Fostering Change in Organizational Culture Using a Critical Ethnographic Approach

Healthcare organizations are striving to meet legislated and public expectations to include patients as equal partners in their care, and research is needed to guide successful implementation and outcomes. The current research examined the meaning of customer service as related to the culture of care relationships within a Canadian hospital in southeastern Ontario. The goals were to better understand these expectations, develop shared meanings and influence cultural change from the perspective of the organization’s employees about their interactions with patients, families and work colleagues, and to generate ideas and groundswell for change. An ethnographic approach within the critical research paradigm was used over the course of a three phase study, where direct care healthcare providers (Phase 1), mid-level leaders (Phase 2) and senior leaders (Phase 3) volunteered to explore their values, philosophies and suggestions for change in the organization’s care relationships. This paper describes Phase 2 of the overall research project. A mixed methodology was used where mid-level leaders were individually surveyed and then participated in a focus group and/or interview to discuss these concepts. Mid-level leaders indicated that providing excellent customer service was important in their own work with many customers including staff, patients and their families, students, volunteers and outside agencies. They believed that this in turn led to improved partnerships for care, health service transitions and linkages, customer satisfaction and health outcomes. The majority stated that the organization’s culture would support change related to customer service relationships and opportunities for this were explored

Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey

Objective: To examine fatal drowning associated with aquatic rescues and prior self‐reported experience of undertaking an aquatic rescue in Australia. Methods: Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue‐related fatal unintentional drowning between 1 January 2006 and 31 December 2015. Results: Twenty‐three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X2=35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X2=13.5; p<0.001). Females were more likely to have rescued a child (0‐4 years of age) (X2=29.2; p<0.001) from a swimming pool (X2=34.3; p<0.001). Fifty‐one people drowned while performing an aquatic rescue (Males=82.4%; 25–44 years of age=53.0%; beaches=54.9%). Conclusions: Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community‐wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning

Cumulative lactate and hospital mortality in ICU patients

BACKGROUND: Both hyperlactatemia and persistence of hyperlactatemia have been associated with bad outcome. We compared lactate and lactate-derived variables in outcome prediction. METHODS: Retrospective observational study. Case records from 2,251 consecutive intensive care unit (ICU) patients admitted between 2001 and 2007 were analyzed. Baseline characteristics, all lactate measurements, and in-hospital mortality were recorded. The time integral of arterial blood lactate levels above the upper normal threshold of 2.2 mmol/L (lactate-time-integral), maximum lactate (max-lactate), and time-to-first-normalization were calculated. Survivors and nonsurvivors were compared and receiver operating characteristic (ROC) analysis were applied. RESULTS: A total of 20,755 lactate measurements were analyzed. Data are srpehown as median [interquartile range]. In nonsurvivors (n = 405) lactate-time-integral (192 [0–1881] min·mmol/L) and time-to-first normalization (44.0 [0–427] min) were higher than in hospital survivors (n = 1846; 0 [0–134] min·mmol/L and 0 [0–75] min, respectively; all p < 0.001). Normalization of lactate <6 hours after ICU admission revealed better survival compared with normalization of lactate >6 hours (mortality 16.6% vs. 24.4%; p < 0.001). AUC of ROC curves to predict in-hospital mortality was the largest for max-lactate, whereas it was not different among all other lactate derived variables (all p > 0.05). The area under the ROC curves for admission lactate and lactate-time-integral was not different (p = 0.36). CONCLUSIONS: Hyperlactatemia is associated with in-hospital mortality in a heterogeneous ICU population. In our patients, lactate peak values predicted in-hospital mortality equally well as lactate-time-integral of arterial blood lactate levels above the upper normal threshold

Supernova 1987A: Rotation and a Binary Companion

In this paper we provide a possible link between the structure of the bipolar nebula surrounding SN1987A and the properties of its progenitor star. A Wind Blwon Bubble (WBB) scenario is emplyed, in which a fast, tenuous wind from a Blue Supergiant expands into a slow, dense wind, expelled during an earlier Red Supergiant phase. The bipolar shapre develops due to a pole-to-equator density contrast in the slow wind (ie, the slow wind forms a slow torus). We use the Wind Compressed Disk (WCD) model of Bjorkman & Cassinelli (1992) to determine the shape of the slow torus. In the WCD scenario, the shape of the torus is determined by the rotation of the progenitor star. We then use a self-similar semi-analytical method for wind blown bubble evolution to determine the shape of the resulting bipolar nebula. We find that the union of the wind-compressed-disk and bipolar-wind-blown- bubble models allows us to recover the salient properties of SN1987A's circumstellar nebula. In particular, the size, speed and density of SN1987A's inner ring are easily reproduced in our calculations. An exploration of parameter space shows the the red supergiant progenitor must be been rotating at > 0.3 of its breakup speed. We conclude that the progenitor was most likely spun up by a merger with a binary companion. Using a simple model for the binary merger we find that the companion is likely to have had a mass > 0.5 M_sun.Comment: 30 pages, 4 figure

