High-energy and high-intensity lasers are essential for pushing the boundaries of science. Their development has allowed leaps forward in basic research areas, including laser–plasma interaction, high-energy density science, metrology, biology and medical technology. The Helmholtz International Beamline for Extreme Fields user consortium contributes and operates two high-peak-power optical lasers using the high energy density instrument at the European X-ray free electron laser (EuXFEL) facility. These lasers will be used to generate transient extreme states of density and temperature to be probed by the X-ray beam. This paper introduces the ReLaX laser, a short-pulse high-intensity Ti:Sa laser system, and discusses its characteristics as available for user experiments. It will also present the first experimental commissioning results validating its successful integration into the EuXFEL infrastructure and viability as a relativistic-intensity laser driver.

Introduction: Acute heart failure (AHF) is a common emergency department (ED) presentation and may be associated with poor outcomes. Conversely, many patients rapidly improve with ED treatment and may not need hospital admission. Because there is little evidence to guide disposition decisions by ED and admitting physicians, we sought to create a risk score for predicting short-term serious outcomes (SSO) in patients with AHF. Methods: We conducted prospective cohort studies at 9 tertiary care hospital EDs from 2007 to 2019, and enrolled adult patients who required treatment for AHF. Each patient was assessed for standardized real-time clinical and laboratory variables, as well as for SSO (defined as death within 30 days or intubation, non-invasive ventilation (NIV), myocardial infarction, coronary bypass surgery, or new hemodialysis after admission). The fully pre-specified, logistic regression model with 13 predictors (age, pCO2, and SaO2 were modeled using spline functions with 3 knots and heart rate and creatinine with 5 knots) was fitted to the 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions and estimated a sample size of 170 SSOs. Results: The 2,246 patients had mean age 77.4 years, male sex 54.5%, EMS arrival 41.1%, IV NTG 3.1%, ED NIV 5.2%, admission on initial visit 48.6%. Overall there were 174 (7.8%) SSOs including 70 deaths (3.1%). The final risk scale is comprised of five variables (points) and had c-statistic of 0.76 (95% CI: 0.73-0.80): 1.Valvular heart disease (1) 2.ED non-invasive ventilation (2) 3.Creatinine 150-300 (1) ≥300 (2) 4.Troponin 2x-4x URL (1) ≥5x URL (2) 5.Walk test failed (2) The probability of SSO ranged from 2.0% for a total score of 0 to 90.2% for a score of 10, showing good calibration. The model was stable over 1,000 bootstrap samples. Choosing a risk model total point admission threshold of >2 would yield a sensitivity of 80.5% (95% CI 73.9-86.1) for SSO with no change in admissions from current practice (48.6% vs 48.7%). Conclusion: Using a large prospectively collected dataset, we created a concise and sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of this risk scoring scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

Introduction: Depending on the time and day of initial Emergency Department (ED) presentation, some patients may require a return to the ED the following day for ultrasound examination. Return visits for ultrasound may be time and resource intensive for both patients and the ED. Qualitative experience suggests that a percentage of return ultrasounds could be performed at a non-ED facility. Our objective was to undertake a retrospective audit of return for ultrasound usage, patterns and outcomes at 2 academic EDs. Methods: A retrospective review of all adult patients returning to the ED for ultrasound at both LHSC ED sites in 2016 was undertaken. Each chart was independently reviewed by two emergency medicine consultants. Charts were assessed for day and time of initial presentation and return, type of ultrasound ordered, and length of ED stay on initial presentation and return visit. Opinion based questions were considered by reviewers, including urgency of diagnosis clarification required, if symptoms were still present on return, and if any medical or surgical treatment or follow up was arranged based on ultrasound results. Agreement between reviewers was assessed. Results: After eliminating charts for which the return visit was not for a scheduled ultrasound examination, 328 patient charts were reviewed. 63% of patients were female and median [IQR] age was 40 years [27-56]. Abdomen/pelvis represented 50% of the ultrasounds; renal 24%; venous Doppler 15.9%. Symptoms were still present and documented in 79% of cases. 22% of cases required a medical intervention and 9% an immediate surgical intervention. 11% of patients were admitted to hospital on their return visit. Outpatient follow-up based on US results was initiated in 29% of cases. Median [IQR] combined LOS was 479.5 minutes [358.5-621.75]. Agreement between reviewers for opinion based questions was poor (63%-96%). Conclusion: Ideally, formal ultrasound should be available on a 24 hour basis for ED patients in order to avoid return visits. A percentage of return for ultrasound examinations do not result in any significant change in treatment. Emergency departments should consider the development of pathways to avoid return visits for follow up ultrasound when possible. The low incidence of surgical treatment in those returning for US suggests that this population could be served in a non-hospital setting. Further research is required to support this conclusion.

