Measurement of the Atmospheric Muon Spectrum from 20 to 3000 GeV

The absolute muon flux between 20 GeV and 3000 GeV is measured with the L3 magnetic muon spectrometer for zenith angles ranging from 0 degree to 58 degree. Due to the large exposure of about 150 m2 sr d, and the excellent momentum resolution of the L3 muon chambers, a precision of 2.3 % at 150 GeV in the vertical direction is achieved. The ratio of positive to negative muons is studied between 20 GeV and 500 GeV, and the average vertical muon charge ratio is found to be 1.285 +- 0.003 (stat.) +- 0.019 (syst.).Comment: Total 32 pages, 9Figure

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life

School organizational culture: The peak of research in the context of neoliberal policies

Inscrita numa matriz teórica multirreferencial, a problemática da cultura organizacional tem sido objecto de múltiplos desenvolvimentos conceptuais e diversificadas apropriações políticas e ideológicas. No campo da educação e no contexto mais específico das organizações escolares, as abordagens culturais e simbólicas sofreram algumas inflexões teóricas apenas compreensíveis quando contextualizadas no quadro mais global das políticas internacionais de cariz neoliberal e neoconservador. Neste trabalho, procura-se reflectir criticamente sobre a forma como a problemática da cultura organizacional em contexto escolar passa a ser (re)perspectivada numa altura em que se expandem alguns objectivos e valores políticos associados às ideologias da modernização e da racionalização. Num segundo momento, tomando como ponto de partida a análise de um vasto número de investigações integradas em quatro bases de dados electrónicas de âmbito internacional, debatemos as principais tendências teóricas, conceptuais e metodológicas deste campo de estudo, fazendo sobressair o lugar e o estatuto da escola enquanto contexto privilegiado de investigação, designadamente nos domínios crítico-reflexivos.Within a multi-referential theoretical framework, the issue of organizational culture has been a subject for multiple conceptual developments and different ideological and political appropriations. In the field of education and in the specific context of school organizations, the cultural and symbolic approaches were subjected to some theoretical inflections. These can only be understood in the global framework of international policies of neoliberal and neoconservative nature. First, this paper critically discusses how the issue of organizational culture in school context was put in perspectives at a time when some political-ideological objectives and values were associated to modernization and rationalization ideologies. Based on the analysis of a great number of researches included in four electronic databases with an international scope, it then discusses the main theoretical, conceptual and methodological trends of this field of study, stressing the place and statute of school as a privileged research context, namely in the reflexive and critical domain.info:eu-repo/semantics/publishedVersio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries