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Objective Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. Methods We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. Results The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. Conclusions Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.

We present here a novel scheme for the high-resolution spectrometry of high-flux gamma-ray beams with energies per photon in the multi-GeV range. The spectrometer relies on the conversion of the gamma-ray photons into electron-positron pairs in a solid foil with high atomic number. The measured electron and positron spectra are then used to reconstruct the spectrum of the gamma-ray beam. The performance of the spectrometer has been numerically tested against the predicted photon spectra expected from non-linear Compton scattering in the proposed LUXE experiment, showing high fidelity in identifying distinctive features such as Compton edges and non-linearities.

The rapid progress that plasma wakefield accelerators are experiencing is now posing the question as to whether they could be included in the design of the next generation of high-energy electron-positron colliders. However, the typical structure of the accelerating wakefields presents challenging complications for positron acceleration. Despite seminal proof-of-principle experiments and theoretical proposals, experimental research in plasma-based acceleration of positrons is currently limited by the scarcity of positron beams suitable to seed a plasma accelerator. Here, we report on the first experimental demonstration of a laser-driven source of ultra-relativistic positrons with sufficient spectral and spatial quality to be injected in a plasma accelerator. Our results indicate, in agreement with numerical simulations, selection and transport of positron beamlets containing N e + ≥ 10 5 positrons in a 5% bandwidth around 600 MeV, with femtosecond-scale duration and micron-scale normalised emittance. Particle-in-cell simulations show that positron beams of this kind can be guided and accelerated in a laser-driven plasma accelerator, with favourable scalings to further increase overall charge and energy using PW-scale lasers. The results presented here demonstrate the possibility of performing experimental studies of positron acceleration in a laser-driven wakefield accelerator.

A machine learning model was created to predict the electron spectrum generated by a GeV-class laser wakefield accelerator. The model was constructed from variational convolutional neural networks, which mapped the results of secondary laser and plasma diagnostics to the generated electron spectrum. An ensemble of trained networks was used to predict the electron spectrum and to provide an estimation of the uncertainty of that prediction. It is anticipated that this approach will be useful for inferring the electron spectrum prior to undergoing any process that can alter or destroy the beam. In addition, the model provides insight into the scaling of electron beam properties due to stochastic fluctuations in the laser energy and plasma electron density.

While plasma-based accelerators have the potential to positively impact a broad range of research topics, a route to application will only be possible through improved understanding of their stability. We present experimental results of a laser wakefield accelerator in the nonlinear regime in a helium gas jet target with a density transition produced by a razor blade in the flow. Modifications to the target setup are correlated with variations in the plasma density profile diagnosed via interferometry and the shot-to-shot variations of the density profile for nominally equal conditions are characterized. Through an in-depth sensitivity study using particle-in-cell simulations, the effects of changes in the plasma density profile on the accelerated electron beams are investigated. The results suggest that blade motion is more detrimental to stability than gas pressure fluctuations, and that early focusing of the laser may reduce the deleterious effects of such density fluctuations.

Measuring signatures of strong-field quantum electrodynamics (SF-QED) processes in an intense laser field is an experimental challenge: it requires detectors to be highly sensitive to single electrons and positrons in the presence of the typically very strong x-ray and γ -photon background levels. In this paper, we describe a particle detector capable of diagnosing single leptons from SF-QED interactions and discuss the background level simulations for the upcoming Experiment-320 at FACET-II (SLAC National Accelerator Laboratory). The single particle detection system described here combines pixelated scintillation LYSO screens and a Cherenkov calorimeter. We detail the performance of the system using simulations and a calibration of the Cherenkov detector at the ELBE accelerator. Single 3 GeV leptons are expected to produce approximately 537 detectable photons in a single calorimeter channel. This signal is compared to Monte-Carlo simulations of the experiment. A signal-to-noise ratio of 18 in a single Cherenkov calorimeter detector is expected and a spectral resolution of 2% is achieved using the pixelated LYSO screens.

Abstract Measuring signatures of strong-field quantum electrodynamics (SF-QED) processes in an intense laser field is an experimental challenge: it requires detectors to be highly sensitive to single electrons and positrons in the presence of the typically very strong x-ray and γ -photon background levels. In this paper, we describe a particle detector capable of diagnosing single leptons from SF-QED interactions and discuss the background level simulations for the upcoming Experiment-320 at FACET-II (SLAC National Accelerator Laboratory). The single particle detection system described here combines pixelated scintillation LYSO screens and a Cherenkov calorimeter. We detail the performance of the system using simulations and a calibration of the Cherenkov detector at the ELBE accelerator. Single 3 GeV leptons are expected to produce approximately 537 detectable photons in a single calorimeter channel. This signal is compared to Monte-Carlo simulations of the experiment. A signal-to-noise ratio of 18 in a single Cherenkov calorimeter detector is expected and a spectral resolution of 2% is achieved using the pixelated LYSO screens.

