High-Performance Work Systems as an Initiator of Employee Proactivity and Flexible Work Processes

We offer a conceptual framework that explicates the effect of high-performance work systems (HPWS) on the flexibility of organizational work processes. The flexibility of work processes is conceptualized as the extent to which organizational work routines can be modified by employees to better exploit existing capabilities or be adapted to explore new alternatives. We argue that HPWS directly facilitate individual proactivity, and foster a supportive social structure that further enables individuals to be proactive in modifying their work processes. The proposed model is in response to calls for researchers to consider proximal outcomes related to the use of human resource management (HRM) systems and, more specifically, the need to better understand how HRM systems can enable employees to respond to threats and opportunities. Future research issues are also considered, including recommendations for empirical assessment of how employees modify their work processes

The factors associated with high-quality communication for critically ill children

OBJECTIVE: Timely, high quality communication with families is essential to family-centered decision-making. Quality communication is represented by widespread documentation of prognostic, goals-of-care conversations (PGOCC) in the pediatric intensive care unit (PICU) and should occur without variation by patient characteristics. METHODS: Cohort included 645 PICU admissions in the top decile of risk of mortality on admission over six years. Electronic medical records were used to determine PGOCC, diagnosis on admission and complex chronic condition (CCC) status. Multivariate logistic regression and time-to-event analyses were used. RESULTS: Overall, 31% had a documented PGOCC. 51% had CCC status. 11% had an oncologic, 13% had a cardiovascular diagnosis on admission. 94% of patients who died in the PICU had PGOCC documented, but among the 200 patients with documented PGOCC, 78% did not die in the PICU. Oncologic diagnosis on admission was associated with a higher likelihood of PGOCC compared to non-CCC patients (ARR=1.86; SE=0.26) whereas no other diagnosis category reached the level of statistical significance. Median time from admission to PGOCC was 2 days. Age, gender and CCC status were not associated with whether a PGOCC was documented or with time from admission to PGOCC documentation. 45% of PGOCC in the cohort and 50% of conversations in patients with CCC were documented by PICU physicians. CONCLUSIONS: This study reveals the opportunity for improvement in documentation of PGOCC for critically ill children. It raises the questions of why there is variation of PGOCC across disease categories and whether PGOCC should be considered a quality measure for family-centered care

Effect of anti-retroviral therapy on oxidative stress in hospitalized HIV-infected adults with and without TB.

BackgroundHIV infection and opportunistic infections cause oxidative stress (OS), which is associated with tissue damage. Anti-retroviral therapy (ART) is used to treat HIV and decrease the risk of opportunistic infections, but it is unclear whether ART reduces OS. Association of ART with OS was investigated.MethodsWe stratified a convenience sample of frozen serum or plasma from HIV-infected, ART-naïve (n=21); HIV-infected, ART-treated (n=14); HIV and PTB co-infected, ART-naïve (n=21); HIV and PTB co-infected, ART-treated (n=25) patients. Controls (n=21) were HIV-negative adults without TB symptoms. Concentration of OS markers namely: transaminases (ALT and AST), gamma glutamyl transpeptidase (GGT), albumin, total protein, malondialdehyde (MDA), vitamin C, and total anti-oxidant status (TAS) were determined.ResultsAST (p<0.001), GGT (p<0.001), total protein (p=0.001) and MDA (p<0.001) were higher in HIV patients compared to controls. Vitamin C (P<0.0001) and albumin (p<0.01) were lower in HIV-patients relative to controls. ART was only associated with higher albumin (p=0.001), higher GGT (p=0.02) and lower vitamin C (p=0.009). HIV and PTB co-infection was only significantly associated with higher GGT (p=0.01) and AST (p=0.03).ConclusionWe identified severe OS among HIV-patients. ART was associated with both increased and reduced markers of OS hence suggesting that ART may not attenuate OS

Molecular genetics and pathophysiology of 17 beta-hydroxysteroid dehydrogenase 3 deficiency.

