Trends of in-hospital cardiac arrests in a single tertiary hospital with a mature rapid response system

Background Most studies on rapid response system (RRS) have simply focused on its role and effectiveness in reducing in-hospital cardiac arrests (IHCAs) or hospital mortality, regardless of the predictability of IHCA. This study aimed to identify the characteristics of IHCAs including predictability of the IHCAs as our RRS matures for 10 years, to determine the best measure for RRS evaluation. Methods Data on all consecutive adult patients who experienced IHCA and received cardiopulmonary resuscitation in general wards between January 2010 and December 2019 were reviewed. IHCAs were classified into three groups: preventable IHCA (P-IHCA), non-preventable IHCA (NP-IHCA), and inevitable IHCA (I-IHCA). The annual changes of three groups of IHCAs were analyzed with Poisson regression models. Results Of a total of 800 IHCA patients, 149 (18.6%) had P-IHCA, 465 (58.1%) had NP-IHCA, and 186 (23.2%) had I-IHCA. The number of the RRS activations increased significantly from 1,164 in 2010 to 1,560 in 2019 (P = 0.009), and in-hospital mortality rate was significantly decreased from 9.20/1,000 patients in 2010 to 7.23/1000 patients in 2019 (P = 0.009). The trend for the overall IHCA rate was stable, from 0.77/1,000 patients in 2010 to 1.06/1,000 patients in 2019 (P = 0.929). However, while the incidence of NP-IHCA (P = 0.927) and I-IHCA (P = 0.421) was relatively unchanged over time, the incidence of P-IHCA decreased from 0.19/1,000 patients in 2010 to 0.12/1,000 patients in 2019 (P = 0.025). Conclusions The incidence of P-IHCA could be a quality metric to measure the clinical outcomes of RRS implementation and maturation than overall IHCAs.

Case Report: High Doses of Intravenous Immunoglobulins as a Successful Treatment for Late Onset Immune Agranulocytosis After Rituximab Plus Bendamustine

Late onset neutropenia (LON) related to rituximab or rituximab plus chemotherapy is defined as an unexplained absolute neutrophil count of ≤1.5 × 109/L starting at least four weeks after the last rituximab administration. LON is infrequent and its pathophysiology remains unknown. There are no guidelines or consensus strategies for the optimal management of patients developing LON. The majority of the patients recover promptly with no specific treatment and only some cases need to be managed with granulocytic colony stimulating factor (G-CSF), usually with a rapid response. Here, we describe a 69-year-old patient with Waldenström’s macroglobulinemia who presented a septic event in the context of severe LON after rituximab plus bendamustine. The diagnosed of agranulocytosis was established by bone marrow examination. Interestingly, anti-neutrophil antibodies bound to the patient’s granulocytes were found suggesting an autoimmune mechanism. The patient did not respond to G-CSF but achieved a rapid response after high doses of intravenous immunoglobulins with full white blood cell recovery.

Rapid response petrology for the opening eruptive phase of the 2021 Cumbre Vieja eruption, La Palma, Canary Islands

How and why magmatic systems reactivate and evolve is a critical question for monitoring and hazard mitigation efforts during initial response and ongoing volcanic crisis management. Here we report the first integrated petrological results and interpretation provided to monitoring authorities during the ongoing eruption of Cumbre Vieja, La Palma, Canary Islands, Spain. The first eruptive products comprised simultaneous Strombolian fountain-fed lava flows and tephra fall from near-continuous eruption plumes. From combined field, petrographic and geochemical analyses conducted in the 10 days following sample collection, we infer low percentage mantle melts with a variably equilibrated multimineralic crystal-cargo and compositional fractionation by winnowing during eruptive processes. Hence ‘rapid response’ petrology can untangle complex magmatic and volcanic processes for this eruption, which combined with further study and methodological improvement can increasingly assist in active decision making.

A Self-powered and Sensitive Terahertz Photodetection based on PdSe2

With the rapid development of terahertz technology, terahertz detectors are expected to play a key role in diverse areas such as homeland security and imaging, materials diagnostics, biology and medical sciences, communication. Whereas self-powered, rapid response, and room temperature terahertz photodetectors are confronted with huge challenges. Here, we report a novel rapid response and self-powered terahertz photothermoelectronic (PTE) photodetector based on a low-dimensional material: palladium selenide (PdSe2). An order of magnitude performance enhancement was observed in photodetection based on PdSe2/graphene heterojunction that resulted from the integration of graphene and enhanced the Seebeck effect. Under 0.1 THz and 0.3 THz irradiation, the device displays a stable and repeatable photoresponse at room temperature without bias. Furthermore, rapid rise (5.0 μs) and decay (5.4 μs) times are recorded under 0.1 THz irradiation. Our results demonstrate the promising prospect of the detector based on PdSe2 in terms of air-stable, suitable sensitivity, and speed, which may have great application in terahertz detection.

Rapid response pathway united to reduce self-harm (RUSH): a case study of a pilot pathway for children and young people

Purpose In response to elevated local self-harm and suicide rates, and the lack of a dedicated pathway for children and young people (CYP) who self-harm, a rapid response pathway united to reduce self-harm (RUSH) was developed and implemented within Norwich (Norfolk, England). This public health case study aims to describe the pathway model and share its outcomes, learnings, and reflections over the pilot year. Design/methodology/approach RUSH was a community-based pilot pathway aiming to support CYP, 11–18 years old, engaging in or at risk of engaging in repeated self-harm and subsequently at risk of repeated attendance at local emergency departments. From May 2020 to April 2021, RUSH supported 61 CYP using funding from NHS England and Improvement. Findings This case study shares the pathway’s outcomes, through a mixed-method evaluation. Results indicate statistically significant reductions in self-harm frequency (p = 0.01) and anxiety and depression symptomatology (p < 0.001); a statistically significant increase in progress towards goals (p < 0.001); and a general downward trend in re-attendance at local emergency departments following RUSH. Findings also illustrate high service user satisfaction. Framework analysis of focus group data highlights positive experiences with hope for recommissioning from a staff perspective. Originality/value This study will be valuable for services looking to develop and implement a similar service provision, in response to the need to tackle self-harm rates as a broader approach to suicide prevention. In light of the NHS long-term plan (2019), it also serves as an example of how to develop and use a strategic co-production group, and work collaboratively with the voluntary, community and social enterprise sectors.