Background: Genetic studies have indicated a high prevalence of mutations for hereditary haemochromatosis (HH) in Irish populations. Given the high cost of genetic screening and the ethical implications thereof, we assessed the role of transferrin saturation (TS) as a primary screening test for HH in an Irish population seeking medical care. Methods: TS and ferritin were measured on 330 consecutive blood specimens received in the laboratory for routine screening. Patients with TS > 45% were genetically screened for the C282Y and H63D mutations. Results: Twenty-six patients had TS values > 45%. Of these, specimens were available for genetic screening on 20 patients. Three previously undiagnosed patients were found to be C282Y homozygotes and one a compound heterozygote (C282Y/H63D). The prevalence of C282Y homozygotes was 0·93%, which is similar to the reported prevalence found in Irish populations by genetic screening. Conclusion: Given the number of positive findings in this study, we conclude that, in the absence of a national programme, TS could be used as part of a health-screening panel in the Irish setting. Patients expressing iron overload would be detected before organ damage occurred, leading to less severe clinical disease and better patient prognosis.

Serial cranial computed tomograms were carried out in 136 children with acute lymphoblastic leukaemia who were receiving 24 Gy or 18 Gy of cranial irradiation and continuing treatment with doses of methotrexate given weekly orally or intramuscularly. The findings were correlated with treatment variables, the development of fits, and the intelligence quotient (IQ). Reversible brain shrinkage, attributed to treatment with steroids, was found on 87 of 114 initial scans (76%); 14 showed changes in white matter during treatment (10%), and calcification was found in 13 either during or after treatment (10%). Eight children (6%) had fits, and in six of the eight there were changes in white matter or calcification on the scans. Comparison of the two radiotherapy dosages showed no difference in the incidence of abnormalities seen on computed tomography, fits, or serial IQ measurements, but children receiving intramuscular methotrexate had a higher incidence of calcification and a lower mean IQ at one year than those who received the drug orally, although this difference was not apparent later. Younger children were more likely to develop changes on computed tomograms and fits, and to have low IQs on completion of treatment, with changes most apparent in those less than 2 years of age. There were highly significant correlations between abnormalities on computed tomography, fits, and IQ. These findings confirm the neurological vulnerability of younger children with acute lymphoblastic leukaemia, show an association between abnormalities on computed tomography and intellectual deficit, and suggest that methotrexate is more toxic when given intramuscularly than orally. They provide no evidence that 18 Gy of cranial irradiation is less toxic than 24 Gy, and indicate the need for alternative treatment regimens.

21 patients (10 male, 11 female) aged between 11 months and 29 years with Shwachman's syndrome are reviewed. All patients had exocrine pancreatic insufficiency. Haematological features included neutropenia in 19 (95%), anaemia in 10 (50%), and thrombocytopenia in 14 (70%); one patient developed erythroleukaemia. Severe infections occurred in 17 (85%) from which 3 (15%) died. Only one child exceeded the 3rd centile for height, and growth retardation was particularly evident in the older patients. All had skeletal abnormalities or delayed skeletal maturation, or both. Metaphyseal dyschondroplasia affected 13 of the older patients and was associated with skeletal deformities. Eight of 9 children under 2 1/2 years had rib abnormalities. Respiratory function tests in children under 2 years demonstrated reduced thoracic gas volume and chest wall compliance. Older patients had reduced forced expiratory volume and forced vital capacity. Neurological assessment showed developmental retardation or reduced IQ assessments, or both, in 85% of patients studied. Other neurological abnormalities included hypotonia, deafness, and retinitis pigmentosa. Neonatal problems had been present in 16 (80%) of the patients and 5 were of low birthweights. Hepatomegaly with biochemical evidence of liver involvement occurred in the younger patients and resolved with age. Other associated features included dental abnormalities, renal dysfunction, an icthyotic maculopapular rash in 13 (65%), delayed puberty, diabetes mellitus, and various dysmorphic features. These findings stress the diverse manifestations of the syndrome and extend knowledge on a number of aspects. Sibship segregation ratios support an autosomal mode of inheritance and an hypothesis for the pathophysiological basis of this syndrome is advanced.