Clinical factors associated with the non-utilization of an anaesthesia incident reporting system

Background Incident reporting is a widely recommended method to measure undesirable events in anaesthesia. Under-utilization is a major weakness of voluntary incident reporting systems. Little is known about factors influencing reporting practices, particularly the clinical environment, anaesthesia team composition, severity of the incident, and perceived risk of litigation. The purpose of this study was to assess each of these, using an existing anaesthesia database. Methods We performed a retrospective cohort study and analysed 46 207 surgical patients. We used multivariate analysis to identify factors associated with the non-utilization of the reporting system. Results We found that in 7022 (15.1%) of the procedures performed, the incident reporting system was not used. Factors associated with the non-use of the system were regional anaesthesia/local anaesthesia, odds ratio (OR) 1.64 [95% confidence interval (CI) 1.03-2.62], emergency procedures OR 1.15 (95% CI: 1.05-1.27), and a consultant anaesthetist working without a trainee, OR 1.71 (95% CI: 1.03-2.82). In contrast, factors such as longer duration of surgery, OR 0.85 (95% CI: 0.76-0.94), the presence of a senior anaesthesia trainee, OR 0.86 (95% CI: 0.81-0.92), and the occurrence of severe complications with a high risk of litigation (i.e. death, nerve injuries) were less associated with a non-use of the reporting system, OR 0.65 (95% CI: 0.44-0.97). Team composition and time of day had no measurable impact on reporting practices. Conclusions Clinical factors play a significant role in the utilization of an anaesthesia incident reporting system and more particularly, severity of complications and higher liability risks which appear more as incentives than barriers to incident reportin

High resolution structural characterisation of laser-induced defect clusters inside diamond

Laser writing with ultrashort pulses provides a potential route for the manufacture of three-dimensional wires, waveguides and defects within diamond. We present a transmission electron microscopy (TEM) study of the intrinsic structure of the laser modifications and reveal a complex distribution of defects. Electron energy loss spectroscopy (EELS) indicates that the majority of the irradiated region remains as $sp^3$ bonded diamond. Electrically-conductive paths are attributed to the formation of multiple nano-scale, $sp^2$-bonded graphitic wires and a network of strain-relieving micro-cracks

INTEGRAL discovery of non-thermal hard X-ray emission from the Ophiuchus cluster

We present the results of deep observations of the Ophiuchus cluster of galaxies with INTEGRAL in the 3-80 keV band. We analyse 3 Ms of INTEGRAL data on the Ophiuchus cluster with the IBIS/ISGRI hard X-ray imager and the JEM-X X-ray monitor. In the X-ray band using JEM-X, we show that the source is extended, and that the morphology is compatible with the results found by previous missions. Above 20 keV, we show that the size of the source is slightly larger than the PSF of the instrument, and is consistent with the soft X-ray morphology found with JEM-X and ASCA. Thanks to the constraints on the temperature provided by JEM-X, we show that the spectrum of the cluster is not well fitted by a single-temperature thermal Bremsstrahlung model, and that another spectral component is needed to explain the high energy data. We detect the high energy tail with a higher detection significance (6.4 sigma) than the BeppoSAX claim (2 sigma). Because of the imaging capabilities of JEM-X and ISGRI, we are able to exclude the possibility that the excess emission comes from very hot regions or absorbed AGN, which proves that the excess emission is indeed of non-thermal origin. Using the available radio data together with the non-thermal hard X-ray flux, we estimate a magnetic field B ~ 0.1-0.2 mu G.Comment: 8 pages, 9 figures, accepted by A&

Cygnus X-3 transition from the ultrasoft to the hard state

Aims: The nature of Cygnus X-3 is still not understood well. This binary system might host a black hole or a neutron star. Recent observations by INTEGRAL have shown that Cygnus X-3 was again in an extremely ultrasoft state. Here we present our analysis of the transition from the ultrasoft state, dominated by blackbody radiation at soft X-rays plus non-thermal emission in the hard X-rays, to the low hard state. Methods: INTEGRAL observed Cyg X-3 six times during three weeks in late May and early June 2007. Data from IBIS/ISGRI and JEM-X1 were analysed to show the spectral transition. Results: During the ultrasoft state, the soft X-ray spectrum is well-described by an absorbed (NH = 1.5E22 1/cm**2) black body model, whereas the X-ray spectrum above 20 keV appears to be extremely low and hard (Gamma = 1.7). During the transition, the radio flux rises to a level of >1 Jy, and the soft X-ray emission drops by a factor of 3, while the hard X-ray emission rises by a factor of 14 and becomes steeper (up to Gamma = 4). Conclusions: The ultrasoft state apparently precedes the emission of a jet, which is apparent in the radio and hard X-ray domain.Comment: 4 pages, 3 figures, accepted for publication as A&A Research Not

Discovery of the INTEGRAL X/Gamma-ray transient IGR J00291+5934: a Comptonised accreting ms pulsar ?

