“Quality teaches you how to use water. It doesn’t provide a water pump”: a qualitative study of context and mechanisms of action in an Ethiopian quality improvement program

Background Quality improvement collaboratives are a common approach to bridging the quality-of-care gap, but little is known about implementation in low-income settings. Implementers rarely consider mechanisms of change or the role of context, which may explain collaboratives’ varied impacts. Methods To understand mechanisms and contextual influences we conducted 55 in-depth interviews with staff from four health centres and two hospitals involved in quality improvement collaboratives in Ethiopia. We also generated control charts for selected indicators to explore any impacts of the collaboratives. Results The cross facility learning sessions increased the prominence and focus on quality, allowed learning from experts and peers and were motivational through public recognition of success or a desire to emulate peers. Within facilities, new structures and processes were created. These were fragile and sometimes alienating to those outside the improvement team. The trusted and respected mentors were important for support, motivation and accountability. Where mentor visits were infrequent or mentors less skilled, team function was impacted. These mechanisms were more prominent, and quality improvement more functional, in facilities with strong leadership and pre-existing good teamwork; as staff had shared goals, an active approach to problems and were more willing and able to be flexible to implement change ideas. Quality improvement structures and processes were more likely to be internally driven and knowledge transferred to other staff in these facilities, which reduced the impact of staff turnover and increased buy-in. In facilities which lacked essential inputs, staff struggled to see how the collaborative could meaningfully improve quality and were less likely to have functioning quality improvement. The unexpected civil unrest in one region strongly disrupted the health system and the collaborative. These contextual issues were fluid, with multiple interactions and linkages. Conclusions The study confirms the need to carefully consider context in the implementation of quality improvement collaboratives. Facilities that implement quality improvement successfully may be those that already have characteristics that foster quality. Quality improvement may be alienating to those outside of the improvement team and implementers should not assume the organic spread or transfer of quality improvement knowledge

New pixelized Micromegas detector with low discharge rate for the COMPASS experiment

New Micromegas (Micro-mesh gaseous detectors) are being developed in view of the future physics projects planned by the COMPASS collaboration at CERN. Several major upgrades compared to present detectors are being studied: detectors standing five times higher luminosity with hadron beams, detection of beam particles (flux up to a few hundred of kHz/mm^{2}, 10 times larger than for the present Micromegas detectors) with pixelized read-out in the central part, light and integrated electronics, and improved robustness. Two solutions of reduction of discharge impact have been studied, with Micromegas detectors using resistive layers and using an additional GEM foil. Performance of such detectors has also been measured. A large size prototypes with nominal active area and pixelized read-out has been produced and installed at COMPASS in 2010. In 2011 prototypes featuring an additional GEM foil, as well as an resistive prototype, are installed at COMPASS and preliminary results from those detectors presented very good performance. We present here the project and report on its status, in particular the performance of large size prototypes with an additional GEM foil.Comment: 11 pages, 5 figures, proceedings to the Micro-Pattern Gaseous Detectors conference (MPGD2011), 29-31 August 2011, Kobe, Japa

A new approach to calculate the gluon polarization

We derive the Leading-Order master equation to extract the polarized gluon distribution G(x;Q^2) = x \deltag(x;Q^2) from polarized proton structure function, g1p(x;Q^2). By using a Laplace-transform technique, we solve the master equation and derive the polarized gluon distribution inside the proton. The test of accuracy which are based on our calculations with two different methods confirms that we achieve to the correct solution for the polarized gluon distribution. We show that accurate experimental knowledge of g1p(x;Q^2) in a region of Bjorken x and Q^2, is all that is needed to determine the polarized gluon distribution in that region. Therefore, to determine the gluon polarization \deltag /g,we only need to have accurate experimental data on un-polarized and polarized structure functions (F2p (x;Q^2) and g1p(x;Q^2)).Comment: 12 pages, 5 figure

Characteristics of air showers created by extremely high energy gamma-rays

The technique of adjoint cascade equations has been applied to calculate the properties of extremely high energy gamma-rays in the energy range 10^18--10^22 eV with taking into account the LPM effect and interactions of gamma-rays with the geomagnetic field. Such characteristics are analysed as the electron and muon contents at the observation level, the electron cascade curves, the lateral distribution functions of photoproduced muons.Comment: 36 pages, 19 figures, submitted to J.Phys.G: Nucl.Part.Phy

The COMPASS Experiment at CERN

The COMPASS experiment makes use of the CERN SPS high-intensitymuon and hadron beams for the investigation of the nucleon spin structure and the spectroscopy of hadrons. One or more outgoing particles are detected in coincidence with the incoming muon or hadron. A large polarized target inside a superconducting solenoid is used for the measurements with the muon beam. Outgoing particles are detected by a two-stage, large angle and large momentum range spectrometer. The setup is built using several types of tracking detectors, according to the expected incident rate, required space resolution and the solid angle to be covered. Particle identification is achieved using a RICH counter and both hadron and electromagnetic calorimeters. The setup has been successfully operated from 2002 onwards using a muon beam. Data with a hadron beam were also collected in 2004. This article describes the main features and performances of the spectrometer in 2004; a short summary of the 2006 upgrade is also given.Comment: 84 papes, 74 figure

Leading order determination of the gluon polarisation from DIS events with high-p_T hadron pairs

We present a determination of the gluon polarisation Delta g/g in the nucleon, based on the longitudinal double-spin asymmetry of DIS events with a pair of large transverse-momentum hadrons in the final state. The data were obtained by the COMPASS experiment at CERN using a 160 GeV/c polarised muon beam scattering off a polarised ^6LiD target. The gluon polarisation is evaluated by a Neural Network approach for three intervals of the gluon momentum fraction x_g covering the range 0.04 < x_g < 0.27. The values obtained at leading order in QCD do not show any significant dependence on x_g. Their average is Delta g/g = 0.125 +/- 0.060 (stat.) +/- 0.063 (syst.) at x_g=0.09 and a scale of mu^2 = 3 (GeV/c)^2.Comment: 13 pages, 6 figures and 3 table