Multilevel organizational adaptation: Scale invariance in the Scottish healthcare system.

We use the case of a “whole-system” change program in a national healthcare system to empirically examine the multilevel dynamics underlying organizational adaptation. Our analysis demonstrates how the cognitive distance between agents’ causal representations affects opportunities to cooperate in hierarchical systems. Using complexity theory, we identify a scale-invariant causal pathway that can be applied recursively across many organizational levels. At each level, three coupled feedback loops determine how local agents modify their cognitive representations to include uncovered interdependencies and synchronize their adaptive search across organizational boundaries: a “boundary work” loop, a “small wins” loop, and a “parochialism” loop. Our results also point to the scale-dependency of the strength of dissipative processes across levels. These novel results further develop the theory of organizational change and have practical implications for large multilevel organizations, especially regarding the sustainability of improvements

The dynamic nature of social accounts: an examination of how interpretive processes impact on account effectiveness

Social accounts are a powerful tool in influencing the behavior of organizational members during major change. Examination of their effectiveness has largely focused on the design of accounts to influence behavioral and affective responses. However, when used in real life practice, more individualized, interpretive and agentic responses to social accounts have been found to influence effectiveness. Using an example of large-scale organizational change, moving from one hospital facility to another, we explore the dynamic and contextual interpretation of social accounts over time. Our findings expand social account theory by examining how potentially successful change communications are derailed by the relevance of the account in relation to an individual's past, by the individuals' ability to express agency and by temporality; how over time, lived experience can alter the perceived truthfulness of an account and alter its potency

Using immersive audio and vibration to enhance remote diagnosis of mechanical failure in uncrewed vessels.

There is increasing interest in the maritime industry in the potential use of uncrewed vessels to improve the efficiency and safety of maritime operations. This leads to a number of questions relating to the maintenance and repair of mechanical systems, in particular, critical propulsion systems which if a failure occurs could endanger the vessel. While control data is commonly monitored remotely, engineers on board ship also employ a wide variety of sensory feedback such as sound and vibration to diagnose the condition of systems, and these are often not replicated in remote monitoring. In order to assess the potential for enhancement of remote monitoring and diagnosis, this project simulated an engine room (ER) based on a real vessel in Unreal Engine 4 for the HTC ViveTM VR headset. Audio was recorded from the vessel, with mechanical faults synthesized to create a range of simulated failures. In order to simulate operational requirements, the system was remotely fed data from an external server. The system allowed users to view normal control room data, listen to the overall sound of the space presented spatially over loudspeakers, isolate the sound of particular machinery components, and feel the vibration of machinery through a body worn vibration transducer. Users could scroll through a 10-hour time history of system performance, including audio, vibration and data for snapshots at hourly intervals. Seven experienced marine engineers were asked to assess several scenarios for potential faults in different elements of the ER. They were assessed both quantitatively regarding correct fault identification, and qualitatively in order to assess their perception of usability of the system. Users were able to diagnose simulated mechanical failures with a high degree of accuracy, mainly utilising audio and vibration stimuli, and reported specifically that the immersive audio and vibration improved realism and increased their ability to diagnose system failures from a remote location

The Dust Disk around the Vega-Excess Star SAO 26804

We present multiwaveband observations of the K2 Vega-excess star SAO 26804 (= HD 233517). These include James Clerk Maxwell Telescope millimeter-wave photometry, plus spectra in the 8-13 microns and 18-24 microns atmospheric windows, an image at a wavelength of 10 microns through a broadband N filter and near-IR (JHKLL'M) photometry all taken at the United Kingdom Infrared Telescope. The source is resolved at 10 microns, and we can confirm with these observations that the IR excess seen in IRAS observations of this source is associated with the optical star. The image is consistent with the dust being confined to a disk with Full Width at Half Maximum (FWHM) 1.5 sec on the major axis, with an inclination angle of less than 30 deg away from edge-on. This represents the first confirmation that the dust in a Vega-excess star other than beta Pic is confined to a disk geometry. We present models of the source which show that many of the properties of the disk and the dust in it are similar to those which we have previously derived for the disk around SAO 179815, but that there are some very small grains in the disk around the star which give around SAO 179815, but that there are some very small grains in the disk around the star which give rise to a very prominent and narrow silicate dust feature at 9.7 microns and to so-called unidentified infrared bands in the 10 micron region. The larger grains are composed of a mixture of amorphous carbon and silicate with an abundance ratio consistent with an interstellar origin. The total mass of dust in the disk is 3.0 x 10-7 solar mass. Finally, our model suggests that there may be a substantial UV and/or soft X-ray flux from SAO 26804, consistent with it being a very young and rather active star

