Magnetic fullerenes inside single-wall carbon nanotubes

C59N magnetic fullerenes were formed inside single-wall carbon nanotubes by vacuum annealing functionalized C59N molecules encapsulated inside the tubes. A hindered, anisotropic rotation of C59N was deduced from the temperature dependence of the electron spin resonance spectra near room temperature. Shortening of spin-lattice relaxation time, T_1, of C59N indicates a reversible charge transfer toward the host nanotubes above $\sim 350$ K. Bound C59N-C60 heterodimers are formed at lower temperatures when C60 is co-encapsulated with the functionalized C59N. In the 10-300 K range, T_1 of the heterodimer shows a relaxation dominated by the conduction electrons on the nanotubes

Early diagnosis of cancer: systems approach to support clinicians in primary care

Georgia Black and colleagues argue that rather than focusing on the initial consultation efforts to reduce diagnosis times should look at the wider system

The contribution of political skill to the implementation of health services change: a systematic review and narrative synthesis

BACKGROUND: The implementation of strategic health system change is often complicated by informal ‘politics’ in healthcare organisations. Leadership development programmes increasingly call for the development and use of ‘political skill’ as a means for understanding and managing the politics of healthcare organisations. The primary purpose of this review is to determine how political skill contributes to the implementation of health services change, within and across organisations. The secondary purpose is to demonstrate the conceptual variations within the literature. METHODS: The article is based upon a narrative synthesis that included quantitative, qualitative and mixed methods research papers, review articles and professional commentaries that deployed the concept of political skill (or associated terms) to describe and analyse the implementation of change in healthcare services. RESULTS: Sixty-two papers were included for review drawn from over four decades of empirically and conceptually diverse research. The literature is comprised of four distinct literatures with a lack of conceptual coherence. Within and across these domains, political skill is described as influencing health services change through five dimensions of leadership: personal performance; contextual awareness; inter-personal influence; stakeholder engagement, networks and alliances; and influence on policy processes. CONCLUSION: There is a growing body of evidence showing how political skill can contribute to the implementation of health services change, but the evidence on explanatory processes is weak. Moreover, the conceptualisation of political skill is variable making comparative analysis difficult, with research often favouring individual-level psychological and behavioural properties over more social or group processes

Personal and organisational health literacy in the non‐specific symptom pathway for cancer: An ethnographic study

Introduction: People being investigated for cancer face a wealth of complex information. Non‐specific symptom pathways (NSS) were implemented in the United Kingdom in 2017 to address the needs of patients experiencing symptoms such as weight loss, fatigue or general practitioner ‘gut feeling’, who did not have streamlined pathways for cancer investigation. This study aimed to explore the health literacy skills needed by patients being investigated for cancer in NSS pathways. Methods: This study employed ethnographic methods across four hospitals in England, including interviews, patient shadowing and clinical care observations, to examine NSS pathways for cancer diagnosis. We recruited 27 patients who were shadowed and interviewed during their care. We also interviewed 27 professionals. The analysis focused on patient communication and understanding, drawing on the concepts of personal and organisational health literacy. Results: Our analysis derived six themes highlighting the considerable informational demands of the NSS pathway. Patients were required to understand complex blood tests and investigations in primary care and often did not understand why they were referred. The NSS pathway itself was difficult to understand with only a minority of patients appreciating that multiple organs were being investigated for cancer. The process of progressing through the pathway was also difficult to understand, particularly around who was making decisions and what would happen next. The results of investigations were complex, often including incidental findings. Patients whose persistent symptoms were not explained were often unsure of what to do following discharge. Conclusion: We have identified several potential missed opportunities for organisations to support patient understanding of NSS pathways which could lead to inappropriate help‐seeking post‐discharge. Patients' difficulties in comprehending previous investigations and findings could result in delays, overtesting or inadequately targeted investigations, hindering the effective use of their medical history. Third, patients' limited understanding of their investigations and results may impede their ability to engage in patient safety by reporting potential care errors. Patient or Public Contribution: Patient, public, clinical and policy representatives contributed to developing the research objectives through a series of meetings and individual conversations in preparation for the study. We have held several events in which patients and the public have had an opportunity to give feedback about our results, such as local interest groups in North London and academic conferences. A clinical contributor (J.‐A. M.) was involved in data analysis and writing the manuscript

Quantum gravity correction, evolution of scalar field and inflation

We take the first nontrivial coefficient of the Schwinger-DeWitt expansion as a leading correction to the action of the second-derivative metric-dilaton gravity. To fix the ambiguities related with an arbitrary choice of the gauge fixing condition and the parametrization for the quantum field, one has to use the classical equations of motion. As a result, the only corrections are the ones to the potential of the scalar field. It turns out that the parameters of the initial classical action may be chosen in such a way that the potential satisfies most of the conditions for successful inflation.Comment: 11 pages, 3 figure

Knowledge management infrastructure to support quality improvement: A qualitative study of maternity services in four European hospitals

