Performance Assessment of Out-of-Hospital Use of Pelvic Circumferential Compression Devices for Severely Injured Patients in Switzerland: A Nationwide Retrospective Cross-Sectional Study.

Patients with severe pelvic fractures carry a greater risk of severe bleeding, and pelvic compression devices (PCCD) are used to stabilize the pelvis on the pre-hospital scene. The aim of this study was to describe the use of PCCD in the pre-hospital setting on a nationwide scale (Switzerland) and determine the sensitivity, specificity and rates of over- and under-triage of the current application practices. The secondary objective was to identify pre-hospital factors associated with unstable pelvic fractures. Retrospective cross-sectional study using anonymized patient data (1 January 2015-31 December 2020) from the Swiss Trauma Registry (STR). Based on AIS scores, patients were assigned a unique principal diagnosis among three categories (unstable pelvic fracture-stable pelvic fracture-other) and assessed for use or not of PCCD. Secondarily, patient characteristics, initial pre-hospital vital signs, means of pre-hospital transport and trauma mechanism were also extracted from the database. 2790 patients were included for analysis. A PCCD was used in 387 (13.9%) patients. In the PCCD group, 176 (45.5%) had an unstable pelvic fracture, 52 (13.4%) a stable pelvic fracture and 159 (41.1%) an injury unrelated to the pelvic region. In the group who did not receive a PCCD, 214 (8.9%) had an unstable pelvic fracture, 182 (7.6%) a stable pelvic fracture and 2007 (83.5%) an injury unrelated to the pelvic region. The nationwide sensitivity of PCCD application was 45.1% (95% CI 40.1-50.2), the specificity 91.2% (95% CI 90-92.3), with both over- and under-triage rates of 55%. The prevalence of unstable fractures in our population was 14% (390/2790). We identified female sex, younger age, lower systolic blood pressure, higher shock index, pedestrian hit and fall ≥3 m as possible risk factors for an unstable pelvic fracture. Our results demonstrate a nationwide both over- and under-triage rate of 55% for out-of-hospital PCCD application. Female gender, younger age, lower blood pressure, higher shock index, pedestrian hit and fall >3 m are possible risk factors for unstable pelvic fracture, but it remains unclear if those parameters are relevant clinically to perform pre-hospital triage

Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study.

Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above

Construction and Performance of a Micro-Pattern Stereo Detector with Two Gas Electron Multipliers

The construction of a micro-pattern gas detector of dimensions 40x10 cm**2 is described. Two gas electron multiplier foils (GEM) provide the internal amplification stages. A two-layer readout structure was used, manufactured in the same technology as the GEM foils. The strips of each layer cross at an effective crossing angle of 6.7 degrees and have a 406 um pitch. The performance of the detector has been evaluated in a muon beam at CERN using a silicon telescope as reference system. The position resolutions of two orthogonal coordinates are measured to be 50 um and 1 mm, respectively. The muon detection efficiency for two-dimensional space points reaches 96%.Comment: 21 pages, 17 figure

Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey.

BACKGROUND: In 2011-12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population. METHODS: Point-prevalence surveys took place from May, 2011, to November, 2012, in 1149 hospitals in EU Member States, Iceland, Norway, and Croatia. Patients present on the ward at 0800 h on the day of the survey and who were not discharged at the time of the survey were included. Data were collected by locally trained health-care workers according to patient-based or unit-based protocols. We extracted data from the ECDC database for all paediatric patients (age 0-18 years). We report adjusted prevalence for health-care-associated infections by clustering at the hospital and country level. We also calculated risk factors for development of health-care-associated infections with use of a generalised linear mixed-effects model. FINDINGS: We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7-4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6-20·3) and neonatal intensive care units (10·7%, 9·0-12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]). INTERPRETATION: Infection prevention and control strategies in children should focus on prevention of bloodstream infections, particularly among neonates and infants. FUNDING: None

UCN anomalous losses and the UCN capture cross-section on material defects

Experimental data shows anomalously large Ultra Cold Neutrons (UCN) reflection losses and that the process of UCN reflection is not completely coherent. UCN anomalous losses under reflection cannot be explained in the context of neutron optics calculations. UCN losses by means of incoherent scattering on material defects are considered and cross-section values calculated. The UCN capture cross-section on material defects is enhanced by a factor of 10^4 due to localization of UCN around defects. This phenomenon can explain anomalous losses of UCN.Comment: 13 pages, 4 figure

