The optimal balance between quality and efficiency in proton radiography imaging technique at various proton beam energies: A Monte Carlo study.

Proton radiography is a novel imaging modality that allows direct measurement of the proton energy loss in various tissues. Currently, due to the conversion of so-called Hounsfield units from X-ray Computed Tomography (CT) into relative proton stopping powers (RPSP), the uncertainties of RPSP are 3-5% or higher, which need to be minimized down to 1% to make the proton treatment plans more accurate. In this work, we simulated a proton radiography system, with position-sensitive detectors (PSDs) and a residual energy detector (RED). The simulations were built using Geant4, a Monte Carlo simulation toolkit. A phantom, consisting of several materials was placed between the PSDs of various Water Equivalent Thicknesses (WET), corresponding to an ideal detector, a gaseous detector, silicon and plastic scintillator detectors. The energy loss radiograph and the scattering angle distributions of the protons were studied for proton beam energies of 150MeV, 190MeV and 230MeV. To improve the image quality deteriorated by the multiple Coulomb scattering (MCS), protons with small angles were selected. Two ways of calculating a scattering angle were considered using the proton's direction and position. A scattering angle cut of 8.7mrad was applied giving an optimal balance between quality and efficiency of the radiographic image. For the three proton beam energies, the number of protons used in image reconstruction with the direction method was half the number of protons kept using the position method.

Perception of patient safety differs by clinical area and discipline.

BACKGROUND: Current thinking about patient safety emphasizes the relationship between organizational factors, that is, latent risk factors (LRFs) and patient safety. This study explores the influence of the operating theatre (OT), intensive care unit (ICU), and disciplines on ratings of LRFs. If we have an understanding of the contribution made by these factors, we can identify significant points from which we can promote a safe environment. METHODS: Staff in four university hospitals were sent a survey relating to the state of LRFs, which included communication, planning and coordination, design, maintenance, equipment, teamwork, team instructions, housekeeping, situational awareness, hierarchy, and procedures. RESULTS: The ICU staff had more favourable perceptions of training, communication, team instruction, and hierarchy. The OT staff had more favourable perceptions of technical LRFs. We found three profiles for disciplines: (i) anaesthetists and intensivists had more favourable perceptions of technical LRFs than surgeons and nurses. (ii) Anaesthetists, anaesthesia nurse-technicians, and recovery nurses had a poorer perception of non-technical skills. (iii) Anaesthesia nurse-technicians and recovery nurses had less favourable perceptions of procedures, housekeeping, and situational awareness than anaesthetists and intensivists. CONCLUSIONS: As healthcare focuses its safety efforts towards system issues rather than towards the individual provider of care, attention has turned to organizational factors, known as LRFs. Understanding how LRFs affect safety should enable us to design more effective measures that will improve overall safety. Strategies for improving patient safety should be tailored specifically for various clinical areas and disciplines.

Observation of excited Λ(b)(0) baryons.

Using pp collision data corresponding to 1.0 fb(-1) integrated luminosity collected by the LHCb detector, two narrow states are observed in the Λ(b)(0)π(+)π(-) spectrum with masses 5911.97±0.12(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2) and 5919.77±0.08(stat)±0.02(syst)±0.66(Λ(b)(0) mass) MeV/c(2). The significances of the observations are 5.2 and 10.2 standard deviations, respectively. These states are interpreted as the orbitally excited Λ(b)(0) baryons, Λ(b)(*0)(5912) and Λ(b)(*0)(5920).

First evidence of direct CP violation in charmless two-body decays of Bs0 mesons.

Using a data sample corresponding to an integrated luminosity of 0.35 fb-1 collected by LHCb in 2011, we report the first evidence of CP violation in the decays of Bs0} mesons to K±π∓ pairs, ACP(Bs0→Kπ)=0.27±0.08(stat)±0.02(syst), with a significance of 3.3σ. Furthermore, we report the most precise measurement of CP violation in the decays of B0 mesons to K±π∓ pairs, ACP(B0→Kπ)=-0.088±0.011(stat)±0.008(syst), with a significance exceeding 6σ.

Strong constraints on the rare decays B(s)(0) → µ+ µ- and B0 → µ+ µ-.

