Expanded use of a fast photography technique to characterize laser-induced plasma plumes

Expanded use of fast photography is proposed to characterize laser ablation plasma plumes by the analysis of a set of photographs by means of appropriate mathematical algorithms. The laser ablation plasma plumes studied were generated by ablation of both a multicomponent target of the nominal composition Ni50Mn37Sn13 and a highly pure Cu target (Cu) using a Q-switched Nd-YAG laser system:The experiments were conducted under different background argon pressures. Several photograph parameters such as intensity per unit time of exposure for a pixel, mean intensity per pixel per unit time of exposure, integrated intensity and cross correlation were studied. The intensity per unit time of exposure allowed for identification of the fast component of the triple structure of the expanding plasma into the background gas (that travels at a speed close to the one measured in vacuum). This parameter together with the use of cross correlation enabled the identification of regions of the expanded plasma plume with higher and lower similarities in their optical emission behavior. The mean intensity per pixel per unit time of exposure can be used as a measurement of the amount of light emitted by the plume as a function of time

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Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)