Neutrino non-standard interactions with the KM3NeT/ORCA detector

KM3NeT/ORCA is a dense array that constitutes the low-energy branch of the KM3NeT project with the main goal of resolving the question of the neutrino mass ordering. At present, the KM3NeT/ORCA Phase 1 has already been deployed, which means that six out of the planned 115 detection lines are operational. Even with this limited configuration, neutrino oscillations can already be measured and studied. In this contribution, the sensitivity to the neutrino Non-Standard Interactions (NSI) parameter eµt using the current stage of the KM3NeT/ORCA detector together with the projections for the final configuration are presented.Postprint (published version

KM3NeT performance on oscillation and absorption tomography of the Earth

The KM3NeT neutrino telescope, currently under construction, consists of two detectors in the Mediterranean Sea, ORCA and ARCA, both using arrays of optical modules to detect the Cherenkov light produced by charged particles created in neutrino interactions. Although originally designed for neutrino oscillation and astrophysical research, this experiment also bears unprecedented possibilities for other fields of physics. Here we present its performance for neutrino tomography, i.e. the study of the Earth’s internal structure and composition. Owing to the different energy ranges covered by its two detectors ORCA and ARCA, KM3NeT will be the first experiment to perform both oscillation and absorption neutrino tomography. Resonance effects in the oscillations of GeV neutrinos traversing the Earth will allow KM3NeT/ORCA to measure the electron density along their trajectory, leading to potential constraints of the proton-to-nucleon (Z/A) ratio in the traversed matter. Absorption tomography aims at the detection of neutrinos in the TeV-PeV range with KM3NeT/ARCA. At PeV energies, the Earth is opaque for neutrinos which leads to a reduction of the upgoing neutrino flux at the detector side from which conclusions can be drawn about the density of the inner layers of the Earth. We show here first sensitivity studies of the potential of KM3NeT to address open questions of geophysics concerning the chemical composition and matter distribution in the Earth’s core and mantle through neutrino tomography.Article signat per 297 autors/es: M.Ageron, S. Aiello, A. Albert, M. Alshamsi, S. Alves Garre, Z. Aly, A. Ambrosone, F. Ameli, M. Andre, G. Androulakis, M. Anghinolfi, M. Anguita, G. Anton, M. Ardid, S. Ardid, W. Assal, J. Aublin, C. Bagatelas, B. Baret, S. Basegmez du Pree, M. Bendahman, F. Benfenati, E. Berbee, A. M. van den Berg, V. Bertin, S. Beurthey, V. van Beveren, S. Biagi, M. Billault, M. Bissinger, M. Boettcher, M. Bou Cabo, J. Boumaaza, M. Bouta, C. Boutonnet, G. Bouvet, M. Bouwhuis, C. Bozza, H.Brânzas, R. Bruijn, J. Brunner, R. Bruno, E. Buis, R. Buompane, J. Busto, B. Caiffi, L. Caillat, D. Calvo, S. Campion, A. Capone, H. Carduner, V. Carretero, P. Castaldi, S. Celli;, R. Cereseto, M. Chabab, C. Champion, N. Chau, A. Chen, S. Cherubini, V. Chiarella, T. Chiarusi, M. Circella, R. Cocimano, J. A. B. Coelho, A. Coleiro, M. Colomer