Introduction: We previously derived (N = 559) and validated (N = 1,100) the 10-item Ottawa Heart Failure Risk Scale (OHFRS), to assist with disposition decisions for patients with acute heart failure (AHF) in the emergency department (ED). In the current study we sought to use a larger dataset to develop a more concise and more accurate risk scale. Methods: We analyzed data from the prior two studies and from a new cohort. For all 3 groups we conducted prospective cohort studies that enrolled patients who required treatment for AHF at 8 tertiary care hospital EDs. Patients were followed for 30 days. The primary outcome was short-term serious outcome (SSO), defined as death within 30 days, intubation or non-invasive ventilation (NIV) after admission, myocardial infarction, or relapse resulting in hospital admission within 14 days. The fully pre-specified logistic regression model with 13 predictors (where age, pCO2, and SaO2 were modeled using spline functions) was fitted to 10 multiple imputation datasets. Harrell's fast stepdown procedure reduced the number of variables. We calculated the potential impact on sensitivity (95% CI) for SSO and hospital admissions, and estimated a sample size of 2,000 patients. Results: The 1,986 patients had mean age 77.3 years, male 54.1%, EMS arrival 41.2%, IV NTG 3.3%, ED NIV 5.4%, admission on initial visit 49.5%. Overall there were 236 (11.9%) SSOs including 61 deaths (3.1%), meaning that current admission practice sensitivity for SSO was only 59.7%. The final HEARTRISK6 scale is comprised of 6 variables (points) (C-statistic 0.68): Valvular heart disease (2) Antiarrhythmic medication (2) ED non-invasive ventilation (3) Creatinine 80–150 (1); ≥150 (3) Troponin ≥3x URL (2) Walk test failed (1). The probability of SSO ranged from 4.8% for a total score of 0 to 62.4% for a score of 10, showing good calibration. Choosing a HEARTRISK6 total point admission threshold of ≥3 would yield sensitivity of 70.8% (95%CI 64.5-76.5) for SSO with a slight decrease in admissions to 47.9%. Choosing a threshold of ≥2 would yield a sensitivity of 84.3% (95%CI 79.0-88.7) but require 66.6% admissions. Conclusion: Using a large prospectively collected dataset, we created a more concise and more sensitive risk scale to assist with admission decisions for patients with AHF in the ED. Implementation of the HEARTRISK6 scale should lead to safer and more efficient disposition decisions, with more high-risk patients being admitted and more low-risk patients being discharged.

Multilayers consisting of two immiscible components (e.g. Fe/Ag Fe/Au or Ni/NiO) could by transformed by an annealing process into a nanostructured system of non statistically distributed nearly spherical particles in a surrounding matrix of the complementary component. The non statistical arrangement of the particles and the dynamics of the disintegration process strongly depend on the initial interface energy, i.e. the local interface curvature and the local interfacial stress. Detailed microstructure investigations of the different systems are used to interpret the measured transport properties.