A search for B(s)(0) → µ+ µ- and B0 → µ+ µ decays is performed using 1.0 fb(-1) of pp collision data collected at sqrt[s] = 7 TeV with the LHCb experiment at the Large Hadron Collider. For both decays, the number of observed events is consistent with expectation from background and standard model signal predictions. Upper limits on the branching fractions are determined to be B(B(s)(0) → µ+ µ-) < 4.5(3.8)×10(-9) and B(B0 → µ+ µ-) < 1.0(0.81)×10(-9) at 95% (90%) confidence level.

Determination of the sign of the decay width difference in the B(s)(0) system.

The interference between the K+ K- S-wave and P-wave amplitudes in B(s)(0) → J/ψK+ K- decays with the K+ K- pairs in the region around the ϕ(1020) resonance is used to determine the variation of the difference of the strong phase between these amplitudes as a function of K+ K- invariant mass. Combined with the results from our CP asymmetry measurement in B(s)(0) → J/ψϕ decays, we conclude that the B(s)(0) mass eigenstate that is almost CP = +1 is lighter and decays faster than the mass eigenstate that is almost CP = -1. This determines the sign of the decay width difference ΔΓ(s) ≡ Γ(L) - Γ(H) to be positive. Our result also resolves the ambiguity in the past measurements of the CP violating phase ϕ(s) to be close to zero rather than π. These conclusions are in agreement with the standard model expectations.

First observation of the decay B(c)+ → J/ψπ(+) π- π+.

The decay B(c)(+) → J/ψπ(+) π(-) π(+) is observed for the first time, using 0.8 fb(-1) of pp collisions at sqrt[s] = 7 TeV collected by the LHCb experiment. The ratio of branching fractions B(B(c)(+) → J/ψπ(+) π(-) π(+))/B(B(c)(+)→J/ψπ^{+}) is measured to be 2.41 ± 0.30 ± 0.33, where the first uncertainty is statistical and the second is systematic. The result is in agreement with theoretical predictions.

First observation of the decays B(0) → D(+)K(-)π(+)π(-) and B(-) → D(0)K(-)π(+)π(-).

First observations of the Cabibbo-suppressed decays B(0) → D(+)K(-)π(+)π(-) and B(-) → D(0)K(-)π(+)π(-) are reported using 35 pb(-1) of data collected with the LHCb detector. Their branching fractions are measured with respect to the corresponding Cabibbo-favored decays, from which we obtain B(B(0) → D(+)K(-)π(+)π(-))/B(B(0) → D(+)π(-)π(+)π(-))=(5.9±1.1±0.5)×10(-2) and B(B(-) → D(0)K(-)π(+)π(-))/B(B(-) → D(0)π(-)π(+)π(-))=(9.4±1.3±0.9)×10(-2), where the uncertainties are statistical and systematic, respectively. The B(-) → D(0)K(-)π(+)π(-) decay is particularly interesting, as it can be used in a similar way to B(-) → D(0)K(-) to measure the Cabibbo-Kobayashi-Maskawa phase γ.

Differential branching fraction and angular analysis of the decay B0 → K*0 µ+ µ-.

The angular distributions and the partial branching fraction of the decay B0 → K*0 µ+ µ- are studied by using an integrated luminosity of 0.37 fb(-1) of data collected with the LHCb detector. The forward-backward asymmetry of the muons, A(FB), the fraction of longitudinal polarization, F(L), and the partial branching fraction dB/dq2 are determined as a function of the dimuon invariant mass. The measurements are in good agreement with the standard model predictions and are the most precise to date. In the dimuon invariant mass squared range 1.00-6.00 GeV2/c4, the results are A(FB)=-0.06(-0.14)(+0.13)±0.04, F(L)=0.55±0.10±0.03, and dB/dq2=(0.42±0.06±0.03)×10(-7) c4/GeV2. In each case, the first error is statistical and the second systematic.

Observation of B(s)(0) → J/ψf(2)'(1525) in J/ψK+ K- final states.

The decay B(s)(0) → J/ψK+ K- is investigated using 0.16 fb(-1) of data collected with the LHCb detector using 7 TeV pp collisions. Although the J/ψϕ channel is well known, final states at higher K+ K- masses have not previously been studied. In the K+ K- mass spectrum we observe a significant signal in the f(2)'(1525) region as well as a nonresonant component. After subtracting the nonresonant component, we find B(B(s)(0) → J/ψf(2)'(1525))/B(B(s)(0) → J/ψϕ) = (26.4 ± 2.7 ± 2.4)%.