Molla, S. Colonges, R. Coniglione, A. Cosquer, P. Coyle, M. Cresta, A. Creuso, A. Cruz, G. Cuttone, A. D’Amico, R. Dallier, B. De Martino, M. De Palma, I. Di Palma, A. F. Díaz, D. Diego- Tortosa, C. Distefano, A. Domi, C. Donzaud, D. Dornic, M. Dörr, D. Drouhin, T. Eberl, A. Eddyamoui, T. van Eeden, D. van Eijk, I. El Bojaddaini, H. Eljarrari, D. Elsaesser, A. Enzenhöfer, V. Espinosa, P. Fermani, G. Ferrara, M. D. Filipovic, F. Filippini, J. Fransen, L. A. Fusco, D. Gajanana, T. Gal, J. García Méndez, A. Garcia Soto, E. Garçon, F. Garufi, C. Gatius, N. Geißelbrecht, L. Gialanella, E. Giorgio, S. R. Gozzini, R. Gracia, K. Graf, G. Grella, D. Guderian, C. Guidi, B. Guillon, M. Gutiérrez, J. Haefner, S. Hallmann, H. Hamdaoui, H. van Haren, A. Heijboer, A. Hekalo, L. Hennig, S. Henry, J. J. Hernández-Rey, J. Hofestädt, F. Huang,W. Idrissi Ibnsalih, A. Ilioni, G. Illuminati, C.W. James, D. Janezashvili, P. Jansweijer, M. de Jong, P. de Jong, B. J. Jung, M. Kadler, P. Kalaczynski, O. Kalekin,U. F. Katz, F. Kayzel, P.Keller, N. R. Khan Chowdhury, G. Kistauri, F. van der Knaap, P. Kooijman, A. Kouchner, M. Kreter, V. Kulikovskiy, M. Labalme, P. Lagier, R. Lahmann, P. Lamare, M. Lamoureux, G. Larosa, C. Lastoria, J. Laurence, A. Lazo, R. Le Breton, E. Le Guirriec, S. Le Stum, G. Lehaut, O. Leonardi, F. Leone, E. Leonora, C. Lerouvillois, J. Lesrel, N. Lessing, G. Levi, M. Lincetto, M. Lindsey Clark, T. Lipreau, C. LLorens Alvarez, A. Lonardo, F. Longhitano, D. Lopez-Coto, N. Lumb, L. Maderer, J. Majumdar, J. Manczak, A. Margiotta, A. Marinelli, A. Marini, C. Markou, L. Martin, J. A. Martínez-Mora, A. Martini, F. Marzaioli, S. Mastroianni, K.W. Melis, G. Miele, P. Migliozzi, E. Migneco, P. Mijakowski, L. S. Miranda, C. M. Mollo, M. Mongelli, A. Moussa, R. Muller, P. Musico, M. Musumeci, L. Nauta, S. Navas, C. A. Nicolau, B. Nkosi, B. Ó Fearraigh, M. O’Sullivan, A. Orlando, G. Ottonello, S. Ottonello, J. Palacios González5, G. Papalashvili, R. Papaleo, C. Pastore, A. M. Paun, G. E. Pavalas, G. Pellegrini, C. Pellegrino, M. Perrin-Terrin, V. Pestel, P. Piattelli, C. Pieterse, O. Pisanti, C. Poirè, V. Popa, T. Pradier, F. Pratolongo, I. Probst, G. Pühlhofer, S. Pulvirenti, G. Quéméner, N. Randazzo, A. Rapicavoli, S. Razzaque, D. Real, S. Reck, G. Riccobene, L. Rigalleau, A. Romanov, A. Rovelli, J. Royon, F. Salesa Greus, D. F. E. Samtleben, A. Sánchez Losa, M. Sanguineti, A. Santangelo, D. Santonocito, P. Sapienza, J. Schmelling, J. Schnabel, M. F. Schneider, J. Schumann, H. M. Schutte, J. Seneca, I. Sgura, R. Shanidze, A. Sharma, A. Sinopoulou, B. Spisso, M. Spurio, D. Stavropoulos, J. Steijger, S. M. Stellacci, M. Taiuti, F. Tatone, Y. Tayalati, E. Tenllado, D. Tézier, T. Thakore, S. Theraube, H. Thiersen, P. Timmer, S. Tingay, S. Tsagkli, V. Tsourapis, E. Tzamariudaki, D. Tzanetatos, C. Valieri, V. Van Elewyck, G. Vasileiadis, F. Versari, S. Viola, D. Vivolo, G. de Wasseige, J.Wilms, R.Wojaczynski, E. deWolf, T. Yousfi, S. Zavatarelli, A. Zegarelli, D. Zito, J. D. Zornoza, J. Zúñiga, N. Zywucka.Postprint (published version

