaxis administration, time to surgery, and operative approach. However, there remains opportunities for improvement in the choice of diagnostic imaging modality, postoperative antibiotic stewardship to timely discontinue prophylactic antibiotics, and the implementation of ambulatory treatment pathways for uncomplicated appendicitis in the healthy young adult.
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2276432-X
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  • 4
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2023-02), p. 57-67
    Abstract: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15 years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2276432-X
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  • 5
    In: European Journal of Trauma and Emergency Surgery, Springer Science and Business Media LLC, Vol. 49, No. 1 ( 2023-02), p. 17-32
    Abstract: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90 days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p  〈   0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p =  0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p =  0.045] complications could be detected when using energy devices. Conclusions Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
    Type of Medium: Online Resource
    ISSN: 1863-9933 , 1863-9941
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2276432-X
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  • 6
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2020
    In:  Monthly Notices of the Royal Astronomical Society Vol. 498, No. 4 ( 2020-09-30), p. 5116-5127
    In: Monthly Notices of the Royal Astronomical Society, Oxford University Press (OUP), Vol. 498, No. 4 ( 2020-09-30), p. 5116-5127
    Abstract: High-angular-resolution observations of discs at mm wavelengths (on scales of a few au) are now commonplace, but there is a current lack of a comparable angular resolution for observations at cm wavelengths. This presents a significant barrier to improving our understanding of planet formation, in particular how dust grains grow from mm to cm sizes. In this paper, we examine the ability of the Square Kilometre Array (SKA) to observe dust substructure in a young, planet-forming disc at cm wavelengths. We use dusty hydrodynamics and continuum radiative transfer to predict the distribution and emission of 1-cm dust grains (or pebbles) within the disc, and simulate continuum observations with the current SKA1-MID design baseline at frequencies of 12.5 GHz (Band 5b, ∼2.4 cm) on 5–10 au scales. The SKA will provide high-fidelity observations of the cm dust emission substructure in discs for integration times totalling hundreds of hours. Radial structure can be obtained at a sufficient resolution and S/N from shorter (tens of hours) integration times by azimuthal averaging in the image plane. By modelling the intensity distribution directly in the visibility plane, it is possible to recover a similar level of (axisymmetric) structural detail from observations with integration times one to two orders of magnitude lower than required for high-fidelity imaging. Our results demonstrate that SKA1-MID will provide crucial constraints on the distribution and morphology of the raw material for building planets, the pebbles in protoplanetary discs.
    Type of Medium: Online Resource
    ISSN: 0035-8711 , 1365-2966
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2016084-7
    SSG: 16,12
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  • 7
    Online Resource
    Online Resource
    Cambridge University Press (CUP) ; 2012
    In:  Proceedings of the International Astronomical Union Vol. 8, No. S287 ( 2012-01), p. 455-459
    In: Proceedings of the International Astronomical Union, Cambridge University Press (CUP), Vol. 8, No. S287 ( 2012-01), p. 455-459
    Abstract: Hydrogen radio recombination line (RRL) masers are a rare phenomenon in star forming regions. Since RRL masers were first detected in 1989 toward the emission line star MWC349A, several single-dish surveys at millimeter wavelengths have been carried out to detect other RRL maser objects. However, although RRL maser amplification is expected to appear at wavelengths 〈 2mm, MWC349A still remains as the only RRL maser object known to date. In this contribution, I will present our recent findings of two new RRL maser objects with the Submillimeter Array (SMA) toward the massive star forming regions Cepheus A HW2 and MonR2-IRS2. Sub-millimeter observations with interferometers such as the SMA and the Atacama Large Millimeter Array (ALMA) open the possibility to detect a much larger sample of RRL maser objects, where very detailed information about the kinematics and physical structure of the innermost ionized regions can be obtained toward these objects.
    Type of Medium: Online Resource
    ISSN: 1743-9213 , 1743-9221
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2012
    detail.hit.zdb_id: 2170724-8
    SSG: 16,12
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  • 8
    In: Proceedings of the International Astronomical Union, Cambridge University Press (CUP), Vol. 14, No. S345 ( 2018-08), p. 337-338
    Abstract: Formaldehyde (H 2 CO) and its deuterated forms can be produced both in the gas phase and on grain surfaces. However, the relative importance of these two chemical pathways is unclear. Our recent single dish observation of formaldehyde and its deuterated species suggests that they form mostly on grain surfaces although some gas-phase contribution is expected at the warm HMPO stage. Since the single dish beam is larger, and since these high-mass star-forming regions are clustered and complex, it is however unclear whether the emission arises from the protostellar sources or from starless/pre-stellar cores associated with them. Therefore, interferometric observations are needed to separate the emission originating from the small and dense cores, to disentangle their formation routes and then being able to use them as powerful diagnostic tools of the physical and chemical properties of high-mass star forming regions.
