Collaborative Caring: Stories and Reflections on Teamwork in Health Care

[Excerpt] There are many theoretical and conceptual books and countless articles that have explored issues of teamwork in general and teamwork in health care in particular. The editors, and many of the authors in this book, have read most, and have even written some of them. To tackle the issue of teamwork, we have, however, taken a different approach. Rather than write a theoretical book about what teamwork is, what it is not, where it exists in health care, what barriers prevent its implementation and how they can be removed, we have chosen instead to address these questions through narratives and reflections that vividly describe good teamwork as well as problems in creating, leading, and working on genuine teams. What we believe is too often lacking in the literature is a clear and compelling picture of what teamwork looks like on the ground, in the institutions where health care work is delivered and where teams play well, or don\u27t play well, on a daily basis. The question we ask here is thus: What is the state of play in most health care institutions? To describe the state of play, we have asked clinicians to write what we think of as where the rubber hits the road stories or reflections about the nature of teamwork in their own particular work setting. To gather these stories, we talked to many people in different health care disciplines. In the invitation for submissions we wrote the following: We are seeking short, concise narratives that describe a concrete example in which you personally have been involved. The idea here is not to focus so much on the individual doctor-patient, nurse-patient, therapist-patient communication but the teamwork that was involved in ensuring that the standard of care was met or exceeded. If the patient or family was involved, so much the better. Stories can deal with interprofessional or intraprofessional teamwork. On balance, we would prefer to have more stories about interprofessional or occupational teamwork. Nonetheless, we recognize that interprofessional work depends on the ability to create teamwork within an occupation or profession. Stories involving support staff, such as housekeepers who spoke up about a patient safety issue, are definitely within the purview of this book. We would also welcome personal reflections that would enhance our understanding of either how to produce genuine teamwork or the obstacles that stand in its way

Optimal Eigenvalue Shrinkage in the Semicircle Limit

Recent studies of high-dimensional covariance estimation often assume the proportional growth asymptotic, where the sample size $n$ and dimension $p$ are comparable, with $n, p \rightarrow \infty$ and $\gamma_n \equiv p/n \rightarrow \gamma > 0$. Yet, many datasets have very different numbers of rows and columns. Consider instead disproportional growth, where $n, p \rightarrow \infty$ and $\gamma_n \rightarrow 0$ or $\gamma_n \rightarrow \infty$. With far fewer dimensions than observations, the disproportional limit $\gamma_n \rightarrow 0$ may seem similar to classical fixed-$p$ asymptotics. In fact, either disproportional limit induces novel phenomena distinct from the proportional and fixed-$p$ limits. We study the spiked covariance model, finding for each of 15 different loss functions optimal shrinkage and thresholding rules. Readers who initially view the disproportionate limit $\gamma_n \rightarrow 0$ as similar to classical fixed-$p$ asymptotics may expect, given the dominance in that setting of the sample covariance estimator, that there is no alternative here. On the contrary, our optimal procedures demand extensive eigenvalue shrinkage and offer substantial performance benefits. The sample covariance is similarly improvable in the disproportionate limit $\gamma_n \rightarrow \infty$. Practitioners may worry how to choose between proportional and disproportional growth frameworks in practice. Conveniently, under the spiked covariance model there is no conflict between the two and no choice is needed; one unified set of closed forms (used with the aspect ratio $\gamma_n$ of the practitioner's data) offers full asymptotic optimality in both regimes. At the heart of these phenomena is the spiked Wigner model. Via a connection to the spiked covariance model as $\gamma_n \rightarrow 0$, we derive optimal shrinkers for the Wigner setting

On Collisionless Electron-Ion Temperature Equilibration in the Fast Solar Wind

We explore a mechanism, entirely new to the fast solar wind, of electron heating by lower hybrid waves to explain the shift to higher charge states observed in various elements in the fast wind at 1 A.U. relative to the original coronal hole plasma. This process is a variation on that previously discussed for two temperature accretion flows by Begelman & Chiueh. Lower hybrid waves are generated by gyrating minor ions (mainly alpha-particles) and become significant once strong ion cyclotron heating sets in beyond 1.5 R_sun. In this way the model avoids conflict with SUMER electron temperature diagnostic measurements between 1 and 1.5 R_sun. The principal requirement for such a process to work is the existence of density gradients in the fast solar wind, with scale length of similar order to the proton inertial length. Similar size structures have previously been inferred by other authors from radio scintillation observations and considerations of ion cyclotron wave generation by global resonant MHD waves.Comment: 32 pages including 11 figures, 4 tables, accepted by Ap

Representative Farm Analysis of the H.R. 2646 Farm Bill Proposal

Agricultural and Food Policy,

National Institute of Neurological Disorders and Stroke (NINDS): Advances in understanding and treating neuropathy, 24–25 October 2006; Bethesda, Maryland

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75348/1/j.1529-8027.2008.00154.x.pd

Rhythmogenic neuronal networks, pacemakers, and k-cores

Neuronal networks are controlled by a combination of the dynamics of individual neurons and the connectivity of the network that links them together. We study a minimal model of the preBotzinger complex, a small neuronal network that controls the breathing rhythm of mammals through periodic firing bursts. We show that the properties of a such a randomly connected network of identical excitatory neurons are fundamentally different from those of uniformly connected neuronal networks as described by mean-field theory. We show that (i) the connectivity properties of the networks determines the location of emergent pacemakers that trigger the firing bursts and (ii) that the collective desensitization that terminates the firing bursts is determined again by the network connectivity, through k-core clusters of neurons.Comment: 4+ pages, 4 figures, submitted to Phys. Rev. Let

Economic Outlook for Representative Cotton Farms Given the August 2003 FAPRI/AFPC Baseline

The farm level economic impacts of the Farm Security and Rural Investment Act of 2002 on representative cotton farms are projected in this report. The analysis was conducted over the 2001-2007 planning horizon using FLIPSIM, AFPC’s whole farm simulation model. Data to simulate farming operations in the nation’s major cotton production regions came from two sources: - Producer panel cooperation to develop economic information to describe and simulate representative cotton farms. - Projected prices, policy variables, and input inflation rates from the Food and Agricultural Policy Research Institute (FAPRI) August 2003 Baseline. The primary objective of the analysis is to determine the farms’ economic viability by region through the life of the 2002 Farm Bill, given sector level conditions projected in the August 2003 FAPRI Baseline. The FLIPSIM policy simulation model incorporates the historical risk faced by cotton farmers for prices and production. This report presents the results of the August 2003 Baseline in a risk context using selected simulated probabilities and ranges for annual net cash farm income values. The probability of a farm experiencing annual cash flow deficits and the probability of a farm losing real net worth are included as indicators of the cash flow and equity risks facing farms through the year 2007. This report is organized into five sections. The first section summarizes the process used to develop the representative farms and the key assumptions utilized for the farm level analysis. The second section summarizes the FAPRI August 2003 Baseline and the policy and price assumptions used for the representative farm analyses. The third section presents the results of the simulation analyses for cotton farms. Two appendices constitute the final section of the report. Appendix A provides tables to summarize the physical and financial characteristics for each of the representative farms. Appendix B provides the names of producers, land grant faculty, and industry leaders who cooperated in the panel interview process to develop the representative cotton farms.Agribusiness, Agricultural and Food Policy, Crop Production/Industries,