The possibility of performing electron density and temperature measurements in a high power helicon plasma is a crucial issue in the framework of the AWAKE (Advanced WAKefield Experiment) project, which demonstrates acceleration of particles using $\text{GeV}~\text{m}^{-1}$ electric fields in plasmas. For AWAKE, a helicon is currently envisaged as a candidate plasma source due to its capability for low electron and ion temperature, high electron density and production of an elongated plasma column. A plasma diagnostic to accurately determine the electron density in AWAKE regimes would be a valuable supporting tool. A demonstration Thomson scattering (TS) diagnostic was installed and successfully tested on the resonant antenna ion device (RAID) at the Swiss Plasma Center of Ecole Polytechnique Fédérale de Lausanne. RAID produces a helicon plasma column with characteristics similar to those of the AWAKE helicon source, and is therefore an optimal testbed for application to the AWAKE device. The spectrometer employed in RAID is based on polychromators which collect the light scattered by plasma electrons in spectrally filtered wavelength regions. Results from TS on RAID demonstrate conditions of electron density and temperature respectively of $n_{e}=1.10\,(\pm 0.19)\times 10^{19}~\text{m}^{-3}$ and $T_{e}=2.3\,(\pm 0.6)~\text{eV}$ in a steady-state discharge in an Ar plasma with 5 kW of RF power. If the same polychromator system is used for AWAKE, where the electron density attained is $2\times 10^{20}~\text{m}^{-3}$, the contribution to measurement error due to coherent scattering is ${\sim}2.5\,\%$. Presented here are details of the TS diagnostic and the first tests in RAID, and the expectations for the system when employed on the AWAKE device.

Introduction: Trauma care is highly complex and prone to medical errors. Accordingly, several studies have identified adverse events and conditions leading to potentially preventable or preventable deaths. Depending on the availability of specialized trauma care and the trauma system organization, between 10 and 30% of trauma-related deaths worldwide could be preventable if optimal care was promptly delivered. This narrative review aims to identify the main determinants and areas for improvements associated with potentially preventable trauma mortality. Methods: A literature review was performed using Medline, Embase and Cochrane Central Register of Controlled Trials from 1990 to a maximum of 6 months before submission for publication. Experimental or observational studies that have assessed determinants and areas for improvements that are associated with trauma death preventability were considered for inclusion. Two researchers independently selected eligible studies and extracted the relevant data. The main areas for improvements were classified using the Joint Commission on Accreditation of Healthcare Organizations patient event taxonomy. No statistical analyses were performed given the data heterogeneity. Results: From the 3647 individual titles obtained by the search strategy, a total of 37 studies were included. Each study included between 72 and 35311 trauma patients who had sustained mostly blunt trauma, frequently following a fall or a motor vehicle accident. Preventability assessment was performed for 17 to 2081 patients using either a single expert assessment (n = 2, 5,4%) or an expert panel review (n = 35, 94.6%). The definition of preventability and the taxonomy used varied greatly between the studies. The rate of potentially preventable or preventable death ranged from 2.4% to 76.5%. The most frequently reported areas for improvement were treatment delay, diagnosis accuracy to avoid missed or incorrect diagnosis and adverse events associated with the initial procedures performed. The risk of bias of the included studies was high for 32 studies because of the retrospective design and the panel review preventability assessment. Conclusion: Deaths occurring after a trauma remain often preventable. Included studies have used unstandardized definitions of a preventable death and various methodologies to perform the preventability assessment. The proportion of preventable or potentially preventable death reported in each study ranged from 2.4% to 76.5%. Delayed treatment, missed or incorrect initial diagnosis and adverse events following a procedure were commonly associated with preventable trauma deaths and could be targeted to develop quality improvement and monitoring projects.

