An Interrogation of Turnover Antecedents at an Automobile Manufacturer in Northwest Ohio

The manufacturing industry is one of the largest industries in Northwest Ohio. With the growing influence of Lean/Six Sigma manufacturing systems, the industry is becoming much more automated and team-oriented. The manufacturing facility in question is a Tier 1 and 2 automotive manufacturer that is a part of one of the largest global companies in this sector and uses many Lean and Six Sigma processes across three shifts. In recent years, this company has seen a trend of high turnover and it is a constant point of contention for both supervisors and Human Resources. The current study aimed to determine the most significant correlations and predictors of turnover using the Job Descriptive Index, training investment, and other scales to quantitatively aid the management team in creating interventions to reduce turnover

Improving surgical training : maximising the benefits of surgical simulation

Background Surgical training is undergoing a period of great change, partly due to the increasingly complex and specialised nature of modern surgical practice. Other factors include working hour restrictions and the need for efficient turnover which restrict trainingtime, and the growing awareness of ethical issues surrounding training on patients. Traditional apprenticeship models of surgical training are increasingly unfeasible and are being replaced by skills lab training, utilising bench models and simulators. A growing body of research supports the value of surgical simulators in surgical training. We aim to investigate ways to improve surgical training, investigating factors which may increase the benefits of simulator-based training programmes. Methods We trained a total of 80 surgical trainees and medical students to perform a variety of image-guided procedures on virtual reality-based surgical simulators. The full procedures we selected were colonoscopy, hand-assisted laparoscopic colectomy and endovascular renal artery stenting. In addition, we used basic surgical tasks as part of the training programmes. The 3 full procedures and basic tasks were used during the 4 principle studies from which the data was collected. All our subjects underwent training and assessment. Using these procedures, we investigated the impact of proximate feedback on performance, the value of expert versus non-expert feedback, performance although the relationship is not yet clearly defined. In a moreexperienced cohort we found a relationship between specific visuospatial abilities and image-guided procedural performance, and in the intermediate and less experienced cohort, pyschomotor ability was more relevant. Perceptual ability appeared to be less important. Attaining proficiency improves skill retention which otherwise partially declines in the absence of reinforcement. Procedure specific error scores showed better retention than instrument handling scores, which may reflect the value of a cognitive curriculum. A proficiency-based progression training programme for colonoscopy was created, utilising many of these factors and this led to an improved clinical performance. We found high correlations between instrument handling and generic performance metrics on all the simulators, but lower correlations between error scores and these metrics. All our assessment systems demonstrated high inter rater reliability. Conclusion We have identified many ways to optimise simulator-based surgical training. Simulator-based training is likely to become as integral to surgery as to the aviation industry and it\u27s potential benefits should be maximised. The findings from this research could be incorporated into curriculum design for future training courses. Improving surgical training should ultimately improve patient care. transferability and retention of surgical skills, trainee self-assessment, the relationship between innate ability and performance and the impact of simulator-based training curricula on real clinical performance. We also examined the internal consistency of performance metrics and outcomes and assessed inter-rater reliability for our assessments. Results Our data demonstrate a steep learning curve during repetition of a simulated procedure, highlighting the value of intensive skills lab training. Standardised feedback reduces error commission, and has less effect on more generalised aspects of performance which improve in the absence of feedback. Error commission is aseparate performance metric from the performance assessments which are provided by the simulator. Error scores and more general scores have individual merit but clinically relevant performance metrics should be emphasised during training. Feedback from an expert reduces error commission more than feedback by a non-expert, but has less effect on more generic aspects of performance. However, when errors are objectively assessed, feedback from a non-expert who is familiar with the simulator is equally effective to feedback from an expert. Subject confidence risesafter intensive skills training sessions, and self-assessment reflects overallperformance improvements, although is less accurate for specific performance markers. There is a wide range of inter-subject variability for accuracy of self-assessment, and this self-assessment should be an integral part of all training curricula. Practice on non-surgical tasks such as video games appears to improve performance although our results did not reach statistical significance, likely due to aninsufficient training schedule. Innate ability testing is relevant to surgical skill