We report the discovery of a high-energy transient with the IBIS/ISGRI detector on board the INTEGRAL observatory. The source, namely IGR J00291+5934, was first detected on 2nd December 2004 in the routine monitoring of the IBIS/ISGRI 20--60 keV images. The observations were conducted during Galactic Plane Scans, which are a key part of the INTEGRAL Core Programme observations. After verifying the basic source behaviour, the discovery was announced on 3rd December. The transient shows a hard Comptonised spectrum, with peak energy release at about 20 keV and a total luminosity of ~ 0.9E36 erg/s in the 5--100 keV range, assuming a distance of 3 kpc. Following the INTEGRAL announcement of the discovery of IGR J00291+5934, a number of observations were made by other instruments. We summarise the results of those observations and, together with the INTEGRAL data, identifiy IGR J00291+5934 as the 6th member of a class of accreting X-ray millisecond pulsars.Comment: Accepted for publication as an A&A Letter 24/01/2005. 5 pages, 2 figure

Very Extended X-ray and H-alpha Emission in M82: Implications for the Superwind Phenomenon

We discuss the properties and implications of a 3.7x0.9 kpc region of spatially-coincident X-ray and H-alpha emission about 11.6 kpc to the north of the galaxy M82 previously discussed by Devine and Bally (1999). The PSPC X-ray spectrum is fit by thermal plasma (kT=0.80+-0.17 keV) absorbed by only the Galactic foreground column density. We evaluate the relationship of the X-ray/H-alpha ridge to the M82 superwind. The main properties of the X-ray emission can all be explained as being due to shock-heating driven as the superwind encounters a massive ionized cloud in the halo of M82. This encounter drives a slow shock into the cloud, which contributes to the excitation of the observed H-alpha emission. At the same time, a fast bow-shock develops in the superwind just upstream of the cloud, and this produces the observed X-ray emission. This interpretation would imply that the superwind has an outflow speed of roughly 800 km/s, consistent with indirect estimates based on its general X-ray properties and the kinematics of the inner kpc-scale region of H-alpha filaments. The gas in the M82 ridge is roughly two orders-of-magnitude hotter than the minimum "escape temperature" at this radius, so this gas will not be retained by M82. (abridged)Comment: 24 pages (latex), 3 figures (2 gif files and one postscript), accepted for publication in Part 1 of The Astrophysical Journa

The Asymmetric Wind in M82

We have obtained detailed imaging Fabry-Perot observations of the nearby galaxy M82, in order to understand the physical association between the high-velocity outflow and the starburst nucleus. The observed velocities of the emitting gas in M82 reveal a bipolar outflow of material, originating from the bright starburst regions in the galaxy's inner disk, but misaligned with respect to the galaxy spin axis. The deprojected outflow velocity increases with radius from 525 to 655 km/s. Spectral lines show double components in the centers of the outflowing lobes, with the H-alpha line split by ~300 km/s over a region almost a kiloparsec in size. The filaments are not simple surfaces of revolution, nor is the emission distributed evenly over the surfaces. We model these lobes as a composite of cylindrical and conical structures, collimated in the inner ~500 pc but expanding at a larger opening angle of ~25 degrees beyond that radius. We compare our kinematic model with simulations of starburst-driven winds in which disk material surrounding the source is entrained by the wind. The data also reveal a remarkably low [NII]/H-alpha ratio in the region of the outflow, indicating that photoionization by the nuclear starburst may play a significant role in the excitation of the optical filament gas, particularly near the nucleus.Comment: 42 pages AASTeX with 16 figures; accepted for publication in ApJ; figures reformatted for better printin

INTEGRAL and XMM-Newton observations of the weak GRB 030227

We present INTEGRAL and XMM-Newton observations of the prompt gamma-ray emission and the X-ray afterglow of GRB030227, the first GRB for which the quick localization obtained with the INTEGRAL Burst Alert System (IBAS) has led to the discovery of X-ray and optical afterglows. GRB030227 had a duration of about 20 s and a peak flux of 1.1 photons cm^-2 s^-1 in the 20-200 keV energy range. The time averaged spectrum can be fit by a single power law with photon index about 2 and we find some evidence for a hard to soft spectral evolution. The X-ray afterglow has been detected starting only 8 hours after the prompt emission, with a 0.2-10 keV flux decreasing as t^-1 from 1.3x10e-12 to 5x10e-13 erg cm^-2 s^-1. The afterglow spectrum is well described by a power law with photon index 1.94+/-0.05 modified by a redshifted neutral absorber with column density of several 10e22 cm^-2. A possible emission line at 1.67 keV could be due to Fe for a redshift z=3, consistent with the value inferred from the absorption.Comment: 16 pages, 5 figures, latex, Accepted for publication in The Astrophysical Journal Letter

Integral results on GRB030320: a long gamma-ray burst detected at the edge of the field of view

GRB030320 is the 5th Gamma-ray burst (GRB) detected by INTEGRAL in the field of view (FoV). It is so far the GRB with the largest off-axis angle with respect to the INTEGRAL pointing direction, near to the edge of the FoV of both main instruments, IBIS and SPI. Nevertheless, it was possible to determine its position and to extract spectra and fluxes. The GRB nature of the event was confirmed by an IPN triangulation. It is a ~ 60 s long GRB with two prominent peaks separated by ~ 35 s. The spectral shape of the GRB is best represented by a single power law with a photon index Gamma ~ 1.7. The peak flux in the 20 - 200 keV band is determined to ~ 5.7 photons cm-2 s-1 and the GRB fluence to 1.1 x 10-5 erg cm-2. Analysing the spectral evolution of the GRB, a ``hard-to-soft'' behaviour emerges. A search for an optical counterpart has been carried out, but none was found.Comment: 5 pages, 3 figures. Accepted for publication in A&AL (INTEGRAL issue

Quasar Spectral Slope Variability in the Optical Band

We performed a new analysis of B and R light curves of a sample of PG quasars. We confirm the variability-redshift correlation and its explanation in terms of spectral variability, coupled with the increase of rest-frame observing frequency for quasars at high redshift. The analysis of the instantaneous spectral slope for the whole quasar samples indicates both an inter-QSO and intra-QSO variability-luminosity correlation. Numerical simulations show that the latter correlation cannot be entirely due to the addition of the host galaxy emission to a nuclear spectrum of variable luminosity but constant shape, implying a spectral variability of the nuclear component. Changes of accretion rate are also insufficient to explain the amount of spectral variation, while hot spots possibly caused by local disk instabilities can explain the observations.Comment: 20 pages, 6 figures, to appear in Ap.J., January 200