Charge Nurse Perspectives on Frontline Leadership in Acute Care Environments

A recently issued report from the Institute of Medicine (IOM) in the United States on the Future of Nursing included a recommendation that nurses should receive leadership development at every level in order to transform the healthcare system. Charge nurses, at the frontline of patient care in acute care settings, are in key positions to lead this change. This paper presents findings from research conducted with nurses in the Tenet Health System. Charge nurses from ten facilities who attended a one-day work shop were surveyed to gain insight into the experience of being a frontline leader in today's acute care environment. The relationship of these findings to the IOM report and the implications for both the Tenet Health System and other healthcare organizations that are working to support nurses who assume these challenging roles are discussed

Non-gapped Fermi surfaces, quasiparticles and the anomalous temperature dependence of the near-EFE_F electronic states in the CMR oxide La2−2x_{2-2x}Sr1+2x_{1+2x}Mn2_2O7_7 with x=0.36x=0.36

After years of research into colossal magnetoresistant (CMR) manganites using bulk techniques, there has been a recent upsurge in experiments directly probing the electronic states at or near the surface of the bilayer CMR materials La$_{2-2x}$Sr$_{1+2x}$Mn$_2$O$_7$ using angle-resolved photoemission or scanning probe microscopy. Here we report new, temperature dependent, angle resolved photoemission data from single crystals with a doping level of $x=0.36$. The first important result is that there is no sign of a pseudogap in the charge channel of this material for temperatures below the Curie temperature $T_C$. The second important result concerns the temperature dependence of the electronic states. The temperature dependent changes in the Fermi surface spectra both at the zone face and zone diagonal regions in $k$-space indicate that the coherent quasiparticle weight disappears for temperatures significantly above $T_C$, and that the $k$-dependence of the T-induced changes in the spectra invalidate an interpretation of these data in terms of the superposition of a `universal' metallic spectrum and an insulating spectrum whose relative weight changes with temperature. In this sense, our data are not compatible with a phase separation scenario.Comment: 6 pages, 4 figure

Fall-experiments on Merapi basaltic andesite and constraints on the generation of pyroclastic surges

International audienceWe have performed fall-experiments with basaltic andesite rock samples from Merapi volcano, using an apparatus designed to analyze samples heated up to 850°C. Relative pressure changes during impact and fragmentation of the samples were measured by a pressure transducer. From 200°C, dynamic pressure waves were formed on impact and fragmentation. Peak and duration of the pressure signal, and degree of fragmentation were found to strongly increase with increasing temperature of rock samples. The pressure waves are most likely generated by sudden heating of air forcing it to expand. We propose that the observed pressure changes are analogues to pyroclastic surges that may be generated on impact and fragmentation of large blocks during passage of a pyroclastic flow over a steep cliff. We infer that rock temperatures of ca. 400°C are sufficient for this process to occur, a temperature common in pyroclastic flows even in distal reaches

Text-based vs. graphical information formats in sepsis prevention and early detection: A randomized controlled trial on informed choice

Sepsis is associated with 11 million global deaths annually. Although serious consequences of sepsis can generally be avoided with prevention and early detection, research has not yet addressed the efficacy of evidence-based health information formats for different risk groups. This study examines whether two evidence-based health information formats—text based and graphical—differ in how well they foster informed choice and risk and health literacy and in how well they support different sepsis risk groups. Based on a systematic literature review, two one-page educative formats on sepsis prevention and early detection were designed—one text based and one graphical. A sample of 500 German participants was randomly shown one of the two formats; they were then assessed on whether they made informed choices and on their risk and health literacy. For both formats, >70% of participants made informed choices for sepsis prevention and >75% for early detection. Compared with the graphical format, the text-based format was associated with higher degrees of informed choice (p = 0.012, OR = 1.818) and risk and health literacy (p = 0.032, OR = 1.710). Both formats can foster informed choices and risk and health literacy on sepsis prevention and early detection, but the text-based format appears to be more effective

