The impact of a nurse led rapid response system on adverse, major adverse events and activation of the medical emergency team

Aim: To identify the relationship between one example of a rapid response system (RRS), specifically, an after-hours Clinical Team Co-Ordinator (CTC), and the incidence of Medical Emergency Team (MET) activations and, adverse and major adverse events in medical patients. Method: A retrospective chart audit of patients' medical records was undertaken. The intervention group consisted of 150 randomly selected medical patients admitted during three months after the introduction of the CTC after-hours service. The control group consisted of 150 randomly selected medical patients admitted before the introduction of the after-hours CTC service. Multiple logistic regression was used to determine which of the potential predictors, along with the after-hours CTC service, were associated with adverse and major adverse events. Results: A total of 130 patients (n = 63, 42% control; n = 67, 45% intervention) exhibited physiological abnormalities that should have activated the MET yet it was only activated five times. In total there were 69 adverse events (n = 32, 21% control; n = 36, 25% intervention) and 25 major adverse events (n = 7, 5% control; n = 18, 12% intervention). There were more adverse and major adverse events identified after the introduction of the CTC after-hours service. Changes in heart rate and reduction in Glasgow Coma Scores (GCS) were significant predictors of an adverse event. A low urine output and a drop of two or more in the GCS were significant predictors of a major adverse event. Conclusions: The introduction of an after-hours CTC service in a specific clinical site was associated with an increase in the identification of adverse and major adverse events in medical patients. Further exploration of nurse-led rapid response systems should be undertaken in different clinical settings

Macular hole formation, progression, and surgical repair: case series of serial optical coherence tomography and time lapse morphing video study

<p>Abstract</p> <p>Background</p> <p>To use a new medium to dynamically visualize serial optical coherence tomography (OCT) scans in order to illustrate and elucidate the pathogenesis of idiopathic macular hole formation, progression, and surgical closure.</p> <p>Case Presentations</p> <p>Two patients at the onset of symptoms with early stage macular holes and one patient following repair were followed with serial OCTs. Images centered at the fovea and at the same orientation were digitally exported and morphed into an Audiovisual Interleaving (avi) movie format. Morphing videos from serial OCTs allowed the OCTs to be viewed dynamically. The videos supported anterior-posterior vitreofoveal traction as the initial event in macular hole formation. Progression of the macular hole occurred with increased cystic thickening of the fovea without evidence of further vitreofoveal traction. During cyst formation, the macular hole enlarged as the edges of the hole became elevated from the retinal pigment epithelium (RPE) with an increase in subretinal fluid. Surgical repair of a macular hole revealed initial closure of the macular hole with subsequent reabsorption of the sub-retinal fluid and restoration of the foveal contour.</p> <p>Conclusions</p> <p>Morphing videos from serial OCTs are a useful tool and helped illustrate and support anterior-posterior vitreofoveal traction with subsequent retinal hydration as the pathogenesis of idiopathic macular holes.</p

The FASER Detector

FASER, the ForwArd Search ExpeRiment, is an experiment dedicated to searching for light, extremely weakly-interacting particles at CERN's Large Hadron Collider (LHC). Such particles may be produced in the very forward direction of the LHC's high-energy collisions and then decay to visible particles inside the FASER detector, which is placed 480 m downstream of the ATLAS interaction point, aligned with the beam collisions axis. FASER also includes a sub-detector, FASER$\nu$, designed to detect neutrinos produced in the LHC collisions and to study their properties. In this paper, each component of the FASER detector is described in detail, as well as the installation of the experiment system and its commissioning using cosmic-rays collected in September 2021 and during the LHC pilot beam test carried out in October 2021. FASER will start taking LHC collision data in 2022, and will run throughout LHC Run 3

Beam Optics Modelling Through Fringe Fields During Injection and Extraction at the CERN Proton Synchrotron

As the beam is injected and extracted from the CERN Proton Synchrotron, it passes through the fringing magnetic fields of the main bending units (MUs). In this study, tracking simulations using field maps created from a 3D magnetic model of the MUs are compared to beam based measurements made through the fast injection and slow extraction regions. The behaviour of the fringe field is characterised and its implementation in the MAD-X model of the machine is described

Slow extraction with octupoles at CERN proton synchrotron to improve extraction efficiency

The extraction inefficiency of the slow extraction process induces radioactivity in the area surrounding the electrostatic septum. Studies at the CERN Proton Synchrotron (PS) are investigating beam loss reduction techniques to improve the efficiency of the beams provided to the experiments of the East Area. Powering octupoles distorts the transverse phase-space of the extracted beam which can be exploited to maximize the number of particles in the field region of the septum with respect to the number lost on the septum. The effect of octupoles on the separatrices near the third-order resonance is simulated with MADX-PTC tools to observe phase space folding and to predict the multipole parameters needed to minimize beam loss. Experimental studies are performed to confirm the validity of the simulation models and to quantify the net benefit of using octupoles to improve the extraction efficiency

Benchmarking simulations of slow extraction driven by RF transverse excitation at the CERN Proton Synchrotron

Resonant slow extraction is a beam extraction method which provides a continuous spill over a longer duration than can be achieved with fast single-turn or non-resonant multi-turn extraction. By using transverse excitation to drive the circulating particles onto the resonance, a beam can be delivered to stationary target experiments which require low intensity, long-duration beams.In order to accurately and efficiently simulate the extraction process over a wide range of timescales, new modelling tools and computing platforms must be explored. By utilising optimised computational hardware - such as General Purpose Graphics Processing Units (GPGPUs), and next-generation simulation software (such as Xsuite), computation times for simulations can be reduced by several orders of magnitude.This contribution presents recent developments of resonant slow extraction modelling and benchmarking with a comparison to measurements made at CERN’s Proton Synchrotron (PS), with a particular focus on understanding the dynamics of transverse RF excitation and effect on spill quality