Introduction: The incidence of out-of-hospital cardiac arrest (OHCA) in school is approximately 2.1 for 100,000 per year. Although rare, it is a devastating event for the local community. Schools with public access to automated external defibrillators (AED) and an emergency response plan have demonstrated increased survival rates of up to 70% for students who suffer cardiac arrest. Previous studies identified numerous barriers to successful cardiac resuscitation in public school systems. The main objectives of this study were to identify those barriers in the Quebec region elementary school system and to assess the impacts of an AED focused training session. Methods: A previously validated survey focused on the potential barriers to successful defibrillation in OHCA and on demographic variables was sent to 139 elementary schools. Later, 92 employees within three elementary schools who responded to the survey were evaluated before and after receiving training on the use of AED in a mock cardiac arrest scenario. The primary outcome was the time to first shock and the secondary outcomes included correct AED pad placement and safety of the procedure. Results: Survey response rate was 53%, which is comparable to previous studies assaying barriers to cardiac resuscitation in public school systems. 95% of school respondents reported the presence of an AED on the school premises but 46% stated that no formal AED training course was provided to employees. Out of the four schools who reported a previous OHCA, only one had access to an AED at the time of the event. Following focused AED training, 92% of school workers successfully completed a defibrillation sequence in a mock scenario, from 53% before (p < 0.001, McNemar test). The time to first shock went from 66 seconds (95% CI 63-70) to 47 seconds (95% CI 45-49; -29%, p < 0.001). Proper pad placement was the most problematic step for participants and personnel who reported previous training had better performance (OR 3.15, 95% CI 1.33-7.42, p = 0.009). Conclusion: Most elementary schools in the Quebec region have access to AEDs. However, inadequate AED training represents a significant barrier to successful defibrillation in the event of an OHCA. Our results showed that a simple focused AED training could improve the performance of school workers and optimize the chain of survival.

Introduction: The Brain Injury Guidelines (BIG) stratifies complicated mild traumatic brain injury (mTBI) patients into 3 groups to guide hospitalization, neurosurgical consultation and repeat head-CT. BIG-1 patients could be managed safely without neurosurgical consultation or transfer. Systematic transfer to neurotrauma centers provide few benefits to this subgroup leading to overtriage. Similarly, unnecessary clinical and radiological follow-ups utilize significant health-care resources. Objective: to validate the safety and efficacy of the BIG for complicated mTBIs. Methods: We performed a multicenter historical cohort study in 3 level-1 trauma centers in Quebec. Patients ≥16 years old assessed in the Emergency Department (ED) with complicated mTBI between 2014 and 2017 were included. Patients with penetrating trauma, cerebral aneurysm or tumor were excluded. Clinical, demographic and radiological data, BIG variables, TBI-related death and neurosurgical intervention were collected using a standardized form. A second reviewer assessed all ambiguous files. Descriptive statistics, over- and under-triage were calculated. Results: A total of 342 patients’ records were assessed. Mean age was 63 ± 20,7 and 236 (69 %) were male. Thirty-five patients were classified under BIG-1 (10.2%), 110 under BIG-2 (32.2%) and 197 under BIG-3 (57.6%). Twenty-six patients (7%) required neurosurgical intervention, all were BIG-3. 90% of TBI-related deaths occurred in BIG-3 and none were classified BIG-1. Among the 192 transfers (51%), 14 were classified under BIG-1 (7.3%) and should not have been transferred according to the guidelines and 50 under BIG-2 (26%). In addition, 40% of BIG-1 received a repeat head computed tomography, although not indicated. Similarly, 7 % of all patients had a neurosurgical consult even if not required. Projected implementation of BIG would lead to 47% of overtriage and 0.3% of undertriage. Conclusion: Our results suggest that the Brain Injury Guidelines could safely identify patients with negative outcomes and could lead to a safe and effective management of complicated mTBI. Applying these guidelines to our cohort could have resulted in significantly fewer repeat head CTs, neurosurgical consults and transfers to level 1 neurotrauma centers.

