The CUORE cryostat: an infrastructure for rare event searches at millikelvin temperatures

The CUORE experiment is the world's largest bolometric experiment. The detector consists of an array of 988 TeO2 crystals, for a total mass of 742 kg. CUORE is presently taking data at the Laboratori Nazionali del Gran Sasso, Italy, searching for the neutrinoless double beta decay of 130Te. A large custom cryogen-free cryostat allows reaching and maintaining a base temperature of about 10 mK, required for the optimal operation of the detector. This apparatus has been designed in order to achieve a low noise environment, with minimal contribution to the radioactive background for the experiment. In this paper, we present an overview of the CUORE cryostat, together with a description of all its sub-systems, focusing on the solutions identified to satisfy the stringent requirements. We briefly illustrate the various phases of the cryostat commissioning and highlight the relevant steps and milestones achieved each time. Finally, we describe the successful cooldown of CUORE

Criteria for clinical audit of women friendly care and providers' perception in Malawi

Background There are two dimensions of quality of maternity care, namely quality of health outcomes and quality as perceived by clients. The feasibility of using clinical audit to assess and improve the quality of maternity care as perceived by women was studied in Malawi. Objective We sought to (a) establish standards for women friendly care and (b) explore attitudinal barriers which could impede the proper implementation of clinical audit. Methods We used evidence from Malawi national guidelines and World Health Organisation manuals to establish local standards for women friendly care in three districts. We equally conducted a survey of health care providers to explore their attitudes towards criterion based audit. Results The standards addressed different aspects of care given to women in maternity units, namely (i) reception, (ii) attitudes towards women, (iii) respect for culture, (iv) respect for women, (v) waiting time, (vi) enabling environment, (vii) provision of information, (viii) individualised care, (ix) provision of skilled attendance at birth and emergency obstetric care, (x) confidentiality, and (xi) proper management of patient information. The health providers in Malawi generally held a favourable attitude towards clinical audit: 100.0% (54/54) agreed that criterion based audit will improve the quality of care and 92.6% believed that clinical audit is a good educational tool. However, there are concerns that criterion based audit would create a feeling of blame among providers (35.2%), and that manager would use clinical audit to identify and punish providers who fail to meet standards (27.8%). Conclusion Developing standards of maternity care that are acceptable to, and valued by, women requires consideration of both the research evidence and cultural values. Clinical audit is acceptable to health professionals in Malawi although there are concerns about its negative implications to the providers

Search for Neutrinoless Double-Beta Decay of 130^{130}Te with CUORE-0

We report the results of a search for neutrinoless double-beta decay in a 9.8~kg$\cdot$yr exposure of $^{130}$Te using a bolometric detector array, CUORE-0. The characteristic detector energy resolution and background level in the region of interest are $5.1\pm 0.3{\rm~keV}$ FWHM and $0.058 \pm 0.004\,(\mathrm{stat.})\pm 0.002\,(\mathrm{syst.})$~counts/(keV$\cdot$kg$\cdot$yr), respectively. The median 90%~C.L. lower-limit sensitivity of the experiment is $2.9\times 10^{24}~{\rm yr}$ and surpasses the sensitivity of previous searches. We find no evidence for neutrinoless double-beta decay of $^{130}$Te and place a Bayesian lower bound on the decay half-life, $T^{0\nu}_{1/2}>$~$2.7\times 10^{24}~{\rm yr}$ at 90%~C.L. Combining CUORE-0 data with the 19.75~kg$\cdot$yr exposure of $^{130}$Te from the Cuoricino experiment we obtain $T^{0\nu}_{1/2} > 4.0\times 10^{24}~\mathrm{yr}$ at 90%~C.L.~(Bayesian), the most stringent limit to date on this half-life. Using a range of nuclear matrix element estimates we interpret this as a limit on the effective Majorana neutrino mass, $m_{\beta\beta}< 270$ -- $760~\mathrm{meV}$.Comment: 6 pages, 5 figures, updated version as published in PR

Analysis Techniques for the Evaluation of the Neutrinoless Double-Beta Decay Lifetime in 130^{130}Te with CUORE-0

We describe in detail the methods used to obtain the lower bound on the lifetime of neutrinoless double-beta ($0\nu\beta\beta$) decay in $^{130}$Te and the associated limit on the effective Majorana mass of the neutrino using the CUORE-0 detector. CUORE-0 is a bolometric detector array located at the Laboratori Nazionali del Gran Sasso that was designed to validate the background reduction techniques developed for CUORE, a next-generation experiment scheduled to come online in 2016. CUORE-0 is also a competitive $0\nu\beta\beta$ decay search in its own right and functions as a platform to further develop the analysis tools and procedures to be used in CUORE. These include data collection, event selection and processing, as well as an evaluation of signal efficiency. In particular, we describe the amplitude evaluation, thermal gain stabilization, energy calibration methods, and the analysis event selection used to create our final $0\nu\beta\beta$ decay search spectrum. We define our high level analysis procedures, with emphasis on the new insights gained and challenges encountered. We outline in detail our fitting methods near the hypothesized $0\nu\beta\beta$ decay peak and catalog the main sources of systematic uncertainty. Finally, we derive the $0\nu\beta\beta$ decay half-life limits previously reported for CUORE-0, $T^{0\nu}_{1/2}>2.7\times10^{24}$ yr, and in combination with the Cuoricino limit, $T^{0\nu}_{1/2}>4.0\times10^{24}$ yr.Comment: 18 pages, 18 figures. (Version 3 reflects only minor changes to the text. Few additional details, no major content changes.

