Exploring the causes of adverse events in hospitals and potential prevention strategies

Objectives To examine the causes of adverse events (AEs) and potential prevention strategies to minimise the occurrence of AEs in hospitalised patients. Methods For the 744 AEs identified in the patient record review study in 21 Dutch hospitals, trained reviewers were asked to select all causal factors that contributed to the AE. The results were analysed together with data on preventability and consequences of AEs. In addition, the reviewers selected one or more prevention strategies for each preventable AE. The recommended prevention strategies were analysed together with four general causal categories: technical, human, organisational and patient-related factors. Results Human causes were predominantly involved in the causation of AEs (in 61% of the AEs), 61% of those being preventable and 13% leading to permanent disability. In 39% of the AEs, patient-related factors were involved, in 14% organisational factors and in 4% technical factors. Organisational causes contributed relatively often to preventable AEs (93%) and AEs resulting in permanent disability (20%). Recommended strategies to prevent AEs were quality assurance/peer review, evaluation of safety behaviour, training and procedures. For the AEs with human and patient-related causes, reviewers predominantly recommended quality assurance/peer review. AEs caused by organisational factors were considered preventable by improving procedures. Discussion Healthcare interventions directed at human causes are recommended because these play a large role in AE causation. In addition, it seems worthwhile to direct interventions on organisational causes because the AEs they cause are nearly always believed to be preventable. Organisational factors are thus relatively easy to tackle. Future research designs should allow researchers to interview healthcare providers that were involved in the event, as an additional source of information on contributing factors.

Stereotactic ablative body radiotherapy combined with immunotherapy: Present status and future perspectives

Radiotherapy is along with surgery and chemotherapy one of the prime treatment modalities in cancer. It is applied in the primary, neoadjuvant as well as the adjuvant setting. Radiation techniques have rapidly evolved during the past decade enabling the delivery of high radiation doses, reducing side-effects in tumour-adjacent normal tissues. While increasing local tumour control, current and future efforts ought to deal with microscopic disease at a distance of the primary tumour, ultimately responsible for disease-progression. This review explores the possibility of bimodal treatment combining radiotherapy with immunotherapy

Overconstrained estimates of neutrinoless double beta decay within the QRPA

Estimates of nuclear matrix elements for neutrinoless double beta decay (0nu2beta) based on the quasiparticle random phase approximations (QRPA) are affected by theoretical uncertainties, which can be substantially reduced by fixing the unknown strength parameter g_pp of the residual particle-particle interaction through one experimental constraint - most notably through the two-neutrino double beta decay (2nu2beta) lifetime. However, it has been noted that the g_pp adjustment via 2\nu2\beta data may bring QRPA models in disagreement with independent data on electron capture (EC) and single beta decay (beta^-) lifetimes. Actually, in two nuclei of interest for 0nu2beta decay (Mo-100 and Cd-116), for which all such data are available, we show that the disagreement vanishes, provided that the axial vector coupling g_A is treated as a free parameter, with allowance for g_A<1 (``strong quenching''). Three independent lifetime data (2nu2beta, EC, \beta^-) are then accurately reproduced by means of two free parameters (g_pp, g_A), resulting in an overconstrained parameter space. In addition, the sign of the 2nu2beta matrix element M^2nu is unambiguously selected (M^2nu>0) by the combination of all data. We discuss quantitatively, in each of the two nuclei, these phenomenological constraints and their consequences for QRPA estimates of the 0nu2beta matrix elements and of their uncertainties.Comment: Revised version (27 pages, including 10 figures), focussed on Mo-100 and Cd-116. To appear in J. Phys. G: Nucl. Phys. (2008

Measurement of the Gamow-Teller Strength Distribution in 58Co via the 58Ni(t,3He) reaction at 115 MeV/nucleon

Electron capture and beta decay play important roles in the evolution of pre-supernovae stars and their eventual core collapse. These rates are normally predicted through shell-model calculations. Experimentally determined strength distributions from charge-exchange reactions are needed to test modern shell-model calculations. We report on the measurement of the Gamow-Teller strength distribution in 58Co from the 58Ni(t,3He) reaction with a secondary triton beam of an intensity of ~10^6 pps at 115 MeV/nucleon and a resolution of \~250 keV. Previous measurements with the 58Ni(n,p) and the 58Ni(d,2He) reactions were inconsistent with each other. Our results support the latter. We also compare the results to predictions of large-scale shell model calculations using the KB3G and GXPF1 interactions and investigate the impact of differences between the various experiments and theories in terms of the weak rates in the stellar environment. Finally, the systematic uncertainties in the normalization of the strength distribution extracted from 58Ni(3He,t) are described and turn out to be non-negligible due to large interferences between the dL=0, dS=1 Gamow-Teller amplitude and the dL=2, dS=1 amplitude.Comment: 14 pages, 8 figure

Фінансовий контролінг як інструмент управління діяльністю суб'єкта господарювання