The influence of multilevel healthcare system interactions on clinical quality improvement (QI) is still largely unexplored. Through the lens of knowledge management (KM) theory, this study explores how hospital managers can enhance the conditions for clinical QI given the specific multilevel and professional interactions in various healthcare systems. The research used an in-depth multilevel analysis in maternity departments in four purposively sampled European hospitals (Portugal, England, Norway and Sweden). The study combines analysis of macro-level policy documents and regulations with semi-structured interviews (96) and non-participant observations (193 hours) of hospital and clinical managers and clinical staff in maternity departments. There are four main conclusions: First, the unique multilevel configuration of national healthcare policy, hospital management and clinical professionals influence the development of clinical QI efforts. Second, these different configurations provide various and often insufficient support and guidance which affect professionals’ action strategies in QI efforts. Third, hospital managers’ opportunities and capabilities for developing a consistent KM infrastructure with reinforcing enabling conditions which merge national policies and guidelines with clinical reality is crucial for clinical QI. Fourth, understanding these interrelationships provides an opportunity for improvement of the KM infrastructure for hospital managers through tailored interventions

New Exactly Solvable Two-Dimensional Quantum Model Not Amenable to Separation of Variables

The supersymmetric intertwining relations with second order supercharges allow to investigate new two-dimensional model which is not amenable to standard separation of variables. The corresponding potential being the two-dimensional generalization of well known one-dimensional P\"oschl-Teller model is proven to be exactly solvable for arbitrary integer value of parameter $p:$ all its bound state energy eigenvalues are found analytically, and the algorithm for analytical calculation of all wave functions is given. The shape invariance of the model and its integrability are of essential importance to obtain these results.Comment: 23 page

Exfoliation of single layer BiTeI flakes

Spin orbit interaction is strongly enhanced in structures where a heavy element is embedded in an inversion asymmetric crystal field. A simple way for realizing such a setup is to take a single atomic layer of a heavy element and encapsulate it between two atomic layers of different elemental composition. BiTeI is a promising candidate for such a 2D crystal. In its bulk form BiTeI consists of loosely coupled three atom thick layers where a layer of high atomic number Bi are sandwiched between Te and I sheets. Despite considerable recent attention to bulk BiTeI due to its giant Rashba spin splitting, the isolation of a single layer remained elusive. In this work we report the first successful isolation and characterization of a single layer of BiTeI using a novel exfoliation technique on stripped gold. Our scanning probe studies and first principles calculations show that the fabricated 100 mu m sized BiTeI flakes are stable at ambient conditions. Giant Rashba splitting and spin-momentum locking of this new 2D crystal opens the way towards novel spintronic applications and synthetic topological heterostructures

“Attending to History” in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration

BACKGROUND: The reconfiguration of specialist hospital services, with service provision concentrated in a reduced number of sites, is one example of major system change (MSC) for which there is evidence of improved patient outcomes. This paper explores the reconfiguration of specialist oesophago-gastric (OG) cancer surgery services in a large urban area of England (Greater Manchester, GM), with a focus on the role of history in this change process and how reconfiguration was achieved after previous failed attempts. METHODS: This study draws on qualitative research from a mixed-methods evaluation of the reconfiguration of specialist cancer surgery services in GM. Forty-six interviews with relevant stakeholders were carried out, along with ~160 hours of observations at meetings and the acquisition of ~300 pertinent documents. Thematic analysis using deductive and inductive approaches was undertaken, guided by a framework of 'simple rules' for MSC. RESULTS: Through an awareness of, and attention to, history, leaders developed a change process which took into account previous unsuccessful reconfiguration attempts, enabling them to reduce the impact of potentially challenging issues. Interviewees described attending to issues involving competition between provider sites, change leadership, engagement with stakeholders, and the need for a process of change resilient to challenge. CONCLUSION: Recognition of, and response to, history, using a range of perspectives, enabled this reconfiguration. Particularly important was the way in which history influenced and informed other aspects of the change process and the influence of stakeholder power. This study provides further learning about MSC and the need for a range of perspectives to enable understanding. It shows how learning from history can be used to enable successful change

The Evolution of Grocery Wholesaling and Grocery Wholesalers in Ireland and Britain since the 1930s

Studies of industry evolution are relatively scarce outside of industries defined by narrow technological bases. Studies of wholesaling are rarer still. These are curious features given that it is probable that service industries behave differently to manufacturing ones and that wholesaling is such a key function of many economies. This paper looks at the evolution of grocery wholesaling and grocery wholesalers in Ireland and Britain since 1930. It focuses on the processes and drivers of the wholesale industry. Similarities and differences between the two countries are discussed. Particular emphasis is placed on the role of government action as a triggering mechanism for change and on the role of trade associations and industry leaders in developing and following through on market and non-market strategies. The pathways of industry evolution identified differ from those seen in manufacturing. They therefore raise a number of issues for the development of understanding and conceptualisation in industry evolution studies