6,075 research outputs found
The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis.
Objectives
To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service.
Methods
Interrupted time-series analysis including all acute NHS trusts in England (n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals.
Results
In one year, Care Quality Commission inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes.
Conclusions
Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced Care Quality Commission inspections slowed after the inspection
All-particle cosmic ray energy spectrum measured by the HAWC experiment from 10 to 500 TeV
We report on the measurement of the all-particle cosmic ray energy spectrum
with the High Altitude Water Cherenkov (HAWC) Observatory in the energy range
10 to 500 TeV. HAWC is a ground based air-shower array deployed on the slopes
of Volcan Sierra Negra in the state of Puebla, Mexico, and is sensitive to
gamma rays and cosmic rays at TeV energies. The data used in this work were
taken from 234 days between June 2016 to February 2017. The primary cosmic-ray
energy is determined with a maximum likelihood approach using the particle
density as a function of distance to the shower core. Introducing quality cuts
to isolate events with shower cores landing on the array, the reconstructed
energy distribution is unfolded iteratively. The measured all-particle spectrum
is consistent with a broken power law with an index of prior to
a break at ) TeV, followed by an index of . The
spectrum also respresents a single measurement that spans the energy range
between direct detection and ground based experiments. As a verification of the
detector response, the energy scale and angular resolution are validated by
observation of the cosmic ray Moon shadow's dependence on energy.Comment: 16 pages, 11 figures, 4 tables, submission to Physical Review
Measurement of the Crab Nebula Spectrum Past 100 TeV with HAWC
We present TeV gamma-ray observations of the Crab Nebula, the standard
reference source in ground-based gamma-ray astronomy, using data from the High
Altitude Water Cherenkov (HAWC) Gamma-Ray Observatory. In this analysis we use
two independent energy-estimation methods that utilize extensive air shower
variables such as the core position, shower angle, and shower lateral energy
distribution. In contrast, the previously published HAWC energy spectrum
roughly estimated the shower energy with only the number of photomultipliers
triggered. This new methodology yields a much improved energy resolution over
the previous analysis and extends HAWC's ability to accurately measure
gamma-ray energies well beyond 100 TeV. The energy spectrum of the Crab Nebula
is well fit to a log parabola shape with emission up to at least 100 TeV. For the first
estimator, a ground parameter that utilizes fits to the lateral distribution
function to measure the charge density 40 meters from the shower axis, the
best-fit values are
=(2.350.04)10 (TeV cm
s), =2.790.02, and
=0.100.01. For the second estimator, a neural
network which uses the charge distribution in annuli around the core and other
variables, these values are
=(2.310.02)10 (TeV cm
s), =2.730.02, and
=0.060.010.02. The first set of uncertainties are statistical;
the second set are systematic. Both methods yield compatible results. These
measurements are the highest-energy observation of a gamma-ray source to date.Comment: published in Ap
Constraining the Ratio in TeV Cosmic Rays with Observations of the Moon Shadow by HAWC
An indirect measurement of the antiproton flux in cosmic rays is possible as
the particles undergo deflection by the geomagnetic field. This effect can be
measured by studying the deficit in the flux, or shadow, created by the Moon as
it absorbs cosmic rays that are headed towards the Earth. The shadow is
displaced from the actual position of the Moon due to geomagnetic deflection,
which is a function of the energy and charge of the cosmic rays. The
displacement provides a natural tool for momentum/charge discrimination that
can be used to study the composition of cosmic rays. Using 33 months of data
comprising more than 80 billion cosmic rays measured by the High Altitude Water
Cherenkov (HAWC) observatory, we have analyzed the Moon shadow to search for
TeV antiprotons in cosmic rays. We present our first upper limits on the
fraction, which in the absence of any direct measurements, provide
the tightest available constraints of on the antiproton fraction for
energies between 1 and 10 TeV.Comment: 10 pages, 5 figures. Accepted by Physical Review
Very high energy particle acceleration powered by the jets of the microquasar SS 433
SS 433 is a binary system containing a supergiant star that is overflowing
its Roche lobe with matter accreting onto a compact object (either a black hole
or neutron star). Two jets of ionized matter with a bulk velocity of
extend from the binary, perpendicular to the line of sight, and
terminate inside W50, a supernova remnant that is being distorted by the jets.
SS 433 differs from other microquasars in that the accretion is believed to be
super-Eddington, and the luminosity of the system is erg
s. The lobes of W50 in which the jets terminate, about 40 pc from the
central source, are expected to accelerate charged particles, and indeed radio
and X-ray emission consistent with electron synchrotron emission in a magnetic
field have been observed. At higher energies (>100 GeV), the particle fluxes of
rays from X-ray hotspots around SS 433 have been reported as flux
upper limits. In this energy regime, it has been unclear whether the emission
is dominated by electrons that are interacting with photons from the cosmic
microwave background through inverse-Compton scattering or by protons
interacting with the ambient gas. Here we report TeV -ray observations
of the SS 433/W50 system where the lobes are spatially resolved. The TeV
emission is localized to structures in the lobes, far from the center of the
system where the jets are formed. We have measured photon energies of at least
25 TeV, and these are certainly not Doppler boosted, because of the viewing
geometry. We conclude that the emission from radio to TeV energies is
consistent with a single population of electrons with energies extending to at
least hundreds of TeV in a magnetic field of ~micro-Gauss.Comment: Preprint version of Nature paper. Contacts: S. BenZvi, B. Dingus, K.
Fang, C.D. Rho , H. Zhang, H. Zho
Performance of fully instrumented detector planes of the forward calorimeter of a Linear Collider detector
Detector-plane prototypes of the very forward calorimetry of a future
detector at an e+e- collider have been built and their performance was measured
in an electron beam. The detector plane comprises silicon or GaAs pad sensors,
dedicated front-end and ADC ASICs, and an FPGA for data concentration.
Measurements of the signal-to-noise ratio and the response as a function of the
position of the sensor are presented. A deconvolution method is successfully
applied, and a comparison of the measured shower shape as a function of the
absorber depth with a Monte-Carlo simulation is given.Comment: 25 pages, 32 figures, revised version following comments from
referee
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