Autosomal recessive mutations in the 17 beta-hydroxysteroid dehydrogenase 3 gene impair the formation of testosterone in the fetal testis and give rise to genetic males with female external genitalia. Such individuals are usually raised as females, but virilize at the time of expected puberty as the result of increases in serum testosterone. Here we describe mutations in 12 additional subjects/families with this disorder. The 14 mutations characterized to date include 10 missense mutations, 3 splice junction abnormalities, and 1 small deletion that results in a frame shift. Three of these mutations have occurred in more than 1 family. Complementary DNAs incorporating 9 of the 10 missense mutations have been constructed and expressed in reporter cells; 8 of the 9 missense mutations cause almost complete loss of enzymatic activity. In 2 subjects with loss of function, missense mutations testosterone levels in testicular venous blood were very low. Considered together, these findings strongly suggest that the common mechanism for testosterone formation in postpubertal subjects with this disorder is the conversion of circulating androstenedione to testosterone by one or more of the unaffected 17 beta-hydroxysteroid dehydrogenase isoenzymes

Addressing the Surgical Deficit: A Global Imperative for Plastic and Reconstructive Surgeons

Despite poor access to quality surgical and anesthesia care for the majority of the world\u27s people, with greatest impact on low- and middle-income countries, surgery has only recently begun to gain acceptance as a necessary component of global health. As a leader in global surgical funding, the field of Plastic and Reconstructive Surgery is uniquely positioned to influence change in global policy and financial support. For improvements in surgical access and outcomes worldwide, investment in surgical systems, commitment to national surgery, obstetric, and anesthesia planning, and continued evaluation and improvement of care delivery should be pursued

Thermocapillary actuation of liquid flow on chemically patterned surfaces

We have investigated the thermocapillary flow of a Newtonian liquid on hydrophilic microstripes which are lithographically defined on a hydrophobic surface. The speed of the microstreams is studied as a function of the stripe width w, the applied thermal gradient |dT/dx| and the liquid volume V deposited on a connecting reservoir pad. Numerical solutions of the flow speed as a function of downstream position show excellent agreement with experiment. The only adjustable parameter is the inlet film height, which is controlled by the ratio of the reservoir pressure to the shear stress applied to the liquid stream. In the limiting cases where this ratio is either much smaller or much larger than unity, the rivulet speed shows a power law dependency on w, |dT/dx| and V. In this study we demonstrate that thermocapillary driven flow on chemically patterned surfaces can provide an elegant and tunable method for the transport of ultrasmall liquid volumes in emerging microfluidic technologies

Gas Accretion Traced in Absorption in Galaxy Spectroscopy

The positive velocity shift of absorption transitions tracing diffuse material observed in a galaxy spectrum is an unambiguous signature of gas flow toward the host system. Spectroscopy probing, e.g., NaI D resonance lines in the rest-frame optical or MgII and FeII in the near-ultraviolet is in principle sensitive to the infall of cool material at temperatures ~ 100-10,000 K anywhere along the line of sight to a galaxy's stellar component. However, secure detections of this redshifted absorption signature have proved challenging to obtain due to the ubiquity of cool gas outflows giving rise to blueshifted absorption along the same sightlines. In this chapter, we review the bona fide detections of this phenomenon. Analysis of NaI D line profiles has revealed numerous instances of redshifted absorption observed toward early-type and/or AGN-host galaxies, while spectroscopy of MgII and FeII has provided evidence for ongoing gas accretion onto >5% of luminous, star-forming galaxies at z ~ 0.5-1. We then discuss the potentially ground-breaking benefits of future efforts to improve the spectral resolution of such studies, and to leverage spatially-resolved spectroscopy for new constraints on inflowing gas morphology.Comment: 21 pages, 7 figures. Invited review to appear in Gas Accretion onto Galaxies, Astrophysics and Space Science Library, eds. A. J. Fox & R. Dav\'e, to be published by Springe

An extracellular steric seeding mechanism for Eph-ephrin signaling platform assembly

Erythropoetin-producing hepatoma (Eph) receptors are cell-surface protein tyrosine kinases mediating cell-cell communication. Upon activation, they form signaling clusters. We report crystal structures of the full ectodomain of human EphA2 (eEphA2) both alone and in complex with the receptor-binding domain of the ligand ephrinA5 (ephrinA5 RBD). Unliganded eEphA2 forms linear arrays of staggered parallel receptors involving two patches of residues conserved across A-class Ephs. eEphA2-ephrinA5 RBD forms a more elaborate assembly, whose interfaces include the same conserved regions on eEphA2, but rearranged to accommodate ephrinA5 RBD. Cell-surface expression of mutant EphA2s showed that these interfaces are critical for localization at cell-cell contacts and activation-dependent degradation. Our results suggest a 'nucleation' mechanism whereby a limited number of ligand-receptor interactions 'seed' an arrangement of receptors which can propagate into extended signaling arrays