The remarkable asymmetric outflow from the Cygnus Egg Nebula

We present ground based continuum images in the infrared, from 1.2 to 19µm, and an H2 2.122µm line emission image of the post-AGB star AFGL2688, the Cygnus Egg Nebula. We show that the standard model of this source, comprising a fast wind focussed by a dense, equatorial, dusty torus into a bipolar flow at position angle 15$^\circ$ and close to the plane of the sky, cannot explain the combination of kinematic information from previous studies and morphological information in our own observations. Nor are the images consistent with a classical bipolar flow, since the apex of the two lobes observed in scattered light in the visible and near-IR are offset in R.A. with respect to one another. We suggest a model which is physically similar, but substantially different geometrically, in which there is a bipolar flow at a position angle closer to 60$^\circ$, rather than 15$^\circ$, still collimated by a dense, equatorial, dusty torus, but the opening angle of the cones out of which the fast bipolar flow is directed is closer to 90$^\circ$, rather than 20$^\circ$ or so as previously suggested. The bipolar flow axis is inclined by about 20-30$^\circ$, rather than in the plane of the sky as in previous models. The dust distribution in the nebula has to be extremely clumpy, and there is evidence that large scale mass loss from the progenitor AGB star occurred in discrete phases, recurring on a timescale of $\sim$750 years. This model implies a much lower velocity for the 'fast' bipolar outflow than does the standard model, which is consistent with very recent Nobeyama Millimetre Array images in 13CO emission. In support of our new model, we present a full radiative transfer model for the source, in axial symmetry, which reveals that the final phase of heavy mass loss included a superwind phase which lasted about two hundred years and removed about 0.7 M$_{\odot}$ from the envelope of the progenitor AGB star. Our results imply that the progenitor star must have been a relatively high mass AGB star. Our radiative transfer model also demonstrates convincingly that, in contrast with previous models, the core of the nebula has to be exceptionally optically thick, with an optical depth greater than unity even at 10µm

Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectiveness

BACKGROUND: Interoceptive exposure has been validated as an effective component of cognitive behavioral therapy (CBT) for the treatment of panic disorder but has hitherto received little research attention. We examined the effectiveness of various interoceptive exposure exercises using the Body Sensations Questionnaire (BSQ) (Chambless et al., 1984). METHODS: We first performed an exploratory principal factor analysis of all the items contained in the BSQ to obtain meaningful dimensions of interoceptive fears. Next, we examined the correlations between each interoceptive exposure task's degree of similarity to panic attacks and each BSQ factor and then examined whether the BSQ factor scores decreased in comparison with the baseline values when the corresponding exposure tasks were successfully completed by the subjects. RESULTS: The factor analyses revealed four factors, which we named "pseudoneurological fears", "gastrointestinal fears", "cardiorespiratory fears" and "fears of dissociative feelings." Among the nine interoceptive exposure tasks, 'hyperventilation', 'shaking head', 'holding breath' and 'chest breathing' were considered to reproduce pseudoneurological symptoms, 'breathing through a straw' was considered to reproduce gastrointestinal symptoms, and 'spinning' was considered to reproduce both pseudoneurological and dissociative symptoms; none of the interoceptive exercises were found to reproduce cardiorespiratory symptoms. Among each group of patients for whom 'hyperventilation', 'holding breath', 'spinning' or 'chest breathing' was effective, a significant improvement in the BSQ pseudoneurological fears factor scores was observed. On the other hand, no significant difference between the baseline and endpoint values of the BSQ gastrointestinal fears or the BSQ fears of dissociative feelings factor scores were observed among the patients for whom 'spinning' or 'breathing through a straw' was effective. CONCLUSION: Several interoceptive exposure tasks were particularly effective in reducing pseudoneurological fears. New interoceptive tasks, especially tasks related to cardiorespiratory and dissociative feelings, are needed

Coastal clustering of HEV; Cornwall, UK.

