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Abstract Background The likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients. Methods The ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months. Discussion The ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment. Trial registration Clinicaltyrials.gov under NCT04620070, registration date 3 November 2020.

In this work, we present 299 candidate young stellar objects (YSOs) in 30 Doradus discovered using Spitzer and Herschel point-source catalogs, 276 of which are new. We study the parental giant molecular clouds in which these YSO candidates form using recently published Atacama Large Millimeter/submillimeter Array (ALMA) Cycle 7 observations of ^12 CO and ^13 CO. The threshold for star formation in 30 Doradus inferred by the LTE-based mass surface density is 178 M _⊙ pc ^−2 , 40% higher than the threshold for star formation in the Milky Way. This increase in star formation threshold in comparison to the Milky Way and increase in line width seen in clumps 11 pc away in comparison to clumps 45 pc away from the R136 super star cluster could be due to injected turbulent energy, increase in interstellar medium pressure, and/or local magnetic field strength. Of the 299 YSO candidates in this work, 62% are not associated with ^12 CO molecular gas. This large fraction can be explained by the fact that 75%–97% of the H _2 gas is not traced by CO. We fit a Kroupa initial mass function to the YSO candidates and find that the total integrated stellar mass is 18,000 M _⊙ and that the region has a star formation rate (SFR) of 0.18 M _⊙ yr ^−1 . The initial mass function determined here applies to the four 150″ × 150″ (37.5 pc × 37.5 pc) subfields and one 150″ × 75″ (37.5 pc × 18.8 pc) subfield observed with ALMA. The SFR in 30 Doradus has increased in the past few million years.

Objectives: In this phantom- and cadaver study we investigated the differences of coronary artery calcium (CAC) volume on ultra-high-resolution computed tomography (U-HRCT) scans and conventional CT. Methods: We scanned a coronary calcium phantom and the coronary arteries of five cadavers using U-HRCT in normal- and super-high resolution (NR, SHR) mode. The NR mode was similar to conventional CT; 896 detector channels, a matrix size of 512, and a slice thickness of 0.5 mm were applied. In SHR mode, we used 1792 detector channels, a matrix size of 1024, and a slice thickness of 0.25 mm. The CAC volume on NR- and SHR images were recorded. Differences in the physical- and the calculated CAC volume were defined as the error value and compared between NR- and SHR images of the phantom. Differences between the CAC volume on NR- and SHR scans of the cadavers were also recorded. Results: The mean error value was lower on SHR- than NR images of the phantom (14.0 %, SD 11.1 vs 20.1 %, SD 15.2, p = 0.01). The mean CAC volume was significantly higher on SHR- than NR images of the cadavers (153.4 mm3, SD 161.0 vs 144.7 mm3, SD 164.8, p

Semi-natural grasslands harbour high biodiversity and play a key role in the supply of ecosystem services (ES). However, abandonment, changes in traditional management practices and agricultural intensification constitute a major threat to these grasslands worldwide and these practices have led to declines in species diversity. In this paper the multi-functionality of semi natural-grasslands is assessed from the ES perspective, within a range of common semi-natural grassland types throughout Estonia. The analysis follows a stepwise approach based on the ES cascade model. Firstly, analyses of the relationships between plant species distribution patterns and environmental factors are described. Secondly, the effect of grassland abandonment on plant species diversity, as well as on the presence of rare and protected plant species is tested. In order to overcome the lack of data on ES at the national scale, plant species diversity and soil organic carbon are tested as surrogate indicators for five ESS: pollination, herbs for traditional medicinal use, nutrient cycling, nutrient retention and biomass production. In the final step, the spatial distribution of ES is assessed, based on an ES hotspots map obtained by detecting areas where high levels of plant species diversity and soil organic carbon overlap. The results show that the majority of ES hotspots are present in wooded meadows and pastures. However, there is an important threat to these hotspots because 45% are not eligible for agri-environmental support., (Copyright © 2019 Elsevier B.V. All rights reserved.)