PURPOSE: Multiple imaging techniques are nowadays available for clinical in-vivo visualization of tumour biology. FDG PET/CT identifies increased tumour metabolism, hypoxia PET visualizes tumour oxygenation and dynamic contrast-enhanced (DCE) CT characterizes vasculature and morphology. We explored the relationships among these biological features in patients with non-small-cell lung cancer (NSCLC) at both the patient level and the tumour subvolume level. METHODS: A group of 14 NSCLC patients from two ongoing clinical trials (NCT01024829 and NCT01210378) were scanned using FDG PET/CT, HX4 PET/CT and DCE CT prior to chemoradiotherapy. Standardized uptake values (SUV) in the primary tumour were calculated for the FDG and hypoxia HX4 PET/CT scans. For hypoxia imaging, the hypoxic volume, fraction and tumour-to-blood ratio (TBR) were also defined. Blood flow and blood volume were obtained from DCE CT imaging. A tumour subvolume analysis was used to quantify the spatial overlap between subvolumes. RESULTS: At the patient level, negative correlations were observed between blood flow and the hypoxia parameters (TBR >1.2): hypoxic volume (−0.65, p = 0.014), hypoxic fraction (−0.60, p = 0.025) and TBR (−0.56, p = 0.042). At the tumour subvolume level, hypoxic and metabolically active subvolumes showed an overlap of 53 ± 36 %. Overlap between hypoxic sub-volumes and those with high blood flow and blood volume was smaller: 15 ± 17 % and 28 ± 28 %, respectively. Half of the patients showed a spatial mismatch (overlap <5 %) between increased blood flow and hypoxia. CONCLUSION: The biological imaging features defined in NSCLC tumours showed large interpatient and intratumour variability. There was overlap between hypoxic and metabolically active subvolumes in the majority of tumours, there was spatial mismatch between regions with high blood flow and those with increased hypoxia. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00259-015-3169-4) contains supplementary material, which is available to authorized users

Measurement of eta photoproduction on the proton from threshold to 1500 MeV

Beam asymmetry and differential cross section for the reaction gamma+p->eta+p were measured from production threshold to 1500 MeV photon laboratory energy. The two dominant neutral decay modes of the eta meson, eta->2g and eta->3pi0, were analyzed. The full set of measurements is in good agreement with previously published results. Our data were compared with three models. They all fit satisfactorily the results but their respective resonance contributions are quite different. The possible photoexcitation of a narrow state N(1670) was investigated and no evidence was found.Comment: 18 pages, 14 figures, 4 tables Submitted to EPJ

Low-lying level structure of 56^{56}Cu and its implications on the rp process

The low-lying energy levels of proton-rich $^{56}$Cu have been extracted using in-beam $\gamma$-ray spectroscopy with the state-of-the-art $\gamma$-ray tracking array GRETINA in conjunction with the S800 spectrograph at the National Superconducting Cyclotron Laboratory at Michigan State University. Excited states in $^{56}$Cu serve as resonances in the $^{55}$Ni(p,$\gamma$)$^{56}$Cu reaction, which is a part of the rp-process in type I x-ray bursts. To resolve existing ambiguities in the reaction Q-value, a more localized IMME mass fit is used resulting in $Q=639\pm82$~keV. We derive the first experimentally-constrained thermonuclear reaction rate for $^{55}$Ni(p,$\gamma$)$^{56}$Cu. We find that, with this new rate, the rp-process may bypass the $^{56}$Ni waiting point via the $^{55}$Ni(p,$\gamma$) reaction for typical x-ray burst conditions with a branching of up to $\sim$40$\%$. We also identify additional nuclear physics uncertainties that need to be addressed before drawing final conclusions about the rp-process reaction flow in the $^{56}$Ni region.Comment: 8 pages, accepted for Phys. Rev.

Noncommutative Differential Forms on the kappa-deformed Space

We construct a differential algebra of forms on the kappa-deformed space. For a given realization of the noncommutative coordinates as formal power series in the Weyl algebra we find an infinite family of one-forms and nilpotent exterior derivatives. We derive explicit expressions for the exterior derivative and one-forms in covariant and noncovariant realizations. We also introduce higher-order forms and show that the exterior derivative satisfies the graded Leibniz rule. The differential forms are generally not graded-commutative, but they satisfy the graded Jacobi identity. We also consider the star-product of classical differential forms. The star-product is well-defined if the commutator between the noncommutative coordinates and one-forms is closed in the space of one-forms alone. In addition, we show that in certain realizations the exterior derivative acting on the star-product satisfies the undeformed Leibniz rule.Comment: to appear in J. Phys. A: Math. Theo

Beta-delayed proton emission in the 100Sn region

Beta-delayed proton emission from nuclides in the neighborhood of 100Sn was studied at the National Superconducting Cyclotron Laboratory. The nuclei were produced by fragmentation of a 120 MeV/nucleon 112Sn primary beam on a Be target. Beam purification was provided by the A1900 Fragment Separator and the Radio Frequency Fragment Separator. The fragments of interest were identified and their decay was studied with the NSCL Beta Counting System (BCS) in conjunction with the Segmented Germanium Array (SeGA). The nuclei 96Cd, 98Ing, 98Inm and 99In were identified as beta-delayed proton emitters, with branching ratios bp = 5.5(40)%, 5.5+3 -2%, 19(2)% and 0.9(4)%, respectively. The bp for 89Ru, 91,92Rh, 93Pd and 95Ag were deduced for the first time with bp = 3+1.9 -1.7%, 1.3(5)%, 1.9(1)%, 7.5(5)% and 2.5(3)%, respectively. The bp = 22(1)% for 101Sn was deduced with higher precision than previously reported. The impact of the newly measured bp values on the composition of the type-I X-ray burst ashes was studied.Comment: 15 pages, 14 Figures, 4 Table