An action research study of clinical leadership, engagement and team effectiveness in working across NHS boundaries.

Clinical leadership and engagement across organisational boundaries has been gaining significant attention over the last few years. Within the NHS, there has been an increased focus within policy directives and the literature on partnership working, collaborations, cross-organisation and cross-profession working. These innovative ways of working are a means of improving the quality and co-ordination of patient care across the pathway, thus influencing the patients’ experience. Despite this focus, the evidence of what constitutes and therefore what can deliver effective inter-organisational clinical leadership and engagement within this context is sparse. This paper identifies the characteristics and impact of effective clinical leadership, clinical engagement and team effectiveness when working across organisational boundaries. The paper demonstrates that there are significant improvements in the delivery of healthcare and patient experience when clinicians work effectively across the whole of the patient pathway, spanning organisational boundaries. Guidelines on critical areas for future development and sustainability is expounded upon as an outcome of this study

Quantum Gravity Corrections to the One Loop Scalar Self-Mass during Inflation

We compute the one loop corrections from quantum gravity to the self-mass-squared of a massless, minimally coupled scalar on a locally de Sitter background. The calculation was done using dimensional regularization and renormalized by subtracting fourth order BPHZ counterterms. Our result should determine whether quantum gravitational loop corrections can significantly alter the dynamics of a scalar inflaton.Comment: 47 pages, 3 figures, 20 tables, uses LaTeX 2 epsilon, version 2 revised for publication in Physical Review

A Spatio-Temporal Point Process Model for Ambulance Demand

Ambulance demand estimation at fine time and location scales is critical for fleet management and dynamic deployment. We are motivated by the problem of estimating the spatial distribution of ambulance demand in Toronto, Canada, as it changes over discrete 2-hour intervals. This large-scale dataset is sparse at the desired temporal resolutions and exhibits location-specific serial dependence, daily and weekly seasonality. We address these challenges by introducing a novel characterization of time-varying Gaussian mixture models. We fix the mixture component distributions across all time periods to overcome data sparsity and accurately describe Toronto's spatial structure, while representing the complex spatio-temporal dynamics through time-varying mixture weights. We constrain the mixture weights to capture weekly seasonality, and apply a conditionally autoregressive prior on the mixture weights of each component to represent location-specific short-term serial dependence and daily seasonality. While estimation may be performed using a fixed number of mixture components, we also extend to estimate the number of components using birth-and-death Markov chain Monte Carlo. The proposed model is shown to give higher statistical predictive accuracy and to reduce the error in predicting EMS operational performance by as much as two-thirds compared to a typical industry practice

Tall Tropical Grasses and Leucaena as Energy Crops for Lower South USA

The tropical leguminous shrub/tree, leucaena (Leucaena spp. mainly leucocephala), and perennial tropical tall grasses such as elephantgrass (Pennisetum purpureum), sugarcane, and energycane (Saccharum spp.) are well adapted to the long growing seasons and high rainfall of humid lower South. In much of the area the topgrowth is killed by frost during winter and plants regenerate from underground parts in spring. Selected accessions from a duplicated 373 accession leucaena nursery had an average annual woody stem dry matter production of 31.4 Mg ha-1 and four seasons growth of 78.9 Mg ha-1. The tall perennial grasses have linear growth rates of 18 to 27 g m-2d-1 for long periods (140 to 196 d and sometimes longer) each season. Oven dry biomass yields of tall grasses have varied from 19 to 45 Mg ha-1 in mild temperate locations to over 60 Mg ha- 1yr-1 in warm subtropics of lower Florida peninsular

A field study for assessing risk-contingent credit for Kenyan pastoralists and dairy farmers

Purpose: The purpose of this paper is to assess the feasibility of risk-contingent credit (RCC) by presenting an experimental and participatory game designed to explain the concept of RCC to Kenyan pastoralists and dairy farmers. The paper investigates the uptake potential of RCC through qualitative assessment of field experiments and focus groups. Design/methodology/approach: The paper presents a method of community engagement through a participatory game played in a series of Focus Group Discussions (FGDs). The paper also presents theoretical justification of RCC in credit market structure. Findings: The game effectively explains the concept and mechanism of RCC by reflecting local situation and production potential. Participatory exercises within focus group discussions indicate that there exists a strong interest and support for RCC. Research limitations/implications: The methodology described in this paper can be used in extension programs for promoting innovative rural microcredit in developing countries but should be modified according to the local production and associated weather and market risks. Originality/value: Micro-insurance and credit program delivery can be improved by the innovative approach of community engagement for explaining financial products

The Axial Anomaly in D=3+1 Light-Cone QED

We consider $(3+1)$-dimensional, Dirac electrons of arbitrary mass, propagating in the presence of electric and magnetic fields which are both parallel to the $x^3$ axis. The magnetic field is constant in space and time whereas the electric field depends arbitrarily upon the light-cone time parameter $x^+ = (x^0 + x^3)/\sqrt{2}$. We present an explicit solution to the Heisenberg equations for the electron field operator in this background. The electric field results in the creation of electron-positron pairs. We compute the expectation values of the vector and axial vector currents in the presence of a state which is free vacuum at $x^+ = 0$. Both current conservation and the standard result for the axial vector anomaly are verified for the first time ever in $(3+1)$-dimensional light-cone QED. An interesting feature of our operator solution is the fact that it depends in an essential way upon operators from the characteristic at $x^- = -L$, in addition to the usual dependence upon operators at $x^+ = 0$. This dependence survives even in the limit of infinite $L$. Ignoring the $x^-$ operators leads to a progressive loss of unitarity, to the violation of current conservation, to the loss of renormalizability, and to an incorrect result for the axial vector anomaly.Comment: 31 pages, LaTeX 2 epsilon, no figures, some typoes corrected for publicatio