Multilayers consisting of two immiscible components (e.g. Fe/Ag Fe/Au or Ni/NiO) could by transformed by an annealing process into a nanostructured system of non statistically distributed nearly spherical particles in a surrounding matrix of the complementary component. The non statistical arrangement of the particles and the dynamics of the disintegration process strongly depend on the initial interface energy, i.e. the local interface curvature and the local interfacial stress. Detailed microstructure investigations of the different systems are used to interpret the measured transport properties.

This research developed new forms of photocatalysts that could potentially move photocatalytic degradation of air contaminants into the main stream of industrially used remediation technologies. Tests of the photocatalytic activity of the TiO2 aerogel catalysts have been carried out using both acetone and methane as the air contaminant. For comparison, the same tests were carried out on a standard (non-aerogel) anatase powder. Despite having very low crystallinity, the aerogel decontaminates the air far more effectively than an equal volume of the anatase powder which indicates that a much larger fraction of the aerogel is activated by the UV light. Experimental data were used to determine adsorption equilibrium constants for acetone, and to determine reaction rate constants assuming a Langmuir-Hinshelwood type rate expression.

Accelerated life testing has long been used to measure the electromigration reliability of integrated circuit (IC) metallization systems. In order to establish or verify electromigration design rules for IC products the measured data is extrapolated over a wide range of operating conditions using phenomenological models. These models assume that the components of the diffusional flux, thermal stress and resulting void morphology are independent of test/operating condition. In this paper, electromigration void morphology and failure criteria are studied over a range of stress conditions and microstructures for non-layered AlCu and AlCuSi metallurgies. The failure criteria, defined as the average change in conductor resistance prior to an open circuit condition, was strongly dependent on test current density. Moreover, the nature of the relationship between failure criteria and current density was governed by the linewidth (W) relative to the median grain size (D50). This dependence can be explained qualitatively in terms of the Blech Effect.

In this paper, experimental results for electromigration void morphology and failure time distribution are presented as a function of test condition, grain size distribution and conductor linewidth. Unpassivated Al-Cu(1.5%)-Si(1.5%) conductors with linewidths in the range lum ≤W ≤l0μm were subjected to accelerated temperature stresses of T=150° C and 250°C and current stresses in the range j= 0.5-4X106 A-cm-2, for each temperature stress. Unlike previous reports, erosion-like voids dominated at all current densities and temperatures for both W/D50≤1 and W/D50 > 1. The void distribution within a line was strongly dependent on test conditions and linewidth. The critical current density was extracted from electromigration lifetimes measured as a function of current density. The results show that the linewidth dependence of electromigration lifetimes depend strongly on the Blech relation.

We have investigated the effects of Cu and Si dopants on electromigration mass transport in Al interconnects for VLSI technology. Four Al alloys with different Cu and Si dopant concentrations (AI-1.5%Cu, AI-1.5%Cu-I.5%Si, AI-0.5%Cu-I.0%Si, and AI-I.O%Cu-I.0%Si) were sputter deposited onto Si substrates covered with 0.55 pRm of Si02 (tetraethylorthosilicate). All metal films were deposited using an MRC903 sputter deposition system to a thickness of 6800Å. Deposition parameters were held constant for each metallurgy, with a base pressure of 7x 10−2 torr, deposition pressure of 102 torr, forward power of 7 Kwatts, and substrate bias of 125 volts. Test structures designed according to National Institute of Standards design guidelines were fabricated in each metallurgy using conventional photolithography and reactive ion etching methods for line widths of 1.0, 1.8, 3.0, 5.0 and 10.0 μm. Accelerated test conditions of T=200°C and DC current density of 2x106 A/cm−2 were used. The results show that electromigration resistance increases with increasing Cu content and decreases as Si content increases. These results are explained in terms of precipitate, grain size distribution, orientation and stress by Transmission Electron Microscopy (TEM) and X-ray Diffraction (XRD). Our results provide a general guideline relating Cu and Si dopant concentrations, film microstructure and the intrinsic reliability of the metallization system.