Time-differentiated target temperature management after out-of-hospital cardiac arrest: a multicentre, randomised, parallel-group, assessor-blinded clinical trial (the TTH48 trial): study protocol for a randomised controlled trial

BACKGROUND The application of therapeutic hypothermia (TH) for 12 to 24 hours following out-of-hospital cardiac arrest (OHCA) has been associated with decreased mortality and improved neurological function. However, the optimal duration of cooling is not known. We aimed to investigate whether targeted temperature management (TTM) at 33 ± 1 °C for 48 hours compared to 24 hours results in a better long-term neurological outcome. METHODS The TTH48 trial is an investigator-initiated pragmatic international trial in which patients resuscitated from OHCA are randomised to TTM at 33 ± 1 °C for either 24 or 48 hours. Inclusion criteria are: age older than 17 and below 80 years; presumed cardiac origin of arrest; and Glasgow Coma Score (GCS) <8, on admission. The primary outcome is neurological outcome at 6 months using the Cerebral Performance Category score (CPC) by an assessor blinded to treatment allocation and dichotomised to good (CPC 1-2) or poor (CPC 3-5) outcome. Secondary outcomes are: 6-month mortality, incidence of infection, bleeding and organ failure and CPC at hospital discharge, at day 28 and at day 90 following OHCA. Assuming that 50 % of the patients treated for 24 hours will have a poor outcome at 6 months, a study including 350 patients (175/arm) will have 80 % power (with a significance level of 5 %) to detect an absolute 15 % difference in primary outcome between treatment groups. A safety interim analysis was performed after the inclusion of 175 patients. DISCUSSION This is the first randomised trial to investigate the effect of the duration of TTM at 33 ± 1 °C in adult OHCA patients. We anticipate that the results of this trial will add significant knowledge regarding the management of cooling procedures in OHCA patients. TRIAL REGISTRATION NCT01689077.

Guide to standard weather summaries.

"Supersedes NAVWEPS 50-1C-534, dated March 1965."

Agriculture, Rural Development, Food and Drug Administration, and related agencies appropriations for 2011 : hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Eleventh Congress, second session /

Mode of access: Internet.

Agriculture, Rural Development, Food and Drug Administration, and related agencies appropriations for 2013 : hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Twelfth Congress, second session /

Shipping list no.: 2012-0266-P (pt. 1A), 2012-0262-P (pt. 1B), 2012-0267-P (pt. 1C), 2012-0317-P (pt. 2), 2013-0006 (pt. 3), 2013-0008-P (pt. 4), 2013-0027-P (pt. 5), 2013-0033-P (pt. 6), 2013-0042-P (pt. 7), 2013-0038-P (pt. 9).

Agriculture, Rural Development, Food and Drug Administration, and related agencies appropriations for 2012 : hearings before a Subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Twelfth Congress, first session /

Shipping list number: 2011-0276-P (pt. 1A), 2011-0274-P (pt. 1B), 2011-0283-P (pt. 1C), 2011-0318-P (pt. 2), 2011-0339-P (pt. 4), 2011-0366-P (pt. 5), 2011-0375-P (pt. 6), 2011-0367-P (pt. 7), 2011-0372-P (pt. 8), 2012-0014-P (pt. 9).

Department of Homeland Security appropriations for 2012 : hearings before a subcommittee of the Committee on Appropriations, House of Representatives, One Hundred Twelfth Congress, first session /

Shipping list number: 2011-0293-P (pt. 1A, 1B), 2011-0295-P (pt. 1C), 2011-0385-P (pt. 2), 2011-0463-P (pt. 3), 2012-0013-P (pt. 4).

The method of characteristics in compressible flow.

Reproduced from typewritten copy.

El minero español : descripción de los puntos de la península donde existen criaderos de todas clases de metales : modo de beneficiar las minas : colección de las ordenanzas y reales órdenes que rijen [sic] en la materia ... /

Mode of access: Internet.

Bartholomaei Riccii Lugiensis Epistolarum familiarum lib.IIII ...

Edit16,

Order : FAA emergency operations plan /

Cover title.

Darstellung der Arabischen Verskunst : mit sechs Anhaengen enthaltend ein arab. Lehrgedicht uerber die Metrik mit Uebersetzung, bemerkungen ueber die Poesie der Araber ... /

Mode of access: Internet.

Aquatic resources of Illinois /

When using this book, students will become familiar with the aquatic resources of Illinois. The information and activities can help you meet the following Illinois learning standards: Mathematics 6.A.2, 6.B.1, 6.B.2, 6.B.3a, 6.C.1a, 6.C.2a, 6.C.3a; Science 11.A.1a, 11.A.1c, 11.A.1d, 11.A.2b, 11.A.2d, 11.A.3a, 11.A.3b, 11.A.3c, 11.A.3f; Social science 16.E.2a, 16.E.2c, 17.A.1a, 17.A.1b, 17.A.2a, 17.A.2b, 17.B.1a, 17.B.1b, 17.C.1a, 17.C.2b, 17.D.2b. For part of the activities an Illinois road map is needed.

Recursos acua ticos de Illinois /

When using this book, students will become familiar with the aquatic resources of Illinois. The information and activities can help you meet the following Illinois learning standards: Mathematics 6.A.2, 6.B.1, 6.B.2, 6.B.3a, 6.C.1a, 6.C.2a, 6.C.3a; Science 11.A.1a, 11.A.1c, 11.A.1d, 11.A.2b, 11.A.2d, 11.A.3a, 11.A.3b, 11.A.3c, 11.A.3f; Social science 16.E.2a, 16.E.2c, 17.A.1a, 17.A.1b, 17.A.2a, 17.A.2b, 17.B.1a, 17.B.1b, 17.C.1a, 17.C.2b, 17.D.2b. For part of the activities an Illinois road map is needed.

Amtliche Sammlung der ältern eidgenössischen Abschiede /

Imprint varies.

Assessing Fracture Connectivity using Stable and Clumped Isotope Geochemistry of Calcite Cements

Understanding flow path connectivity within a geothermal reservoir is a critical component for efficiently producing sustained flow rates of hot fluids from the subsurface. I present a new approach for characterizing subsurface fracture connectivity that combines petrographic and cold cathodoluminescence (CL) microscopy with stable isotope analysis (δ18O and δ13C) and clumped isotope (Δ47) thermometry of fracture-filling calcite cements from a geothermal reservoir in northern Nevada. Calcite cement samples were derived from both drill cuttings and core samples taken at various depths from wells within the geothermal field. CL microscopy of some fracture filling cements shows banding parallel to the fracture walls as well as brecciation, indicating that the cements are related to fracture opening and fault slip. Variations in trace element composition indicated by the luminescence patterns reflect variations in the composition and source of fluids moving through the fractures as they opened episodically. Calcite δ13C and δ18O results also show significant variation among the sampled cements, reflecting multiple generations of fluids and fracture connectivity. Clumped isotope analyses performed on a subset of the cements analyzed for conventional δ18O and δ13C mostly show calcite growth temperatures around 150°C—above the current ambient rock temperature, which indicates a common temperature trend for the geothermal reservoir. However, calcite cements sampled along faults located within the well field showed both cold (18.7°C) and hot (226.1°C) temperatures. The anomalously cool temperature found along the fault, using estimates from clumped isotope thermometry, suggests a possible connection to surface waters for the geothermal source fluids for this system. This information may indicate that some of the faults within the well field are transporting meteoric water from the surface to be heated at depth, which then is circulated through a complex network of fractures and other faults.