824 research outputs found

    Gamma-Ray Constraints on Maximum Cosmogenic Neutrino Fluxes and UHECR Source Evolution Models

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    The dip model assumes that the ultra-high energy cosmic rays (UHECRs) above 1018^{18} eV consist exclusively of protons and is consistent with the spectrum and composition measure by HiRes. Here we present the range of cosmogenic neutrino fluxes in the dip-model which are compatible with a recent determination of the extragalactic very high energy (VHE) gamma-ray diffuse background derived from 2.5 years of Fermi/LAT data. We show that the largest fluxes predicted in the dip model would be detectable by IceCube in about 10 years of observation and are within the reach of a few years of observation with the ARA project. In the incomplete UHECR model in which protons are assumed to dominate only above 1019^{19} eV, the cosmogenic neutrino fluxes could be a factor of 2 or 3 larger. Any fraction of heavier nuclei in the UHECR at these energies would reduce the maximum cosmogenic neutrino fluxes. We also consider here special evolution models in which the UHECR sources are assumed to have the same evolution of either the star formation rate (SFR), or the gamma-ray burst (GRB) rate, or the active galactic nuclei (AGN) rate in the Universe and found that the last two are disfavored (and in the dip model rejected) by the new VHE gamma-ray background.Comment: 19 pages, 16 figures, JHEP3.cls needed to typese

    An Outcome Evaluation of an Evidenced-Based Leadership Framework on Nursing Retention in a Tertiary Medical Center

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    An evidence-based leadership (EBL) framework is an intervention designed to facilitate organizational changes such as the reduction of nursing turnover and the improvement of nursing job enjoyment. This project provides an overview of the effect of nursing turnover on an organization, presents the components of the EBL framework, and provides an evaluation of the influence of EBL on nursing turnover and job enjoyment. The EBL framework provided a method for reducing variance in leadership skill and behavior by outlining specific methods necessary to reduce inconsistency. The project objective was to determine if the implementation of an EBL framework for 820 nursing staff in 10 clinical units at a tertiary medical center improved turnover and job satisfaction, as evidenced by turnover data from the unit-specific dashboards and the National Database of Nursing Quality Indicators (NDNQI) job enjoyment scores. All data were collected retrospectively, pre-implementation to post-implementation of the EBL framework, to determine whether significant improvement occurred in turnover percentages and job enjoyment scores. Results of a t test indicated no statistically significant improvement in turnover percentages or job enjoyment scores 7 months after the implementation of the EBL framework. The nonsignificant results could be attributed to several factors including senior leadership turnover, lack of specific accountability measures for failure to implement the EBL framework (insert comma here) and the restricted time frame of the evaluation period. Despite these nonsignificant results, the evaluation provides a baseline for future longitudinal studies to determine if an EBL framework can influence nursing turnover and job enjoyment after having been in place longer than the 7 months post implementation used for this evaluation

    FDTL voices : drawing from learning and teaching projects

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    This publication draws on insights and experiences from individuals and teams within learning and teaching development projects in higher education. It considers lessons learnt from the processes, outcomes and tangible outputs of the projects across the spectrum of the FDTL initiative, with the intention that colleagues can draw on and benefit from this experience. The overriding theme at the heart of every FDTL project has been the desire to achieve some form of positive and meaningful change at the level of the individual, institution or discipline. The continuing legacy of the programme has been to create wider community involvement as projects have engaged with the higher education sector on multiple levels - personal, institutional, practice, and policy. This publication has remained throughout a collaborative endeavour, supported by Academy colleagues. It is based around the four themes emerging from the initiative as a whole: • Sectoral/Organisational Change • Conceptual Change • Professional and Personal Development Partnership and • Project Managemen

    Modeling Second Order Impacts of Healthcare Innovation

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    Any single health service organization today is likely engaged in dozens of concurrent, often times unrelated change initiatives. Each of these change initiatives is likely supported by evidence that demonstrates the innovation’s intended, first order impact. However, very little attention has been paid to the unintended, second order impacts of innovation. In this dissertation we introduce a model to provide a framework for inquiring about this very type of non-immediate impact. Next, using three innovations currently being implemented in the healthcare industry—training primary care residents to perform in-office colonoscopies, Studer Group’s ‘Evidence Based Leadership,’ and implementation of electronic health records in a hospital-integrated pediatric network—we model the innovations’ second order impacts within the context of our second order impact conceptual model. Cost effectiveness analysis, multiple analysis of variance (MANOVA), and two-level fixed effects modeling are used to across the three interventions. Results from the primary care residency intervention support further investment in colorectal cancer screening training for primary care residents. Results from the Studer Group’s ‘Evidence Based Leadership’ intervention demonstrate mixed results across change interventions and across categories of tenure, suggesting receptivity towards change and organization tenure is highly dependent upon the nuances of a specific change intervention. Finally, results from the implementation of the electronic health record demonstrate improved charge capture. We conclude that this further probing of popular innovations in the industry is warranted for multiple reasons. For one, it is entirely possible that social scientists and economists are prematurely ‘moving on’ to other innovations as soon they have published results from an initial round of inquiry. However, as we will demonstrate in our model, it is conceivable that after the “lights have dimmed” on an innovation’s initial glow, the artifacts of the innovation could very well continue to disrupt structures and processes long after its implementation. If these latent disruptions adversely affect the organization, one could argue that any initial positive impacts were likely overstated. Conversely, if these latent disruptions go on to produce additional benefit to the organization one could argue that any initial positive results were actually understated

    Understanding and Maximising Leadership in Pre-registration Healthcare Curricula: Research Report September 2015

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