Inter-organisational clinical leadership and engagement.

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-organisational and cross-professional working. These innovative ways of working are seen as a means of improving the quality and co-ordination of patient care across the pathway, thus impacting on 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 study identifies the characteristics and impact of effective clinical leadership, clinical engagement and team effectiveness when working across organisational boundaries. „Practical Recommendations‟ have been developed as a mechanism to disseminate the findings. This research is based in the real world, which is complex and messy. The study uses an interpretative stance and gains insights from a number of different perspectives. The methodological approach is action research with a single case study design. Both quantitative and qualitative data are used and these are collected through a team effectiveness tool, focus groups and semi-structured interviews. The study demonstrates there are significant improvements in the delivery of healthcare and patient experience when clinicians work effectively across the whole patient pathway, spanning organisational boundaries. The study findings are: the need for a focus or forum and for clinicians to have the time and space to initiate inter-organisational working; the power of the patient‟s voice, involvement and leadership in delivering impactful change; the need to understand organisational and personal barriers and risks to inter-organisational working; the requirement to align incentives and accountability; the need for the NHS to value service improvement approaches as well as randomised controlled trials; the necessity for clinicians to have managerial and leadership skills to effectively run inter-organisational projects; and, the necessity for senior management and corporate engagement. These findings are supported by the existing literature, whilst also contributing to knowledge and understanding. The study aligns with the current direction of increased inter-organisational working within the NHS, and illustrates the benefits of working in this way. It demonstrates the fundamental role of clinicians (especially doctors) and patients when using this approach. The „Practical Recommendations‟ offer clinicians and managers an opportunity to consider the key elements that determine the success of improvement initiatives spanning a whole pathway or health system. Additionally, this study raises several new research questions and highlights some key recommendations such as: the need to agree the level at which NHS organisations can support inter-organisational working whilst remaining financially and competitively viable; the requirement urgently to review and revise training for doctors to ensure that in the future it equips them for effective participation in inter-organisational working; and the need to ensure the patient voice is focussed on enhancing quality of life through improvements in healthcare, rather than just simple redesign projects

Clusters and cycles in the cosmic ray age distributions of meteorites

Statistically significant clusters in the cosmic ray exposure age distributions of some groups of iron and stone meteorites were observed, suggesting epochs of enhanced collision and breakups. Fourier analyses of the age distributions of chondrites reveal no significant periods, nor does the same analysis when applied to iron meteorite clusters

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

One Loop Corrected Mode Functions for SQED during Inflation

We solve the one loop effective scalar field equations for spatial plane waves in massless, minimally coupled scalar quantum electrodynamics on a locally de Sitter background. The computation is done in two different gauges: a non-de Sitter invariant analogue of Feynman gauge, and in the de Sitter invariant, Lorentz gauge. In each case our result is that the finite part of the conformal counterterm can be chosen so that the mode functions experience no significant one loop corrections at late times. This is in perfect agreement with a recent, all orders stochastic prediction.Comment: 26 pages, uses LaTeX 2 epsilon, no figures, version 2 has an updated reference lis

Scalar Field Equations from Quantum Gravity during Inflation

We exploit a previous computation of the self-mass-squared from quantum gravity to include quantum corrections to the scalar evolution equation. The plane wave mode functions are shown to receive no significant one loop corrections at late times. This result probably applies as well to the inflaton of scalar-driven inflation. If so, there is no significant correction to the $\phi \phi$ correlator that plays a crucial role in computations of the power spectrum.Comment: 19 pages, 5 table

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

Charged Scalar Self-Mass during Inflation

We compute the one loop self-mass of a charged massless, minimally coupled scalar in a locally de Sitter background geometry. The computation is done in two different gauges: the noninvariant generalization of Feynman gauge which gives the simplest expression for the photon propagator and the de Sitter invariant gauge of Allen and Jacobson. In each case dimensional regularization is employed and fully renormalized results are obtained. By using our result in the linearized, effective field equations one can infer how the scalar responds to the dielectric medium produced by inflationary particle production. We also work out the result for a conformally coupled scalar. Although the conformally coupled case is of no great physical interest the fact that we obtain a manifestly de Sitter invariant form for its self-mass-squared establishes that our noninvariant gauge introduces no physical breaking of de Sitter invariance at one loop order.Comment: 41 pages, LaTeX 2epsilon, 3 figures, uses axodra

Evaporite karst geohazards in the Delaware Basin, Texas: review of traditional karst studies coupled with geophysical and remote sensing characterization

Evaporite karst throughout the Gypsum Plain of west Texas is complex and extensive, including manifestations ranging from intrastratal brecciation and hypogene caves to epigene features and suffosion caves. Recent advances in hydrocarbon exploration and extraction has resulted in increased infrastructure development and utilization in the area; as a result, delineation and characterization of potential karst geohazards throughout the region have become a greater concern. While traditional karst surveys are essential for delineating the subsurface extent and morphology of individual caves for speleogenetic interpretation, these methods tend to underestimate the total extent of karst development and require surficial manifestation of karst phenomena. Therefore, this study utilizes a composite suite of remote sensing and traditional field studies for improved karst delineation and detection of potential karst geohazards within gypsum karst. Color InfraRed (CIR) imagery were utilized for delineation of lineaments associated with fractures, while Normalized Density Vegetation Index (NDVI) analyses were used to delineate regions of increased moisture flux and probable zones of shallow karst development. Digital Elevation Models (DEM) constructed from high-resolution LiDAR (Light Detection and Ranging) data were used to spatially interpret sinkholes, while analyses of LiDAR intensity data were used in a novel way to categorize local variations in surface geology. Resistivity data, including both direct current (DC) and capacitively coupled (CC) resistivity analyses, were acquired and interpreted throughout the study area to delineate potential shallow karst geohazards specifically associated with roadways of geohazard concern; however, detailed knowledge of the surrounding geology and local karst development proved essential for proper interpretation of resistivity inversions. The composite suite of traditional field investigations and remotely sensed karst delineations used in this study illustrate how complex gypsum karst terrains can be characterized with greater detail through the utilization of rapidly advancing technologies, especially in arid environments with low vegetation densities

Yukawa Scalar Self-Mass on a Conformally Flat Background

We compute the one loop self-mass-squared of a massless, minimally coupled scalar which is Yukawa-coupled to a massless Dirac fermion in a general conformally flat background. Dimensional regularization is employed and a fully renormalized result is obtained. For the special case of a locally de Sitter background our result is manifestly de Sitter invariant. By solving the effective field equations we show that the scalar mode functions acquire no significant one loop corrections. In particular, the phenomenon of super-adiabatic amplification is not affected. One consequence is that the scalar-catalyzed production of fermions during inflation should not be reduced by changes in the scalar sector before it has time to go to completion.Comment: 23 pages, LaTeX 2epsilon, 3 figures (uses axodraw