Advancing Stability in an Era of Change

Argues for an integrated grantmaking strategy for world security, stewardship, and the peaceful management of change. Focuses on the individual, the nation-state, civil society organizations, private sector corporations, and multilateral institutions

Who\u27s your expert? Use of an expert opinion survey to inform development of American Psychiatric Association practice guidelines.

OBJECTIVE: For many clinical questions in psychiatry, high-quality evidence is lacking. Credible practice guidelines for such questions depend on transparent, reproducible, and valid methods for assessing expert opinion. The objective of this study was to develop and demonstrate the feasibility of a method for assessing expert opinion to aid in the development of practice guidelines by the American Psychiatric Association (APA). METHODS: A snowball process initially soliciting nominees from three sets of professional leaders was used to identify experts on a guideline topic (psychiatric evaluation). In a Web-based survey, the experts were asked to rate their level of agreement that specific assessments improve specific outcomes when they are included in an initial psychiatric evaluation. The experts were also asked about their own practice patterns with respect to the doing of the assessments. The main outcome measures are the following: number of nominated experts, number of experts who participated in the survey, and number and nature of quantitative and qualitative responses. RESULTS: The snowball process identified 1,738 experts, 784 (45 %) of whom participated in the opinion survey. Participants generally, but not always, agreed or strongly agreed that the assessments asked about would improve specified outcomes. Participants wrote 716 comments explaining why they might not typically include some assessments in an initial evaluation and 1,590 comments concerning other aspects of the topics under consideration. CONCLUSIONS: The snowball process based on initial solicitation of Psychiatry\u27s leaders produced a large expert panel. The Web-based survey systematically assessed the opinions of these experts on the utility of specific psychiatric assessments, providing useful information to substantiate opinion-based practice guidelines on how to conduct a psychiatric evaluation. The considerable engagement of respondents shows promise for using this methodology in developing future APA practice guidelines

Public Participation in Environmental Planning in the Great Lakes Region

The need for greater public involvement in environmental decision-making has been highlighted in recent high-profile research reports and emphasized by leaders at all levels of government. In some cases, agencies have opened the door to greater participation in their programs. However, there is relatively little information on what can be gained from greater public involvement and what makes some programs work while others fail. This paper addresses these questions through an evaluation of public participation in environmental planning efforts in the Great Lakes region. The success of participation is measured using five criteria: educating participants, improving the substantive quality of decisions, incorporating public values into decision-making, reducing conflict, and building trust. The paper then discusses the relationship between success and a number of contextual and procedural attributes of a variety of cases. Data come from a "case survey," in which the authors systematically extract information from previously published studies of 30 individual participation cases. The authors conclude that public participation can accomplish important societal goals and that success depends, in large part, on the actions and commitment of government agencies.

Uncovering Hidden Profiles; Managerial Interventions for Discovering Superior Decision Alternatives

A common reason for the use of teams in organizations is the idea that each individual can bring a unique perspective to the decision task; however, research shows that teams often fail to surface and use unique information to evaluate decision alternatives. Under a condition known as the hidden profile, each member uniquely possesses a critical clue needed to uncover the superior solution. Failure to share and adequately evaluate this information will result in poor decision quality. In order to mitigate this team decision-making bias, the present study utilizes experimental research to examine the impact of the devil’s advocacy technique on the decision quality of hidden profile teams. Results show that advocacy groups had higher decision qualities than groups under free discussion; however, advocacy teams also had higher levels of anger and lower levels of individual support for their group’s decision. As a result, while these teams selected the best solution, the presence of a devil’s advocate introduces conditions that may hinder the solution’s implementation. Furthermore, similar experiments with advocacy techniques suggest that the positive effect on decision quality found here is reduced in the presence of stronger hidden profiles

Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Building an Ethical Small Group (Chapter 9 of Meeting the Ethical Challenges of Leadership)

This chapter examines ethical leadership in the small-group context. To help create groups that brighten rather than darken the lives of participants, leaders must foster individual ethical accountability among group members, ensure ethical group interaction, avoid moral pitfalls, and establish ethical relationships with other groups. In his metaphor of the leader\u27s light or shadow, Parker Palmer emphasizes that leaders shape the settings or contexts around them. According to Palmer, leaders are people who have an unusual degree of power to create the conditions under which other people must live and move and have their being, conditions that can either be as illuminating as heaven or as shadowy as hell. 1 In this final section of the text, I\u27ll describe some of the ways we can create conditions that illuminate the lives of followers in small-group, organizational, global, and crisis settings. Shedding light means both resisting and exerting influence. We must fend off pressures to engage in unethical behavior while actively seeking to create healthier moral environments

Attributes of Embodied Leadership: A beginning in the next chapter of leadership development

Research and guidance on leadership behaviour has been documented throughout history, from the epics to more recent leadership theories, evolved over the last century. Why then, when there is so much research and advice available are leaders still making so many errors? A review of literature in leadership studies reveals that recommendations have often been descriptive, assumptive and prescriptive without considering various differences in individuals. Additionally, leadership development often utilises methodologies in which individuals are trained to ‘act’ as leaders rather than fully embody leadership behaviour. This paper explores the generic attributes that describe embodied leadership behaviour. Semistructured interviews were performed on a panel of individuals from different backgrounds and analysed using a grounded theory approach. Along with the interviews, the works of Scharmer (2008) and behavioural traits identified in leadership by Derue, Nahrgang, Wellman and Humphrey (2011) were also taken into consideration. A final consensus was reached using a set of ten attributes that potentially contribute to embodied leadership behaviour; being non-judgemental, embracing uncertainty, active listening, congruence (morals and ethics), intuition, reflective practice, sense of meaning/purpose, holistic decision making, authentic presence and intention

Identifying the science and technology dimensions of emerging public policy issues through horizon scanning

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security