    Type of Medium: Online Resource
    ISSN: 1743-9213 , 1743-9221
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2170724-8
    SSG: 16,12
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  • 9
    In: Astronomy & Astrophysics, EDP Sciences, Vol. 661 ( 2022-5), p. A129-
    Abstract: Context. Cysteamine (NH 2 CH 2 CH 2 SH), a molecule of potential astrobiological interest, has not yet been detected in the interstellar medium. Furthermore, the sulfur- stituted isomer of ethanolamine (or 2-aminoethanol) has been recently detected in the molecular cloud G+0.693–0.027. Aims. In order to conduct a new interstellar search for cysteamine in the molecular cloud G+0.693–0.027, its pure rotational spectrum needs to be investigated in the laboratory. Methods. A pulsed-jet Fourier transform microwave spectrometer and a Stark-modulated free-jet millimeter-wave absorption spectrometer were used to measure the purely rotational spectrum of cysteamine in the range of 6.5-18 GHz (46.12–16.66 mm) and 59.6–120.0 GHz (5.03–2.72 mm), respectively. We used a deep spectral line survey toward the molecular cloud G+0.693-0.027 obtained with the IRAM 30 m and Yebes 40 m radiotelescopes to search for cysteamine. Results. We assigned 815 rotational transition lines of five conformers (gGt, gGg, g ′ Gg, g ′ Gg ′, and g'Gt ) to fit the rotational constants, quartic centrifugal distortion constants, and the 14 N nuclear quadrupole coupling constants. For four conformers ( gGt, gGg, g ′ Gg , and g ′ Gg ′ ) , the 34 S isotopologs were observed, and for two of them ( gGg and g'Gg ), the 13 C and 15 N isotopolog spectra were also detected; all in natural abundance. The five conformers of cysteamine were not detected toward the G+0.693–0.027 molecular cloud. We derived upper limits for their molecular abundances compared to molecular hydrogen of 〈 (0.2–1.3) × 10 –10 . The relative abundances with respect to the oxygen counterpart ethanolamine, previously detected toward this cloud, are NH 2 CH 2 CH 2 OH/NH 2 CH 2 CH 2 SH 〉 0.8–5.3.
    Type of Medium: Online Resource
    ISSN: 0004-6361 , 1432-0746
    RVK:
    RVK:
    Language: English
    Publisher: EDP Sciences
    Publication Date: 2022
    detail.hit.zdb_id: 1458466-9
    SSG: 16,12
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  • 10
    In: The Astrophysical Journal Letters, American Astronomical Society, Vol. 953, No. 1 ( 2023-08-01), p. L6-
    Abstract: MWC 349A is one of the rare stars known to have hydrogen radio recombination line (RRL) masers. The bright maser emission makes it possible to study the dynamics of the system at milliarcsecond (mas) precision. We present Atacama Large Millimeter/submillimeter Array observations of the 1.4 and 0.8 mm continuum emission of MWC 349A, as well as the H30 α and H26 α RRLs. Using the most extended array configuration of C43-10 with a maximum baseline of 16.2 km, we spatially resolved the H30 α line and 1.4 mm continuum emission for the first time. In addition to the known H30 α and H26 α maser emission from a Keplerian disk at LSR velocities from −12 to 28 km s −1 and from an ionized wind for velocities between −12 to −40 km s −1 and 28 to 60 km s −1 , we found evidence of a jet along the polar axis at V LSR from −85 to −40 km s −1 and +60 to +100 km s −1 . These masers are found in a linear structure nearly aligned with the polar axis of the disk. If these masers lie close to the polar axis, their velocities could be as high as 575 km s −1 , which cannot be explained solely by a single expanding wind as proposed in Báez-Rubio et al. We suggest that they originate from a high-velocity jet, likely launched by a magnetohydrodynamic wind. The jet appears to rotate in the same direction as the rotation of the disk. A detailed radiative transfer modeling of these emissions will further elucidate the origin of these masers in the wind.
    Type of Medium: Online Resource
    ISSN: 2041-8205 , 2041-8213
    Language: Unknown
    Publisher: American Astronomical Society
    Publication Date: 2023
    detail.hit.zdb_id: 2207648-7
    detail.hit.zdb_id: 2006858-X
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