Double photo-ionization of He near a polarizable surface

We calculate the differential cross-section of the direct double photo-ionization of He physisorbed on a polarizable surface. By including the influence of the surface potential in the correlated two-electron final state wavefunction, we show that the differential cross-section carries detailed information on the electronic correlations at the surface. In particular, photo-emission along opposite directions, which is prohibited in the free space, is allowed if the surface potential is long-ranged.Comment: To appear in Phys. Rev. B - Rapid Comm. - 4 pages, 2 PostScript figures embedde

Enantioselectivity of the Transfer of Hydrogen Atoms to Acyclic Prochiral Carbon-Centred Radicals Using Chiral Tin Hydrides

Racemic α-bromo esters 2 have been reduced via prochiral that the minor diastereomer of tin hydrides 1a and 1b reacts with good enantioselectivity whereas the major diastereomer radicals 5 with low to moderate enantioselectivities using chiral tin hydrides 1 with a stereogenic tin atom containing reacts almost unselectively. The observed enantioselectivities are also strongly influenced by steric effects of the substituchiral 2-[(1-dimethylaminoalkyl)phenyl] ligands. The tin hydrides 1 were mixtures of diastereomers. It could be shown ents attached to the radical centre

A hiatus in the stratosphere?

Rapid CommunicationCopyright © 2015 Nature Publishing GroupTo the Editor — Since the turn of the twenty-first century there has been a hiatus in the cooling of the lower stratosphere (Fig. 1a). This 'stratospheric hiatus' is happening at the same time as the well-documented hiatus in global surface warming1, during a time of increasing CO2 concentrations ('Surface' line in Fig. 1a). Although CO2 acts to warm the surface and troposphere by decreasing outgoing radiative flux at the tropopause, it cools the stratosphere by increasing net infrared emission, so we might expect the continued increase in CO2 concentrations to have produced lower-stratospheric cooling, as observed through much of the depth of the stratosphere2. Why, then, do we observe a hiatus in the lower stratosphere?NER

Optimal leverage from non-ergodicity

In modern portfolio theory, the balancing of expected returns on investments against uncertainties in those returns is aided by the use of utility functions. The Kelly criterion offers another approach, rooted in information theory, that always implies logarithmic utility. The two approaches seem incompatible, too loosely or too tightly constraining investors' risk preferences, from their respective perspectives. The conflict can be understood on the basis that the multiplicative models used in both approaches are non-ergodic which leads to ensemble-average returns differing from time-average returns in single realizations. The classic treatments, from the very beginning of probability theory, use ensemble-averages, whereas the Kelly-result is obtained by considering time-averages. Maximizing the time-average growth rates for an investment defines an optimal leverage, whereas growth rates derived from ensemble-average returns depend linearly on leverage. The latter measure can thus incentivize investors to maximize leverage, which is detrimental to time-average growth and overall market stability. The Sharpe ratio is insensitive to leverage. Its relation to optimal leverage is discussed. A better understanding of the significance of time-irreversibility and non-ergodicity and the resulting bounds on leverage may help policy makers in reshaping financial risk controls.Comment: 17 pages, 3 figures. Updated figures and extended discussion of ergodicit

Condensation in randomly perturbed zero-range processes

The zero-range process is a stochastic interacting particle system that exhibits a condensation transition under certain conditions on the dynamics. It has recently been found that a small perturbation of a generic class of jump rates leads to a drastic change of the phase diagram and prevents condensation in an extended parameter range. We complement this study with rigorous results on a finite critical density and quenched free energy in the thermodynamic limit, as well as quantitative heuristic results for small and large noise which are supported by detailed simulation data. While our new results support the initial findings, they also shed new light on the actual (limited) relevance in large finite systems, which we discuss via fundamental diagrams obtained from exact numerics for finite systems.Comment: 18 pages, 6 figure