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BACKGROUND: Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay. METHODS: We performed a prospective, observational questionnaire survey in hospitalized patients with LRTI as part of a multicenter trial. Treating physicians and nurses, patients and their relatives were asked on admission and before discharge about feasibility of outpatient treatment over 5 dimensions (medical, nursing, organizational factors, and patients' and relatives' preferences) using continuous scales. RESULTS: On admission, 12.6% of physicians, 15.1% of nurses, 18.0% of patients and 5.2% of relatives believed that outpatient treatment would be possible. Before hospital discharge, 31.1% of physicians, 32.2% of nurses, 11.6% of patients and 4.1% of relatives thought that earlier discharge would have been feasible. Medical factors were the most frequently perceived motives for inpatient management. These perceptions were similar in all LRTI subgroups and independent of disease severity and associated expected mortality risks as assessed by the Pneumonia Severity Index (PSI). CONCLUSION: Independent of type and severity of respiratory tract infection, the misperceived high severity and expected mortality and morbidity were the predominant reasons why treating physicians, nurses, patients and their relatives unanimously believed that inpatient management was necessary. Better assessment and communication about true expected medical risks might contribute to a pathway to shorten in-hospital days and to introduce a more risk-targeted and individually tailored allocation of health-care resources. TRIAL REGISTRATION: NCT00350987. ispartof: BMC Pulmonary Medicine vol:10 issue:1 ispartof: location:England status: published

The CLIC study of a high-energy (0.5 - 5 TeV), high-luminosity (1034 - 1035 cm-2 sec-1) e+e- linear collider is presented. Beam acceleration using high frequency (30 GHz) normal-conducting structures operating at high accelerating fields (150 MV/m) significantly reduces the length and, in consequence, the cost of the linac. Using parameters derived from general scaling laws for linear colliders, the beam stability is shown to be similar to lower frequency designs in spite of the strong wake-field dependency on frequency. A new cost-effective and efficient drive beam generation scheme for RF power production by the so-called "Two-Beam Acceleration" method is described. It uses a thermionic gun and a fully-loaded normal-conducting linac operating at low frequency (937 MHz) to generate and accelerate the drive beam bunches, and RF multiplication by funnelling in compressor rings to produce the desired bunch structure. Recent 30 GHz hardware developments and CLIC Test Facility (CTF) results are described.

The tracking of particles in accelerating structures is presented for cases where the effects of the wake-fields are high. This is particularly the case when the structures are used with high current and relatively low energy as in the drive beam of the Compact Linear Collider Test Facility (CTF 2) with its 3 GHz accelerator and its 30 GHz decelerator. High initial energy spread and transverse wake-fields may impair the beam stability and generate particle loss. The CTF modelling is made with the code PARMELA for the 3 GHz part of the beam line, which includes 3 GHz accelerating sections and a magnetic bunch compressor. For the part containing the 30 GHz power-extracting structures, simulations are done with WAKE, a new algorithm dealing with the effects of the wake-field modes 0 and 1, as well as of the group velocity. Beam transmission through the overall beam line is studied, and results are compared with measurements made on the CTF beam.

The Compact Linear Collider (CLIC) Test Facility (CTF II) at CERN has recently demonstrated Two-Beam power production and acceleration at 30 GHz. With 41 MW of 30 GHz power produced in 14 ns pulses at a repetition rate of 5 Hz, the main beam has been accelerated by 28 MeV with fields of 59 MV/m. The 30 GHz RF power is extracted in low impedance decelerating structures from a low-energy, high-current "drive beam" which runs parallel to the main beam. The average current in the drive-beam train is 25 A, while the peak current exceeds 2 kA. Crosschecks between measured drive-beam charge, 30 GHz power and main-beam energy gain are in good agreement. In this paper, some relevant experimental and technical issues on drive-beam generation, two-beam power production and acceleration are presented.

The second phase of the Compact LInear Collider (CLIC) Test Facility (CTF II) at CERN has demon-strated the feasibility of two-beam acceleration at 30 GHz using a high-charge drive beam, running paral lel to the main beam, as the RF power source. To date accelerating gradients of 59 MV/m at 30 GHz have been achieved. In CTF II, the two beams are generated by 3 GHz RF photo-injectors and are acceler ated in 3 GHz linacs, before injection into the 30 GHz modules. The drive beam linac has to accelerate a 16 ns long train of 48 bunches, each with a nominal charge of 13.4 nC. To cope with the very su bstantial beam-loading special accelerating structures are used (running slightly off the bunch repetition frequency). A magnetic chicane compresses the bunches to less than 5 ps fwhm, this is needed for efficient 30 GHz power generation. The 30 GHz modules are fully-engineered representative sections of CLIC, they include a 30 GHz decelerator for the drive beam, a 30 GHz accelerator for the main beam, high resolution BPM's and a wire-based active align-ment system. The performance achieved so far, as well as the operational experience with the first accelerator of this type, are reported.

For the drive beam generation of the CLIC Test Facility, a RF photo electron gun is required to generate a charge of 1 uC in a train of 48 bunches. The extracted beam energy of 6.5 J leads to a pronounced decrease of the field gradient, causing strong variations in the transverse and longitudinal beam dynamics. The drop in beam momentum yields a variation in focusing of the following solenoid leading to a blow-up of the transversal emittance. A second effect is the change of the bunch spacing caused by differing bunch velocities. These effects are to a large extent determined by the beam loading in the first cell, which contains the photo cathode. In order to reduce this effect with moderate expense of RF power, a new gun design has been developed using a TM02 resonance in the first cell followed by two standard TM01 cells. Beam simulations show that with this gun, the overall change in the longitudinal bunch spacing can be strongly reduced. Also the chromatic effects in the solenoid due to the drop in longitudinal momentum are partially compensated.