Measurement of the Two-Neutrino Double Beta Decay Half-life of 130^{130}Te with the CUORE-0 Experiment

We report on the measurement of the two-neutrino double beta decay half-life of $^{130}$Te with the CUORE-0 detector. From an exposure of 33.4 kg$\cdot$y of TeO$_2$, the half-life is determined to be $T_{1/2}^{2\nu}$ = [8.2 $\pm$ 0.2 (stat.) $\pm$ 0.6 (syst.)] $\times$ 10$^{20}$y. This result is obtained after a detailed reconstruction of the sources responsible for the CUORE-0 counting rate, with a specific study of those contributing to the $^{130}$Te neutrinoless double beta decay region of interest.Comment: Corrected typo in section 9: 3.43E5 Bq/kg should have read 3.43E-5 Bq/k

Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

BACKGROUND: Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. METHODS: This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. RESULTS: Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1). CONCLUSION: The predictors of progression from severe maternal morbidity to mortality were: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community

Reduction of Severe Acute Maternal Morbidity and Maternal Mortality in Thyolo District, Malawi: The Impact of Obstetric Audit

BACKGROUND: Critical incident audit and feedback are recommended interventions to improve the quality of obstetric care. To evaluate the effect of audit at district level in Thyolo, Malawi, we assessed the incidence of facility-based severe maternal complications (severe acute maternal morbidity (SAMM) and maternal mortality) during two years of audit and feedback. METHODOLOGY/PRINCIPAL FINDINGS: Between September 2007 and September 2009, we included all cases of maternal mortality and SAMM that occurred in Thyolo District Hospital, the main referral facility in the area, using validated disease-specific criteria. During two- to three-weekly audit sessions, health workers and managers identified substandard care factors. Resulting recommendations were implemented and followed up. Feedback was given during subsequent sessions. A linear regression analysis was performed on facility-based severe maternal complications. During the two-year study period, 386 women were included: 46 died and 340 sustained SAMM, giving a case fatality rate of 11.9%. Forty-five cases out of the 386 inclusions were audited in plenary with hospital staff. There was a reduction of 3.1 women with severe maternal complications per 1000 deliveries in the district health facilities, from 13.5 per 1000 deliveries in the beginning to 10.4 per 1000 deliveries at the end of the study period. The incidence of uterine rupture and major obstetric hemorrhage reduced considerably (from 3.5 to 0.2 and from 5.9 to 2.6 per 1000 facility deliveries respectively). CONCLUSIONS: Our findings indicate that audit and feedback have the potential to reduce serious maternal complications including maternal mortality. Complications like major hemorrhage and uterine rupture that require relatively straightforward intrapartum emergency management are easier to reduce than those which require uptake of improved antenatal care (eclampsia) or timely intravenous medication or HIV-treatment (peripartum infections)

A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project

BACKGROUND: Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system. METHODS: From October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees. RESULTS: A total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage. CONCLUSION: Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care

Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review

Contains fulltext : 80429.pdf (publisher's version ) (Open Access)BACKGROUND: Improving health workers' performance is vital for achieving the Millennium Development Goals. In the literature on human resource management (HRM) interventions to improve health workers' performance in Low and Middle Income Countries (LMIC), hardly any attention has been paid to the question how HRM interventions might bring about outcomes and in which contexts. Such information is, however, critical to assess the transferability of results. Our aim was to explore if realist review of published primary research provides better insight into the functioning of HRM interventions in LMIC. METHODOLOGY: A realist review not only asks whether an intervention has shown to be effective, but also through which mechanisms an intervention produces outcomes and which contextual factors appear to be of critical influence. Forty-eight published studies were reviewed. Results : The results show that HRM interventions can improve health workers' performance, but that different contexts produce different outcomes. Critical implementation aspects were involvement of local authorities, communities and management; adaptation to the local situation; and active involvement of local staff to identify and implement solutions to problems. Mechanisms that triggered change were increased knowledge and skills, feeling obliged to change and health workers' motivation. Mechanisms to contribute to motivation were health workers' awareness of local problems and staff empowerment, gaining acceptance of new information and creating a sense of belonging and respect. In addition, staff was motivated by visible improvements in quality of care and salary supplements. Only a limited variety of HRM interventions have been evaluated in the health sector in LMIC. Assumptions underlying HRM interventions are usually not made explicit, hampering our understanding of how HRM interventions work. CONCLUSION: Application of a realist perspective allows identifying which HRM interventions might improve performance, under which circumstances, and for which groups of health workers. To be better able to contribute to an understanding of how HRM interventions could improve health workers' performance, a combination of qualitative and quantitative research methods would be needed and the use of common indicators for evaluation and a common reporting format would be required