Constructing solutions to the Bj\"orling problem for isothermic surfaces by structure preserving discretization

In this article, we study an analog of the Bj\"orling problem for isothermic surfaces (that are more general than minimal surfaces): given a real analytic curve $\gamma$ in ${\mathbb R}^3$, and two analytic non-vanishing orthogonal vector fields $v$ and $w$ along $\gamma$, find an isothermic surface that is tangent to $\gamma$ and that has $v$ and $w$ as principal directions of curvature. We prove that solutions to that problem can be obtained by constructing a family of discrete isothermic surfaces (in the sense of Bobenko and Pinkall) from data that is sampled along $\gamma$, and passing to the limit of vanishing mesh size. The proof relies on a rephrasing of the Gauss-Codazzi-system as analytic Cauchy problem and an in-depth-analysis of its discretization which is induced from the geometry of discrete isothermic surfaces. The discrete-to-continuous limit is carried out for the Christoffel and the Darboux transformations as well.Comment: 29 pages, some figure

The characteristics of drowning among different types of international visitors to Australia and how this contributes to their drowning risk

Objective: Australia is a popular destination for international visitors. This study reviews international visitor drowning deaths in Australia and analyses drowning by visitor type. Methods: A total population retrospective study exploring drowning deaths of international visitors was conducted between 2008 and 2018. Data were extracted from the Royal Life Saving National Fatal Drowning Database and categorised into four subgroups: overseas tourists, international students, working holiday makers and work-related visitors. Descriptive statistics, non-parametric tests and relative risk (RR) were calculated. Results: In total, 201 international visitors drowned in Australia, 7% of all drowning deaths; a crude drowning rate of 0.27/100,000 visitors versus 0.95/100,000 for residents (RR=0.19 [95% CI: 0.16–0.22]). Most deaths were males (79%) and people aged 18–34 years (50%). Visitors frequently drowned at beaches (33%), and when swimming (41%). Thirty-five percent recorded a pre-existing medical condition. Overseas tourists on holiday were the most likely to drown compared to other subgroups. Conclusion: International visitors represent a small but increasing proportion of people drowning in Australia. The circumstances of which visitors drown vary by travel purpose, age, country of origin, location of drowning and activity. Implications for public health: International visitors have unique safety needs, requiring tailored prevention based on the purpose of travel and country of origin

Scattering from Singular Potentials in Quantum Mechanics

In non-relativistic quantum mechanics, singular potentials in problems with spherical symmetry lead to a Schrodinger equation for stationary states with non-Fuchsian singularities both as r tends to zero and as r tends to infinity. In the sixties, an analytic approach was developed for the investigation of scattering from such potentials, with emphasis on the polydromy of the wave function in the r variable. The present paper extends those early results to an arbitrary number of spatial dimensions. The Hill-type equation which leads, in principle, to the evaluation of the polydromy parameter, is obtained from the Hill equation for a two-dimensional problem by means of a simple change of variables. The asymptotic forms of the wave function as r tends to zero and as r tends to infinity are also derived. The Darboux technique of intertwining operators is then applied to obtain an algorithm that makes it possible to solve the Schrodinger equation with a singular potential containing many negative powers of r, if the exact solution with even just one term is already known.Comment: 19 pages, plain Tex. In this revised version, the analysis of Eq. (5.29) has been amended, and an appendix has been added for completenes

Anti-HBs re-seroconversion after liver transplantation in a patient with past HBV infection receiving a HBsAg positive graft

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Churn, Baby, Churn: Strategic Dynamics Among Dominant and Fringe Firms in a Segmented Industry

This paper integrates and extends the literatures on industry evolution and dominant firms to develop a dynamic theory of dominant and fringe competitive interaction in a segmented industry. It argues that a dominant firm, seeing contraction of growth in its current segment(s), enters new segments in which it can exploit its technological strengths, but that are sufficiently distant to avoid cannibalization. The dominant firm acts as a low-cost Stackelberg leader, driving down prices and triggering a sales takeoff in the new segment. We identify a “churn” effect associated with dominant firm entry: fringe firms that precede the dominant firm into the segment tend to exit the segment, while new fringe firms enter, causing a net increase in the number of firms in the segment. As the segment matures and sales decline in the segment, the process repeats itself. We examine the predictions of the theory with a study of price, quantity, entry, and exit across 24 product classes in the desktop laser printer industry from 1984 to 1996. Using descriptive statistics, hazard rate models, and panel data methods, we find empirical support for the theoretical predictions