Real-time Multi-Messenger Analysis Framework of KM3NeT

KM3NeT is a multi-purpose cubic-kilometer neutrino observatory in construction in the Mediterranean Sea. It consists of ORCA and ARCA (for Oscillation and Astroparticle Research with Cosmics in the Abyss, respectively); currently both have a few detection lines in operation. Although having different primary goals, both detectors can be used to do neutrino astronomy over a wide energy range, from a few GeV to a few tens of PeV. In view of the growing field of time-domain astronomy, it is increasingly crucial to be able to identify neutrinos in real-time. This online neutrino sample will serve to trigger neutrino alerts that will be sent to the astronomy community and to look for time/space coincidence around external electromagnetic and multi-messenger triggers. These real-time searches can significantly increase the discovery potential of transient cosmic accelerators and refine the pointing directions in the case of poorly localized triggers, such as gravitational waves. In the field of core-collapse supernovae (CCSN), the detection of the MeVscale CCSN neutrinos is crucial as an early warning. KM3NeT’s digital optical modules act as good detectors for these neutrinos. This proceeding presents the status of KM3NeT’s real-time multi-messenger activities, including supernova monitoring, online event reconstruction, event classification and selection, alert distribution, and the first test of the selection on data.Article signat per 297 autors/es: M.Ageron, S. Aiello, A. Albert, M. Alshamsi, S. Alves Garre, Z. Aly, A. Ambrosone, F. Ameli, M. Andre, G. Androulakis, M. Anghinolfi, M. Anguita, G. Anton, M. Ardid, S. Ardid, W. Assal, J. Aublin, C. Bagatelas, B. Baret, S. Basegmez du Pree, M. Bendahman, F. Benfenati, E. Berbee, A. M. van den Berg, V. Bertin, S. Beurthey, V. van Beveren, S. Biagi, M. Billault, M. Bissinger, M. Boettcher, M. Bou Cabo, J. Boumaaza, M. Bouta, C. Boutonnet, G. Bouvet, M. Bouwhuis, C. Bozza, H.Brânzas, R. Bruijn, J. Brunner, R. Bruno, E. Buis, R. Buompane, J. Busto, B. Caiffi, L. Caillat, D. Calvo, S. Campion, A. Capone, H. Carduner, V. Carretero, P. Castaldi, S. Celli;, R. Cereseto, M. Chabab, C. Champion, N. Chau, A. Chen, S. Cherubini, V. Chiarella, T. Chiarusi, M. Circella, R. Cocimano, J. A. B. Coelho, A. Coleiro, M. Colomer Molla, S. Colonges, R. Coniglione, A. Cosquer, P. Coyle, M. Cresta, A. Creuso, A. Cruz, G. Cuttone, A. D’Amico, R. Dallier, B. De Martino, M. De Palma, I. Di Palma, A. F. Díaz, D. Diego- Tortosa, C. Distefano, A. Domi, C. Donzaud, D. Dornic, M. Dörr, D. Drouhin, T. Eberl, A. Eddyamoui, T. van Eeden, D. van Eijk, I. El Bojaddaini, H. Eljarrari, D. Elsaesser, A. Enzenhöfer, V. Espinosa, P. Fermani, G. Ferrara, M. D. Filipovic, F. Filippini, J. Fransen, L. A. Fusco, D. Gajanana, T. Gal, J. García Méndez, A. Garcia Soto, E. Garçon, F. Garufi, C. Gatius, N. Geißelbrecht, L. Gialanella, E. Giorgio, S. R. Gozzini, R. Gracia, K. Graf, G. Grella, D. Guderian, C. Guidi, B. Guillon, M. Gutiérrez, J. Haefner, S. Hallmann, H. Hamdaoui, H. van Haren, A. Heijboer, A. Hekalo, L. Hennig, S. Henry, J. J. Hernández-Rey, J. Hofestädt, F. Huang,W. Idrissi Ibnsalih, A. Ilioni, G. Illuminati, C.W. James, D. Janezashvili, P. Jansweijer, M. de Jong, P. de Jong, B. J. Jung, M. Kadler, P. Kalaczynski, O. Kalekin,U. F. Katz, F. Kayzel, P.Keller, N. R. Khan Chowdhury, G. Kistauri, F. van der Knaap, P. Kooijman, A. Kouchner, M. Kreter, V. Kulikovskiy, M. Labalme, P. Lagier, R. Lahmann, P. Lamare, M. Lamoureux, G. Larosa, C. Lastoria, J. Laurence, A. Lazo, R. Le Breton, E. Le Guirriec, S. Le Stum, G. Lehaut, O. Leonardi, F. Leone, E. Leonora, C. Lerouvillois, J. Lesrel, N. Lessing, G. Levi, M. Lincetto, M. Lindsey Clark, T. Lipreau, C. LLorens Alvarez, A. Lonardo, F. Longhitano, D. Lopez-Coto, N. Lumb, L. Maderer, J. Majumdar, J. Manczak, A. Margiotta, A. Marinelli, A. Marini, C. Markou, L. Martin, J. A. Martínez-Mora, A. Martini, F. Marzaioli, S. Mastroianni, K.W. Melis, G. Miele, P. Migliozzi, E. Migneco, P. Mijakowski, L. S. Miranda, C. M. Mollo, M. Mongelli, A. Moussa, R. Muller, P. Musico, M. Musumeci, L. Nauta, S. Navas, C. A. Nicolau, B. Nkosi, B. Ó Fearraigh, M. O’Sullivan, A. Orlando, G. Ottonello, S. Ottonello, J. Palacios González5, G. Papalashvili, R. Papaleo, C. Pastore, A. M. Paun, G. E. Pavalas, G. Pellegrini, C. Pellegrino, M. Perrin-Terrin, V. Pestel, P. Piattelli, C. Pieterse, O. Pisanti, C. Poirè, V. Popa, T. Pradier, F. Pratolongo, I. Probst, G. Pühlhofer, S. Pulvirenti, G. Quéméner, N. Randazzo, A. Rapicavoli, S. Razzaque, D. Real, S. Reck, G. Riccobene, L. Rigalleau, A. Romanov, A. Rovelli, J. Royon, F. Salesa Greus, D. F. E. Samtleben, A. Sánchez Losa, M. Sanguineti, A. Santangelo, D. Santonocito, P. Sapienza, J. Schmelling, J. Schnabel, M. F. Schneider, J. Schumann, H. M. Schutte, J. Seneca, I. Sgura, R. Shanidze, A. Sharma, A. Sinopoulou, B. Spisso, M. Spurio, D. Stavropoulos, J. Steijger, S. M. Stellacci, M. Taiuti, F. Tatone, Y. Tayalati, E. Tenllado, D. Tézier, T. Thakore, S. Theraube, H. Thiersen, P. Timmer, S. Tingay, S. Tsagkli, V. Tsourapis, E. Tzamariudaki, D. Tzanetatos, C. Valieri, V. Van Elewyck, G. Vasileiadis, F. Versari, S. Viola, D. Vivolo, G. de Wasseige, J.Wilms, R.Wojaczynski, E. deWolf, T. Yousfi, S. Zavatarelli, A. Zegarelli, D. Zito, J. D. Zornoza, J. Zúñiga, N. Zywucka.Postprint (published version

