Nurse led care

What's the difference between medical and nursing care? The answer is not straightforward, but shortages in the medical workforce mean that nurses are increasingly called on to undertake work that was previously done by doctors (such as undertaking surgery,1 prescribing drugs, performing triage in emergency departments), whereas shortages in the nursing workforce mean that healthcare assistants now do many tasks that nurses are trained to do. This fluidity in professional roles and competencies enables the health workforce to respond to need, but are outcomes for patients being improved? Do these benefits come at an additional cost, and if so, are they worth paying for

CO J = 3→2 and J = 2→1 mapping and spectroscopy of NGC 7027

We present spectra and mapping for NGC 7072 in the J = 3→2 and J = 2→1 transitions of CO. The central profile at J = 2→1 is shown to be very similar to the J = 1→0 spectrum measured by Thronson (1983), and this implies a source expansion at roughly constant velocity. The J = 3→2 line however appears weaker, with evidence for appreciable quenching of the higher velocity components. Detailed modelling f the source indicates that densities n must vary appreciably with shell radius R(as nα R-a, where α≥2), and this leads to a corresponding steep radial decrease in the radiation temperature TR. In consequence, the source FWHM is found to decrease appreciably iwth increasing transition frequency, a trend which appears also to be confirmed by our central J = 3→2 scans. It is not however possible to constrain gas kinetic tempertures TK, the level of CO thermalisation, or shell mass M with any degree of confidence - both low and high mass models appear capable of replicating our spectra. Finally, the J = 2→1 spatial velocity map displays evidence for a decrease in velocity width towards the outer regions of the nebula; a feature which is expected of most outflow models. The J = 3→2 map also indicates the presence of a nebular extension to the north-west of the peak emission core, although this is not reproduced in the corresponding J = 1→0 map of Mufson et al. (1975)

A high resolution millimetre and submillimetre study of W3

The continuum bolometer receiver on the James Clerk Maxwell telescope has been used to map the dense core of the star formation region W3 with a spatial resolution of 15-20 arcsec. At 350 and 800 μm, the region appears as two principal peaks around the known IR sources IRS4 and IRS5, while at 1100 μm, a further peak is noted which is interpreted as being due to free-free emission around IRS2. Taking into account the free-free contribution to the intensity, the continuum dust emission from the region is found to be consistent with optically thin emission at all of the three wavelengths considered. Values for the dust optical depth, hydrogen column density, mass, and central density have been obtained for each of the main peaks

Economic evaluation of a nursing-led intermediate care unit

Objectives: The aim of this paper is to examine the costs of introducing a nursing-led ward program together with examining the impact this may have on patients' outcomes. Methods; The study had a sample size of 177 patients with a mean age of 77, and randomized to either a treatment group (care on a nursing-led ward, n = 97) or a control group (standard care usually on a consultant-led acute ward, n = 80). Resource use data including length of stay, tests and investigations performed, and multidisciplinary involvement in care were collected. Results: There were no significant differences in outcome between the two groups. The inpatient costs for the treatment group were significantly higher, due to the longer length of stay in this group. However, the postdischarge costs were significantly lower for the treatment group. Conclusions: The provision of nursing-led intermediate care units has been proposed as a solution to inappropriate use of acute medical wards by patients who require additional nursing rather than medical care. Whether the treatment group is ultimately cost-additive is dependent on how long reductions in postdischarge resource use are maintained

Particle Acceleration and Magnetic Field Generation in Electron-Positron Relativistic Shocks

Shock acceleration is an ubiquitous phenomenon in astrophysical plasmas. Plasma waves and their associated instabilities (e.g., Buneman, Weibel and other two-stream instabilities) created in collisionless shocks are responsible for particle (electron, positron, and ion) acceleration. Using a 3-D relativistic electromagnetic particle (REMP) code, we have investigated particle acceleration associated with a relativistic electron-positron jet front propagating into an ambient electron-positron plasma with and without initial magnetic fields. We find small differences in the results for no ambient and modest ambient magnetic fields. New simulations show that the Weibel instability created in the collisionless shock front accelerates jet and ambient particles both perpendicular and parallel to the jet propagation direction. Furthermore, the non-linear fluctuation amplitudes of densities, currents, electric, and magnetic fields in the electron-positron shock are larger than those found in the electron-ion shock studied in a previous paper at the comparable simulation time. This comes from the fact that both electrons and positrons contribute to generation of the Weibel instability. Additionally, we have performed simulations with different electron skin depths. We find that growth times scale inversely with the plasma frequency, and the sizes of structures created by the Weibel instability scale proportional to the electron skin depth. This is the expected result and indicates that the simulations have sufficient grid resolution. The simulation results show that the Weibel instability is responsible for generating and amplifying nonuniform, small-scale magnetic fields which contribute to the electron's (positron's) transverse deflection behind the jet head.Comment: 18 pages, 8 figures, revised and accepted for ApJ, A full resolution of the paper can be found at http://gammaray.nsstc.nasa.gov/~nishikawa/apjep1.pd