A quantitative study of neurochemically-defined populations of inhibitory interneurons in the superficial dorsal horn of the mouse spinal cord

Around a quarter of neurons in laminae I-II of the dorsal horn are inhibitory interneurons. These play an important role in modulating somatosensory information, including that perceived as pain or itch. Previous studies in rat identified four largely non-overlapping neurochemical populations among these cells, defined by expression of galanin, neuropeptide Y (NPY), neuronal nitric oxide synthase (nNOS) or parvalbumin. The galanin cells were subsequently shown to coexpress dynorphin. Several recent studies have used genetically-modified mice to investigate the function of different interneuron populations, and it is therefore important to determine whether the same pattern applies in mouse, and to estimate the relative sizes of these populations. We show that the neurochemical organisation of inhibitory interneurons in mouse superficial dorsal horn is similar to that in the rat, although a larger proportion of these neurons (33%) express NPY. Between them, these four populations account for ∼75% of inhibitory cells in laminae I-II. Since ∼25% of inhibitory interneurons in this region belong to a novel calretinin-expressing type, our results suggest that virtually all inhibitory interneurons in superficial dorsal horn can be assigned to one of these five neurochemical populations. Although our main focus was inhibitory neurons, we also identified a population of excitatory dynorphin-expressing cells in laminae I-II that are largely restricted to the medial part of the mid-lumbar dorsal horn, corresponding to glabrous skin territory. These findings are important for interpretation of studies using molecular-genetic techniques to manipulate the functions of interneuron populations to investigate their roles in somatosensory processing

Using Social Media to Increase Accessibility to Online Teaching Resources.

The key learning points of Surgical Grand Rounds (SGR) are often not accessible at times of exam revision for students. We sought to use Twitter as an online teaching repository. A SGR Twitter profile was created. 23 SGR presentations were made accessible on Twitter over a 3 month period. 93 students were invited to complete a questionnaire assessing usage of the repository. 84 (90%) in total responded, of these, 25 (80.6%) felt that the online provision of SGR through twitter was useful . The majority (71%) felt that the online content was easily accessible. The novel use of social media is a useful adjunctive educational tool in accessing an online repository of SGR presentations

The importance of expert feedback during endovascular simulator training

ObjectivesComplex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers?MethodsEighteen endovascular novices performed a renal artery angioplasty/stenting (RAS) on the Vascular Interventional Surgical Trainer simulator. They were randomized into three groups: Group A (n = 6, control), no performance feedback; Group B (n = 6, nonexpert feedback), feedback after every procedure from a nonexpert facilitator; and Group C (n = 6, expert feedback), feedback after every procedure from a consultant vascular surgeon. Each trainee completed RAS six times. Simulator-measured performance metrics included procedural and fluoroscopy time, contrast volume, accuracy of balloon placement, and handling errors. Clinical errors were also measured by blinded video assessment. Data were analyzed using SPSS version 15.ResultsA clear learning curve was observed across the six trials. There were no significant differences between the three groups for the general performance metrics, but Group C made fewer errors than Groups A (P = .009) or B (P = .004). Video-based error assessment showed that Groups B and C performed better than Group A (P = .002 and P = .000, respectively).ConclusionVR simulator training for novices can significantly improve general performance in the absence of expert trainers. Procedure-specific qualitative metrics are improved with expert feedback, but nonexpert facilitators can also enhance the quality of training and may represent a valuable alternative to expert clinical faculty

Utilization of the Canadian Interprofessional Health Collaborative as an Evaluation Framework for Student Participation in a Community-Engaged Project

