Automated Diagnosis of Clinic Workflows

Outpatient clinics often run behind schedule due to patients who arrive late or appointments that run longer than expected. We sought to develop a generalizable method that would allow healthcare providers to diagnose problems in workflow that disrupt the schedule on any given provider clinic day. We use a constraint optimization problem to identify the least number of appointment modifications that make the rest of the schedule run on-time. We apply this method to an outpatient clinic at Vanderbilt. For patient seen in this clinic between March 27, 2017 and April 21, 2017, long cycle times tended to affect the overall schedule more than late patients. Results from this workflow diagnosis method could be used to inform interventions to help clinics run smoothly, thus decreasing patient wait times and increasing provider utilization

Unions, Within-Workplace Job Cuts and Job Security Guarantees

Using data from the Workplace Employment Relations Survey 1998, this paper shows that unionisation increased the probability of within-workplace job cuts and the incidence of job security guarantees. As theory predicts, both are more prevalent among market-sector workplaces with higher union density and multi-unionism. Expectations that these effects would be more muted in the public sector were also confirmed.Job cuts, trade unions, job guarantees

Organizational Commitment: Do Workplace Practices Matter?

Using nationally-representative linked employer-employee data for Britain this paper considers whether employers are able to influence the organizational commitment (OC) of their employees through the practices they deploy. We examine the association between OC and two broad groups of HRM practices emphasised in two different strands of the literature, namely "High-Performance Workplace Practices" (HPWPs) and practices associated with "Perceived Organizational Support" (POS). We consider their associations with mean workplace-level OC and individual employees' OC. Although employers may be able to engender greater OC on the part of their employees, the practices that do so are not those emphasized in the HPWP literature, with the exception of consultation and the involvement of employees in decision-taking. POS practices fare a little better but, again, the findings are far from unequivocal. Furthermore, those practices that are 'effective' in engendering higher OC such as tolerance of absence, recruiting on 'values' and allowing employees to make decisions, tend to have a fairly low incidence in British workplaces. There is, however, one finding which chimes with the ideas underpinning the HPWP literature, namely that there are returns to the use of practices in combination. Analyses of both mean workplace-level OC and individual employee OC find an independent positive association between OC and the deployment of multiple practices in combination. This evidence is consistent with practices having synergies, as emphasised in some of the HPWP literature.high performance, organizational commitment, perceived organizational support

HRM and Workplace Motivation: Incremental and Threshold Effects

The HRM-performance linkage often invokes an assumption of increased employee commitment to the organization and other positive effects of a motivational type. We present a theoretical framework in which motivational effects of HRM are conditional on its intensity, utilizing especially the idea of HRM 'bundling'. We then analyse the association between HRM practices and employees' organisational commitment (OC) and intrinsic job satisfaction (IJS). HRM practices have significantly positive relationships with OC and IJS chiefly at high levels of implementation, but with important distinctions between the domain-level analysis (comprising groups of practices for specific domains such as employee development) and the across-domain or HRM-system level. Findings support a threshold interpretation of the link between HRM domains and employee motivation, but at the system-level both incremental and threshold models receive some support.Human resource management, high performance, organizational commitment

Molecular and Cellular Mechanisms Regulating PTH Receptor Signaling and Biology

G protein-coupled receptors (GPCRs) are the largest family of cell surface proteins that initiate intracellular signaling in response to extracellular stimuli. The classical paradigm of GPCR signaling dictates that downstream responses are relatively transient and confined to the cell surface, but this notion has been challenged in recent years following the identification of several receptors that can engage in sustained G protein-dependent signaling responses from early endosomes following internalization of the ligand-receptor complex. This phenomenon was initially discovered for the parathyroid hormone (PTH) type 1 receptor (PTHR), a class B GPCR that mediates the biological effects of endogenous peptide ligands PTH and its related peptide (PTHrP). Despite significant advancements toward understanding the determinants and relevance of PTHR-mediated endosomal cAMP signaling, this aspect of GPCR signaling remains incompletely understood. Here, we utilize a combination of optical, biochemical, cell biological, and physiological approaches to elucidate novel molecular and cellular mechanisms that underlie endosomal cAMP responses by the PTHR, as well as its biological relevance. We demonstrate that extracellular Ca2+ acts as a positive allosteric modulator of the PTHR by prolonging ligand residence time and increasing the propensity of ligand-receptor complexes to engage in endosomal cAMP generation. We subsequently utilize biased agonism to decode the biological information encoded in the spatial versus temporal dimension of cAMP signaling. Finally, we identify Gq coupling as a critical determinant in PTH-mediated endosomal cAMP production. These findings unveil novel insights into mechanisms and biological outcomes of PTHR-mediated signaling that may prove useful in rational drug design

unWISE tomography of Planck CMB lensing

MB lensing tomography, or the cross-correlation between CMB lensing maps and large-scale structure tracers over a well-defined redshift range, has the potential to map the amplitude and growth of structure over cosmic time, provide some of the most stringent tests of gravity, and break important degeneracies between cosmological parameters. In this work, we use the unWISE galaxy catalog to provide three samples at median redshifts $z \sim 0.6, 1.1$ and 1.5, fully spanning the Dark Energy dominated era, together with the most recent Planck CMB lensing maps. We obtain a combined cross-correlation significance $S/N = 79.3$ over the range of scales $100 < \ell < 1000$. We measure the redshift distribution of unWISE sources by a combination of cross-matching with the COSMOS photometric catalog and cross-correlation with BOSS galaxies and quasars and eBOSS quasars. We also show that magnification bias must be included in our analysis and perform a number of null tests. In a companion paper, we explore the derived cosmological parameters by modeling the non-linearities and propagating the redshift distribution uncertainties.Comment: 51 pages, 22 figures. Comments welcome! Revisions reflect version accepted by JCA

Not so dissatisfied after all? The impact of union coverage on job satisfaction

The links between unionisation and job satisfaction remain controversial. In keeping with the existing literature we find strong statistically significant negative correlations between unionisation and overall job satisfaction. However, in contrast to the previous literature we find that once one accounts for fixed unobservable differences between covered and uncovered employees, union coverage is positively and significantly associated with satisfaction with pay and hours of work. Failure to account for fixed unobservable differences between covered and uncovered employees leads to a systematic underestimate of the positive effects of coverage on job satisfaction for both union members and non-members. It seems union coverage has a positive impact on job satisfaction that is plausibly causal

When Does HRM 'Work' in Small British Enterprises?

Using nationally representative workplace data we find substantial use of high-performance work systems (HPWS) in Britain's small enterprises. We find empirical support for the proposition that HPWS have a non-linear association with employees' overall job attitude, with a positive association apparent where HPWS are used intensively. These associations are robust to factors often cited as obstacles to HPWS implementation such as informality and family ownership

HRM and Small-Firm Employee Motivation: Before and after the Recession

A long-running debate in the small firms' literature questions the value of formal 'human resource management' (HRM) practices which have been linked to high performance in larger firms. We contribute to this literature by exploiting linked employer-employee surveys for 2004 and 2011. Using employees' intrinsic job satisfaction and organizational commitment as measures of motivation we find the returns to small firm investments in HRM are u-shaped. Small firms benefit from intrinsically motivating work situations in the absence of HRM practices, find this advantage disturbed when formal HRM practices are initially introduced, but can restore positive motivation when they invest intensively in HRM practices in a way that characterizes 'high performance work systems' (HWPS) and 'strategic human resource management' (SHRM). Although the HPWS effect on employee motivation is modified somewhat by the recessionary transition, it remains rather robust and continues to have positive promise for small firms