PublishedBACKGROUND AND AIMS: Autochthonous hepatitis E virus (HEV) infection is a porcine zoonosis and increasingly recognized in developed countries. In most cases the route of infection is uncertain. A previous study showed that HEV was associated geographically with pig farms and coastal areas. AIM: The aim of the present research was to study the geographical, environmental and social factors in autochthonous HEV infection. METHODS: Cases of HEV genotype 3 infection and controls were identified from 2047 consecutive patients attending a rapid-access hepatology clinic. For each case/control the following were recorded: distance from home to nearest pig farm, distance from home to coast, rainfall levels during the 8 weeks before presentation, and socioeconomic status. RESULTS: A total of 36 acute hepatitis E cases, 170 age/sex-matched controls and 53 hepatitis controls were identified. The geographical spread of hepatitis E cases was not even when compared with both control groups. Cases were more likely to live within 2000 m of the coast (odds ratio=2.32, 95% confidence interval=1.08-5.19, P=0.03). There was no regional difference in the incidence of cases and controls between west and central Cornwall. There was no difference between cases and controls in terms of distance from the nearest pig farm, socioeconomic status or rainfall during the 8 weeks before disease presentation. CONCLUSION: Cases of HEV infection in Cornwall are associated with coastal residence. The reason for this observation is uncertain, but might be related to recreational exposure to beach areas exposed to HEV-contaminated 'run-off' from pig farms. This hypothesis merits further study.The European Centre for the Environment and Human Health (part of the Peninsula College of Medicine and Dentistry which is a joint entity of the University of Exeter, the University of Plymouth and the NHS in the South West) is supported by investment from the European Regional Development Fund and the European Social Fund Convergence Programme for Cornwall and the Isles of Scilly

Association between Radiologists' Experience and Accuracy in Interpreting Screening Mammograms

<p>Abstract</p> <p>Background</p> <p>Radiologists have been observed to differ, sometimes substantially, both in their interpretations of mammograms and in their recommendations for follow-up. The aim of this study was to determine how factors related to radiologists' experience affect the accuracy of mammogram readings.</p> <p>Methods</p> <p>We selected a random sample of screening mammograms from a population-based breast cancer screening program. The sample was composed of 30 women with histopathologically-confirmed breast cancer and 170 women without breast cancer after a 2-year follow-up (the proportion of cancers was oversampled). These 200 mammograms were read by 21 radiologists routinely interpreting mammograms, with different amount of experience, and by seven readers who did not routinely interpret mammograms. All readers were blinded to the results of the screening. A positive assessment was considered when a BI-RADS III, 0, IV, V was reported (additional evaluation required). Diagnostic accuracy was calculated through sensitivity and specificity.</p> <p>Results</p> <p>Average specificity was higher in radiologists routinely interpreting mammograms with regard to radiologists who did not (66% vs 56%; p < .001). Multivariate analysis based on routine readers alone showed that specificity was higher among radiologists who followed-up cases for which they recommended further workup (feedback) (OR 1.37; 95% CI 1.03 to 1.85), those spending less than 25% of the working day on breast radiology (OR 1.49; 95% CI 1.18 to 1.89), and those aged more than 45 years old (OR 1.33; 95% CI 1.12 to 1.59); the variable of average annual volume of mammograms interpreted by radiologists, classified as more or less than 5,000 mammograms per year, was not statistically significant (OR 1.06; 95% CI 0.90 to 1.25).</p> <p>Conclusion</p> <p>Among radiologists who read routinely, volume is not associated with better performance when interpreting screening mammograms, although specificity decreased in radiologists not routinely reading mammograms. Follow-up of cases for which further workup is recommended might reduce variability in mammogram readings and improve the quality of breast cancer screening programs.</p