Purpose: Interprofessional education is a foundational component of many health professions educational programs as it contributes to the goals of the Quadruple Aim by prioritizing collaborative and streamlined quality healthcare. Furthermore, student engagement in interprofessional educational activities provides opportunities to better understand their own and others’ health profession disciplines. The purpose of this project was to utilize Canadian Interprofessional Health Collaborative (CIHC) to evaluate a framework for student engagement in a community-engaged project focused on reducing barriers to care in people living with type 1 diabetes in rural communities. Methods: As members of an interprofessional, type 1 diabetes, community-engaged research team, students from various graduate and pre-health professions programs participated a variety of activities as research assistants to increase their competency as future healthcare practitioners. These activities included research capacity building, interprofessional collaborations, patient and community interactions, and interprofessional healthcare research. Utilizing the CIHC Framework, the learners reflected and assessed their interprofessional competency, growth, professional identify, and understanding of interprofessional collaboration while providing suggestions for future students participating in interprofessional health sciences research. Findings: Learners found the CIHC to be a robust tool for reflecting on their abilities to provide care in an interprofessional team. The community engagement projects heightened their abilities in role clarification, team functioning, and collaborative leadership which were determined by the group to be some of the most essential skills for entering an interprofessional healthcare workforce. Conclusions: Use of the CIHC framework was an effective method to guide learner progress in developing interprofessional skills within a community engagement project. Reflection on achievement of CIHC domains assists learners in identification of growth in professional identity and understanding of interprofessional collaboration

Economic Outlook for Lakeshore Advantage: Getting to 2030

Lakeshore Advantage, a nonprofit economic development organization serving businesses in Allegan and Ottawa counties, teamed up with the W.E. Upjohn Institute for Employment Research to better understand the long-term economic health of its region. The Upjohn Institute conducted an analysis of Allegan and Ottawa counties to hone in on the strengths of these communities and offer insights on where improvements are needed to grow the region and achieve Lakeshore Advantage’s 2030 goals which include ranking at or above selected comparative communities for median household income, average annual pay, total employment growth, and educational attainment. This study includes an examination of the region’s population, income, employment, mobility, and migration and examines how these factors interconnect in achieving Lakeshore Advantage’s 2030 goals. A literature review of features common to successful communities additionally reveals a needed special focus on industry diversification and specialization, educational attainment, and broadband services. The report also reveals several conclusions and key takeaways concerning the Lakeshore Advantage Region. Key aspects from each section of the report are noted here in the Executive Summary, as well as recommendations

A Content Analysis of Catholic School Written Discipline Policies

School discipline has traditionally endorsed the use of exclusionary practices (i.e. suspension and expulsion). Such practices can have a negative short- and long-term impact on student lives, and tend to be enforced disproportionately with certain student populations. Although public school discipline policies have received increased scrutiny in recent years, Catholic school policies have received very little attention. This study presents the results of a content analysis of the written discipline policies of 33 Catholic secondary schools from two dioceses within a major metropolitan area. Results suggest that although variability exists in the types of behaviors included in formal written policies, schools in this sample rely heavily on exclusionary practices as possible consequences to many behaviors, even relatively minor ones. Further, they include positive or restorative consequences minimally, if at all. Suggestions for future research related to discipline practices in Catholic schools are made

Fetal hyperglycemia and a high fat diet contribute to aberrant glucose tolerance and hematopoiesis in adulthood

Background Children exposed to gestational diabetes mellitus (GDM) during pregnancy are at increased risk of obesity, diabetes, and hypertension. Our goal was to identify metabolic and hematopoietic alterations after intrauterine exposure to maternal hyperglycemia that may contribute to the pathogenesis of chronic morbidities. Methods Streptozotocin treatment induced maternal hyperglycemia during the last third of gestation in rat dams. Offspring of control mothers (OCM) and diabetic mothers (ODM) were evaluated for weight, glucose tolerance, insulin tolerance, and hematopoiesis defects. The effects of aging were examined in normal and high fat diet (HFD)-fed young (8-week-old) and aged (11-month-old) OCM and ODM rats. Results Young adult ODM males on a normal diet, but not females, displayed improved glucose tolerance due to increased insulin levels. Aged ODM males and females gained more weight than OCM on a HFD and had worse glucose tolerance. Aged ODM males fed a HFD were also neutrophilic. Increases in bone marrow cellularity and myeloid progenitors preceded neutrophilia in ODM males fed a HFD. Conclusion When combined with other risk factors like HFD and aging, changes in glucose metabolism and hematopoiesis may contribute to the increased risk of obesity, type 2 diabetes, and hypertension observed in children of GDM mothers