Evidence for CP violation in time-integrated D0→h(-)h(+) decay rates.

A search for time-integrated CP violation in D(0)→h(-)h(+) (h=K, π) decays is presented using 0.62 fb(-1) of data collected by LHCb in 2011. The flavor of the charm meson is determined by the charge of the slow pion in the D(*+)→D(0)π(+) and D(*-)→D[over ¯](0)π(-) decay chains. The difference in CP asymmetry between D(0)→K(-)K(+) and D(0)→π(-)π(+), ΔA(CP)≡A(CP)(K(-)K(+))-A(CP)(π(-)π(+)), is measured to be [-0.82±0.21(stat)±0.11(syst)]%. This differs from the hypothesis of CP conservation by 3.5 standard deviations.

Search for lepton number violating decays B+ → π- µ+ µ+ and B+ → K- µ+ µ+.

A search is performed for the lepton number violating decay B+ → h- µ+ µ+, where h- represents a K- or a π-, using an integrated luminosity of 36 pb(-1) of data collected with the LHCb detector. The decay is forbidden in the standard model but allowed in models with a Majorana neutrino. No signal is observed in either channel and limits of B(B+ → K- µ+ µ+) < 5.4×10(-8) and B(B+ → π- µ+ µ+) < 5.8×10(-8) are set at the 95% confidence level. These improve the previous best limits by factors of 40 and 30, respectively.

Measurement of the CP-violating phase ϕ(s) in the decay B(s)(0) → J/ψϕ.

We present a measurement of the time-dependent CP-violating asymmetry in B(s)(0) → J/ψϕ decays, using data collected with the LHCb detector at the LHC. The decay time distribution of B(s)(0) → J/ψϕ is characterized by the decay widths Γ(H) and Γ(L) of the heavy and light mass eigenstates, respectively, of the B(s)(0) - B(s)(0) system and by a CP-violating phase ϕ(s). In a sample of about 8500 B(s)(0) → J/ψϕ events isolated from 0.37 fb(-1) of pp collisions at sqrt[s] = 7 TeV, we measure ϕ(s) = 0.15 ± 0.18(stat) ± 0.06(syst) rad. We also find an average B(s)(0) decay width Γ(s) ≡ (Γ(L) + Γ(H))/2 = 0.657 ± 0.009(stat) ± 0.008(syst) ps(-1) and a decay width difference ΔΓ(s) ≡ Γ(L) - Γ(H) = 0.123 ± 0.029(stat) ± 0.011(syst) ps(-1). Our measurement is insensitive to the transformation (ϕ(s),ΔΓ(s)) ↦ (π - ϕ(s), -ΔΓ(s)).

Opposite-side flavour tagging of B mesons at the LHCb experiment.

The calibration and performance of the opposite-side flavour tagging algorithms used for the measurements of time-dependent asymmetries at the LHCb experiment are described. The algorithms have been developed using simulated events and optimized and calibrated with B+→J/ψK+, B0→J/ψK∗0 and B0→D∗-µ+νµ decay modes with 0.37 fb-1 of data collected in pp collisions at [Formula: see text] during the 2011 physics run. The opposite-side tagging power is determined in the B+→J/ψK+ channel to be (2.10±0.08±0.24) %, where the first uncertainty is statistical and the second is systematic.

Measurement of ϒ production in pp collisions at [Formula: see text].

The production of ϒ(1S), ϒ(2S) and ϒ(3S) mesons in proton-proton collisions at the centre-of-mass energy of [Formula: see text] is studied with the LHCb detector. The analysis is based on a data sample of 25 pb-1 collected at the Large Hadron Collider. The ϒ mesons are reconstructed in the decay mode ϒ→µ+µ- and the signal yields are extracted from a fit to the µ+µ- invariant mass distributions. The differential production cross-sections times dimuon branching fractions are measured as a function of the ϒ transverse momentum pT and rapidity y, over the range pT <15 GeV/c and 2.0

Measurement of ψ(2S) meson production in pp collisions at [Formula: see text].

