Frequency of surgical treatment and related hospital procedures in the United Kingdom: A national ecological study using hospital episode statistics

T.E.F.A. is supported by a Medical Research Council and British Journal of Anaesthesia clinical research training fellowship (grant reference MR/M017974/1), and R.M.P. is supported by an NIHR research professorship. T.D.D. is funded by the Welsh Clinical Academic Training (WCAT) Fellowship. M.A.G. is a Chief Scientist Office (Scotland) NHS Research Scheme Clinicia

Measurement of proton, deuteron, triton, and α particle emission after nuclear muon capture on Al, Si, and Ti with the AlCap experiment

Heavy charged particles after nuclear muon capture are an important nuclear physics background to the muon-to-electron conversion experiments Mu2e and COMET, which will search for charged lepton flavor violation at an unprecedented level of sensitivity. The AlCap experiment measured the yield and energy spectra of protons, deuterons, tritons, and alpha particles emitted after the nuclear capture of muons stopped in Al, Si, and Ti in the low energy range relevant for the muon-to-electron conversion experiments. Individual charged particle types were identified in layered silicon detector packages and their initial energy distributions were unfolded from the observed energy spectra. Detailed information on yields and energy spectra for all observed nuclei are presented in the paper.Comment: 24 pages, 19 figure

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

COMET Phase-I Track Reconstruction using Machine Learning and Computer Vision

The COMET experiment will measure Charged Lepton Flavour Violation by searching for the neutrinoless decay of a muon into an electron while the muon is electromagnetically bound to an atomic nucleus. This μ-e conversion process is not allowed in the Standard Model of particle physics which makes it an excellent probe for Beyond the Standard Model physics. The first phase of the experiment will improve the current sensitivity limit on μ-e conversion from the 7.0 × 10−13 at 90% C.L. to 3.0 × 10−15 at 90% C.L. To achieve this, COMET will utilize several novel design elements to produce the world’s high-intensity muon beam to maximise the number of observed muonic atoms. The high-intensity design of this experiment poses significant challenges to both the tracking and triggering systems. A novel algorithm called the CDC Hit Filter is designed to alleviate these challenges. The algorithm utilizes machine learning classification and a circular Hough Transform to identify and remove background hits. When applied offline, it can remove 98% of background hits while retaining 98% of signal hits. When adapted to the online environment, it can remove 89% of the background hits considered by the trigger while retaining 89% of signal hits. Both of these mark a significant improvement over the more traditional cut-based approach, which can remove 75% of background hits while retaining 75% of signal hits.Open Acces

Changes in perioperative red cell transfusion practice over time in patients undergoing surgery for upper gastrointestinal and liver cancer:a retrospective cohort study at a single tertiary centre

OBJECTIVES: Optimum transfusion trigger for adults undergoing cancer surgery is uncertain. Published guidelines recommend restrictive transfusion strategies in hospitalised adults. We aimed to measure the red cell transfusion rate and haemoglobin trigger in patients undergoing cancer surgery and how closely practice reflected published guidelines. DESIGN: Retrospective cohort study. SETTING: Single tertiary centre. PARTICIPANTS: Adult patients undergoing surgery for upper gastrointestinal or liver malignancy. EXPOSURE: Postguideline change (2015–2017) versus preguideline change (2011–2012). OUTCOME MEASURES: Primary: transfusion rate, secondary: transfusion trigger. Multivariable logistic regression was used to assess factors and adjust for confounders affecting our outcome measures. RESULTS: 1578 surgical records were identified for 1520 patients. 946/1530 (62%) patients had preoperative anaemia. The transfusion rate decreased from 23% in 2011–2012 to 14% in 2015–2017. This change remained significant after adjusting for other variables associated with transfusion rates. Mean pretransfusion haemoglobin in those who were transfused was 78±13 g/L in 2011–2012 and 80±15 g/L in 2015–2017. This change in haemoglobin transfusion triggers was not significant. CONCLUSION: Transfusion rate has decreased over the study period in patients undergoing surgery for malignancy and is consistent with a restrictive transfusion strategy

Radiation hardness study for the COMET Phase-I electronics

Radiation damage on front-end readout and trigger electronics is an important issue in the COMET Phase-I experiment at J-PARC, which plans to search for the neutrinoless transition of a muon to an electron. To produce an intense muon beam, a high-power proton beam impinges on a graphite target, resulting in a high-radiation environment. We require radiation tolerance to a total dose of 1.0kGy and 1MeV equivalent neutron fluence of 1.0×10 12 neq cm −2 including a safety factor of 5 over the duration of the physics measurement. The use of commercially-available electronics components which have high radiation tolerance, if such components can be secured, is desirable in such an environment. The radiation hardness of commercial electronic components has been evaluated in gamma-ray and neutron irradiation tests. As results of these tests, voltage regulators, ADCs, DACs, and several other components were found to have enough tolerance to both gamma-ray and neutron irradiation at the level we require. c.2019 Elsevier. B.V. All rights reserved