This paper describes initial experimental results from an extreme ultraviolet (EUV) radiation-pulsed atom probe microscope. Femtosecond-pulsed coherent EUV radiation of 29.6 nm wavelength (41.85 eV photon energy), obtained through high harmonic generation in an Ar-filled hollow capillary waveguide, successfully triggered controlled field ion emission from the apex of amorphous SiO2 specimens. The calculated composition is stoichiometric within the error of the measurement and effectively invariant of the specimen base temperature in the range of 25 K to 150 K. Photon energies available in the EUV band are significantly higher than those currently used in the state-of-the-art near-ultraviolet laser-pulsed atom probe, which enables the possibility of additional ionization and desorption pathways. Pulsed coherent EUV light is a new and potential alternative to near-ultraviolet radiation for atom probe tomography.

Pulsed coherent extreme ultraviolet (EUV) radiation is a potential alternative to pulsed near-ultraviolet (NUV) wavelengths for atom probe tomography. EUV radiation has the benefit of high absorption within the first few nm of the sample surface for elements across the entire periodic table. In addition, EUV radiation may also offer athermal field ion emission pathways through direct photoionization or core-hole Auger decay processes, which are not possible with the (much lower) photon energies used in conventional NUV laser-pulsed atom probe. We report preliminary results from what we believe to be the world’s first EUV radiation-pulsed atom probe microscope. The instrument consists of a femtosecond-pulsed, coherent EUV radiation source interfaced to a local electrode atom probe tomograph by means of a vacuum manifold beamline. EUV photon-assisted field ion emission (of substrate atoms) has been demonstrated on various insulating, semiconducting, and metallic specimens. Select examples are shown.

The natural ventilation flow driven by an internal buoyant plume in a box involving an upper opening (vent) located at the ceiling (for the outflow) and a large lower opening at the floor (for the inflow) is examined theoretically in a general non-Boussinesq case. Analytical solutions of this emptying–filling box problem allow the characteristics of the flow at the vent to be determined. From these characteristics, a non-dimensional parameter $\unicode[STIX]{x1D6E4}_{d}$ (called the discharge plume parameter) is expressed. This parameter characterizes the initial balance of volume, buoyancy and momentum fluxes in the plume-like flow that forms above the vent. We then note that the value of $\unicode[STIX]{x1D6E4}_{d}$ allows the buoyant fluid layer depth in the box to be estimated, which is a new and interesting result for natural ventilation problems. Following previous experimental results, the decrease of the vent discharge coefficient $C_{d}$ when $\unicode[STIX]{x1D6E4}_{d}$ increases is discussed and a theoretical model based on plume necking is proposed. The emptying–filling box model is then extended for a variable $C_{d}$ (depending on $\unicode[STIX]{x1D6E4}_{d}$ ). Even though the discharge coefficient may be markedly reduced at high values of $\unicode[STIX]{x1D6E4}_{d}$ , our results show that this only affects transients and the steady state of an emptying–filling box for relatively thin buoyant fluid layers.

Previous research has indicated that biological older brothers increase the odds of androphilia in males. This finding has been termed the fraternal birth order effect. The maternal immune hypothesis suggests that this effect reflects the progressive immunization of some mothers to male-specific antigens involved in fetal male brain masculinization. Exposure to these antigens, as a result of carrying earlier-born sons, is hypothesized to produce maternal immune responses towards later-born sons, thus leading to female-typical neural development of brain regions underlying sexual orientation. Because this hypothesis posits mechanisms that have the potential to be active in any situation where a mother gestates repeated male fetuses, a key prediction is that the fraternal birth order effect should be observable in diverse populations. The present study assessed the association between sexual orientation and birth order in androphilic male-to-female transsexuals in Brazil, a previously unexamined population. Male-to-female transsexuals who reported attraction to males were recruited from a specialty gender identity service in southern Brazil (n=118) and a comparison group of gynephilic non-transsexual men (n=143) was recruited at the same hospital. Logistic regression showed that the transsexual group had significantly more older brothers and other siblings. These effects were independent of one another and consistent with previous studies of birth order and male sexual orientation. The presence of the fraternal birth order effect in the present sample provides further evidence of the ubiquity of this effect and, therefore, lends support to the maternal immune hypothesis as an explanation of androphilic sexual orientation in some male-to-female transsexuals.