The differential cross-section for the inclusive production of ψ(2S) mesons in pp collisions at [Formula: see text] has been measured with the LHCb detector. The data sample corresponds to an integrated luminosity of 36 pb-1. The ψ(2S) mesons are reconstructed in the decay channels ψ(2S)→µ+µ- and ψ(2S)→J/ψπ+π-, with the J/ψ meson decaying into two muons. Results are presented both for promptly produced ψ(2S) mesons and for those originating from b-hadron decays. In the kinematic range pT(ψ(2S))≤16 GeV/c and 2

Measurement of relative branching fractions of B decays to ψ(2S) and J/ψ mesons.

The relative rates of B-meson decays into J/ψ and ψ(2S) mesons are measured for the three decay modes in pp collisions recorded with the LHCb detector. The ratios of branching fractions ([Formula: see text]) are measured to be [Formula: see text] where the third uncertainty is from the ratio of the ψ(2S) and J/ψ branching fractions to µ+µ-.

Determination of f(s)/f(d) for 7 TeV pp collisions and measurement of the B0→D-K+ branching fraction.

The relative abundance of the three decay modes B(0)→D(-)K(+), B(0)→D(-)π(+), and B(s)(0)→D(s)(-)π(+) produced in 7 TeV pp collisions at the LHC is determined from data corresponding to an integrated luminosity of 35 pb(-1). The branching fraction of B(0)→D(-)K(+) is found to be B(B(0)→D(-)K(+)) = (2.01 ± 0.18(stat) ± 0.14(syst)) × 10(-4). The ratio of fragmentation fractions f(s)/f(d) is determined through the relative abundance of B(s)(0)→D(s)(-)π(+) to B(0)→D(-)K(+) and B(0)→D(-)π(+), leading to f(s)/f(d) = 0.253 ± 0.017 ± 0.017 ± 0.020, where the uncertainties are statistical, systematic, and theoretical, respectively.

Patient safety: latent risk factors.

The person-centred analysis and prevention approach has long dominated proposals to improve patient safety in healthcare. In this approach, the focus is on the individual responsible for making an error. An alternative is the systems-centred approach, in which attention is paid to the organizational factors that create precursors for individual errors. This approach assumes that since humans are fallible, systems must be designed to prevent humans from making errors or to be tolerant to those errors. The questions raised by this approach might, for example, include asking why an individual had specific gaps in their knowledge, experience, or ability. The systems approach focuses on working conditions rather than on errors of individuals, as the likelihood of specific errors increases with unfavourable conditions. Since the factors that promote errors are not directly visible in the working environment, they are described as latent risk factors (LRFs). Safety failures in anaesthesia, in particular, and medicine, in general, result from multiple unfavourable LRFs, so we propose that effective interventions require that attention is paid to interactions between multiple factors and actors. Understanding how LRFs affect safety can enable us to design more effective control measures that will impact significantly on both individual performance and patient outcomes.

Patient's satisfaction with perioperative care: development, validation, and application of a questionnaire.

BACKGROUND: Measuring patient satisfaction after anaesthesia care is complex. The existing patient satisfaction questionnaires are limited and omit aspects of patient satisfaction, such as professional competence, information provision, service, and staff-patient relationship. The aim of our study was to develop a valid and reliable self-reported multidimensional questionnaire assessing patient satisfaction that included these issues. METHODS: The development of the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq) was as follows: expert consultation, construction of the pilot questionnaire, pilot study, statistical analysis of the results of the pilot study (validity, reliability, and factor analysis), compilation of the definitive questionnaire, main study, and repeated statistical analysis (validity, reliability, and factor analysis). The overall patient satisfaction is expressed by the mean satisfaction score. RESULTS: Three hundred and eighty-two patients consented to participate in the study; 80.4% of the patients (n=307) completed the questionnaire. The LPPSq isolated three dimensions: information (Cronbach's alpha=0.82), fear and concern (Cronbach's alpha=0.69), and staff-patient relationship (Cronbach's alpha=0.94). Patient satisfaction with perioperative care was not directly dependent on the outcomes of anaesthesia but how patients were approached and the amount of information they received. Age (P=0.001), gender (P=0.001), work situation (P=0.003), and specialty (P=0.017) were the characteristics most influencing patient satisfaction. CONCLUSIONS: We developed the LPPSq questionnaire to measure patient satisfaction with perioperative care, of which anaesthesia care is an important element. In this study, information provision and the relationship between staff and patient were the major determinants of patient satisfaction.