Development of an acoustic transceiver for the KM3NeT positioning system

[EN] In this paper we describe an acoustic transceiver developed for the KM3NeT positioning system. The acoustic transceiver is composed of a commercial free flooded transducer, which works mainly in the 20-40 kHz frequency range and withstands high pressures (up to 500 bars). A sound emission board was developed that is adapted to the characteristics of the transducer and meets all requirements: low power consumption, high intensity of emission, low intrinsic noise, arbitrary signals for emission and the capacity of acquiring the receiving signals with very good timing precision. The results of the different tests made with the transceiver in the laboratory and shallow sea water are described, as well as, the activities for its integration in the Instrumentation Line of the ANTARES neutrino telescope and in a NEMO tower for the in situ tests. © 2012 Elsevier B.V. All rights reserved.This work has been supported by the Ministerio de Ciencia e Innovacion (Spanish Government), Project references FPA2009-13983-C02-02, ACI2009-1067, AIC10-D-00583, and Consolider-Ingenio Multidark (CSD2009-00064). It has also been funded by Generalitat Valenciana, Prometeo/2009/26, and the European 7th Framework Programme, Grant no. 212525.Larosa, G.; Ardid Ramírez, M.; Llorens Alvarez, CD.; Bou Cabo, M.; Martínez Mora, JA.; Adrián Martínez, S.; KM3NeT Consortium (2013). Development of an acoustic transceiver for the KM3NeT positioning system. Nuclear Instruments and Methods in Physics Research Section A: Accelerators, Spectrometers, Detectors and Associated Equipment. 725:215-218. https://doi.org/10.1016/j.nima.2012.11.167S21521872

Expectations for the high-energy neutrino detection from starburst galaxies with KM3NeT/ARCA

Star-forming galaxies (SFGs) and starburst galaxies (SBGs) are extragalactic sources which could produce high-energy neutrinos. In principle, they could play a rather important role for explaining at least a sizeable part of IceCube’s observations of astophysical neutrino. Using a recent theoretical model which implemented a blending of spectral indeces, we present the KM3NeT/ARCA sensitivities for such a diffuse flux from the startburst galaxies. In particular, we provide the 5-year differential sensitivity for the two building blocks of ARCA. We make use only of the track-like events in the range of 100 GeV - 10 PeV differentiate in 11 bins of energy. We show how the upcoming neutrino telescope could observe the diffuse SFG and SBG within 5 years of data taking. We found the minimum of the sensitivity at around 100 TeV, which is also the energy where the SBG contribution is expected to peak. This would not only constrain the multi-component fit of the observed astrophysical neutrino flux at that energy (100 TeV), but would also provide us a direct link between the star-forming activity in the reservoir environments and the hadronic emissions.Postprint (published version