Particle Acceleration in Relativistic Jets due to Weibel Instability

Shock acceleration is an ubiquitous phenomenon in astrophysical plasmas. Plasma waves and their associated instabilities (e.g., the Buneman instability, two-streaming instability, and the Weibel instability) created in the shocks are responsible for particle (electron, positron, and ion) acceleration. Using a 3-D relativistic electromagnetic particle (REMP) code, we have investigated particle acceleration associated with a relativistic jet front propagating through an ambient plasma with and without initial magnetic fields. We find only small differences in the results between no ambient and weak ambient magnetic fields. Simulations show that the Weibel instability created in the collisionless shock front accelerates particles perpendicular and parallel to the jet propagation direction. While some Fermi acceleration may occur at the jet front, the majority of electron acceleration takes place behind the jet front and cannot be characterized as Fermi acceleration. The simulation results show that this instability is responsible for generating and amplifying highly nonuniform, small-scale magnetic fields, which contribute to the electron's transverse deflection behind the jet head. The ``jitter'' radiation (Medvedev 2000) from deflected electrons has different properties than synchrotron radiation which is calculated in a uniform magnetic field. This jitter radiation may be important to understanding the complex time evolution and/or spectral structure in gamma-ray bursts, relativistic jets, and supernova remnants.Comment: ApJ, in press, Sept. 20, 2003 (figures with better resolution: http://gammaray.nsstc.nasa.gov/~nishikawa/apjweib.pdf

Particle Acceleration and Radiation associated with Magnetic Field Generation from Relativistic Collisionless Shocks

Shock acceleration is an ubiquitous phenomenon in astrophysical plasmas. Plasma waves and their associated instabilities (e.g., the Buneman instability, two-streaming instability, and the Weibel instability) created in the shocks are responsible for particle (electron, positron, and ion) acceleration. Using a 3-D relativistic electromagnetic particle (REMP) code, we have investigated particle acceleration associated with a relativistic jet front propagating through an ambient plasma with and without initial magnetic fields. We find only small differences in the results between no ambient and weak ambient magnetic fields. Simulations show that the Weibel instability created in the collisionless shock front accelerates particles perpendicular and parallel to the jet propagation direction. The simulation results show that this instability is responsible for generating and amplifying highly nonuniform, small-scale magnetic fields, which contribute to the electron's transverse deflection behind the jet head. The ``jitter'' radiation from deflected electrons has different properties than synchrotron radiation which is calculated in a uniform magnetic field. This jitter radiation may be important to understanding the complex time evolution and/or spectral structure in gamma-ray bursts, relativistic jets, and supernova remnants.Comment: 4 pages, 1 figure, submitted to Proceedings of 2003 Gamma Ray Burst Conferenc

Near infrared spectroscopy of W51 IRS-2

Near-infrared spectra at 2.95-3.5 μm and 3.99-10 μm have been obtained towards W51 IRS-2 and its surroundings, in order to investigate the spatial variations in intensity of the 3.28 μm unidentified feature and the 4.05 μm Brackett-α line. The Br-α and 3.28 μm features occupy a broadly similar spatial zone, which is characterised by an unresolved core responsible for most of the emission, and an extended and considerably weaker halo. Grain properties required to excite the 4.28 microns line, the nature of the 3.28 μm emission, and its relation to the source structure are discussed

Particle acceleration, magnetic field generation, and emission in relativistic pair jets

Shock acceleration is a ubiquitous phenomenon in astrophysical plasmas. Plasma waves and their associated instabilities (e.g., Buneman, Weibel and other two-stream instabilities) created in collisionless shocks are responsible for particle (electron, positron, and ion) acceleration. Using a 3-D relativistic electromagnetic particle (REMP) code, we have investigated particle acceleration associated with a relativistic jet front propagating into an ambient plasma. We find that the growth times of Weibel instability are proportional to the Lorentz factors of jets. Simulations show that the Weibel instability created in the collisionless shock front accelerates jet and ambient particles both perpendicular and parallel to the jet propagation direction.Comment: 4 pages, 2 figures, submitted to Il nuovo cimento (4th Workshop Gamma-Ray Bursts in the Afterglow Era, Rome, 18-22 October 2004