Eco-efficiency is a useful guide to dairy farm sustainability analysis aimed at increasing output (physical or value added) and minimizing environmental impacts (EIs). Widely used partial eco-efficiency ratios (EIs per some functional unit, e.g. kg milk) can be problematic because (i) substitution possibilities between EIs are ignored, (ii) multiple ratios can complicate decision making and (iii) EIs are not usually associated with just the functional unit in the ratio’s denominator. The objective of this study was to demonstrate a ‘global’ eco-efficiency modelling framework dealing with issues (i) to (iii) by combining Life Cycle Analysis (LCA) data and the multiple-input, multiple-output production efficiency method Data Envelopment Analysis (DEA). With DEA each dairy farm’s outputs and LCA-derived EIs are aggregated into a single, relative, bounded, dimensionless eco-efficiency score, thus overcoming issues (i) to (iii). A novelty of this study is that a model providing a number of additional desirable properties was employed, known as the Range Adjusted Measure (RAM) of inefficiency. These properties altogether make RAM advantageous over other DEA models and are as follows. First, RAM is able to simultaneously minimize EIs and maximize outputs. Second, it indicates which EIs and/or outputs contribute the most to a farm’s eco-inefficiency. Third it can be used to rank farms in terms of eco-efficiency scores. Thus, non-parametric rank tests can be employed to test for significant differences in terms of eco-efficiency score ranks between different farm groups. An additional DEA methodology was employed to ‘correct’ the farms’ eco-efficiency scores for inefficiencies attributed to managerial factors. By removing managerial inefficiencies it was possible to detect differences in eco-efficiency between farms solely attributed to uncontrollable factors such as region. Such analysis is lacking in previous dairy studies combining LCA with DEA. RAM and the ‘corrective’ methodology were demonstrated with LCA data from French specialized dairy farms grouped by region (West France, Continental France) and feeding strategy (regardless of region). Mean eco-efficiency score ranks were significantly higher for farms with <10% and 10% to 30% maize than farms with >30% maize in the total forage area before correcting for managerial inefficiencies. Mean eco-efficiency score ranks were higher for West than Continental farms, but significantly higher only after correcting for managerial inefficiencies. These results helped identify the eco-efficiency potential of each region and feeding strategy and could therefore aid advisors and policy makers at farm or region/sector level. The proposed framework helped better measure and understand (dairy) farm eco-efficiency, both within and between different farm groups.

The Florida Children’s Medical Services (CMS) has a long-standing history of ensuring that providers of multiple paediatric subspecialties abide by the highest standards. The cardiac sub-committee has written quality standard documents that participating programmes must meet or exceed. These standards oversee paediatric cardiology services including surgery, catheterisations, and outpatient services. On April, 2012, the cardiac sub-committee decided to develop similar standards in paediatric electrophysiology. A task force was created and began this process. These standards include a catalogue of required and optional equipment, as well as staff and physician credentials. We sought to establish expectations of procedural numbers by practitioner and facility. The task force surveyed the members of the Pediatric and Congenital Electrophysiology Society. Finding no consensus, the task force is committed to generate the data by requiring that the CMS participating programmes enrol and submit data to the Multicenter Pediatric and Adult Congenital EP Quality (MAP-IT™) Initiative. This manuscript details the work of the Florida CMS Paediatric Electrophysiology Task Force.

High quality powder diffraction data were obtained from a specimen containing inseparable impurities, by using single crystal precession photographs to explore all possible reflections for the mineral being studied. In this manner it is acceptable to ignore weak reflections that do not index on the unit cell and that are not observed on the single crystal photographs. Triphylite is given as an example.