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

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

Supporting Self-managed Abortion Care in “practice not premise”: Provider Perspectives, Roles, and Referral Pathways in India

Objective: Describe provider perspectives and roles in self-managed abortion (SMA) in India and identify referral pathways to facility- and self-managed abortion care. Methods: We conducted a qualitative study of 33 semi-structured interviews with a range of providers (medical, community health, and pharmacy) in India. We conducted a thematic analysis and identified referral pathways including the type of provider, the abortion care modality (in-facility or SMA), and the reason. Results: Referrals to facility-managed abortion care were common. Providers\u27 perception of SMA safety coupled with­ liability concerns resulted in discouraging clients from seeking SMA. Nonetheless, participants acknowledged three areas where providers played a role in SMA: providing information, dispensing medication, and providing support. SMA referrals pathways occurred bidirectionally between pharmacy workers and local providers. Some community health workers provided referrals to pharmacies, but more often only provided information and support. Conclusion: Despite provider concerns, support and referrals for SMA do occur in India. Understanding the dynamics of provider perspectives, roles, and referral pathways can inform improvements to comprehensive reproductive health policies and programs in order to promote client-centered abortion care—including SMA—and address provider concerns. There is a need for synergies between the formal health sector and SMA support networks. Keywords: Abortion, self-managed abortion, pharmacy, referrals, quality of car

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

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

Estimations of rip current rescues and drowning in the United States

Rip currents are the greatest hazard to swimmers on surf beaches, but due to a lack of consistent incident reporting in many countries, it is often difficult to quantify the number of rip-current-related rescues and drowning deaths occurring along surf beaches. This study examines this problem using rescue data reported to the United States Lifesaving Association (USLA) by surf beach rescuers from 1997 through 2016. These data were checked, corrected, and culled so that only data from surf beach rescue agencies that reported the primary cause of rescue were included. Results show that rip currents are the primary cause of 81.9&thinsp;% of rescues on surf beaches, with regional variation from 75.3&thinsp;% (East Coast) to 84.7&thinsp;% (West Coast). These values are significantly higher than those previously reported in the scientific literature (e.g., 36.5&thinsp;%, 53.7&thinsp;%). Using this value as a proxy when examining overall surf beach drowning fatalities, it is suggested that more than 100 fatal drownings per year occur due to rip currents in the United States. However, it is clear that the United States data would benefit by an increase in the number of lifeguard agencies which report surf-related rescues by primary cause.</p

Direct and indirect parental exposure to endocrine disruptors and elevated temperature influences gene expression across generations in a euryhaline model fish

Aquatic organisms inhabiting polluted waterways face numerous adverse effects, including physiological disruption by endocrine disrupting compounds (EDCs). Little is known about how the temperatures associated with global climate change may influence the response of organisms exposed to EDCs, and the effects that these combined stressors may have on molecular endpoints such as gene expression. We exposed Menidia beryllina (inland silversides) to environmentally relevant concentrations (1 ng/L) of two estrogenic EDCs (bifenthrin and 17α-ethinylestradiol; EE2) at 22 °C and 28 °C. We conducted this experiment over multiple generations to better understand the potential effects to chronically exposed populations in the wild. We exposed adult parental fish (F0) for 14 days prior to spawning of the next generation. F1 larvae were then exposed from fertilization until 21 days post hatch (dph) before being transferred to clean water tanks. F1 larvae were reared to adulthood, then spawned in clean water to test for further effects of parental exposure on offspring (F2 generation). Gene expression was quantified by performing qPCR on F0 and F1 gonads, as well as F1 and F2 larvae. We did not detect any significant differences in the expression of genes measured in the parental or F1 adult gonads. We found that the 28 °C EE2 treatment significantly decreased the expression of nearly all genes measured in the F1 larvae. This pattern was transferred to the F2 generation for expression of the follicle-stimulating hormone receptor (FSHR) gene. Expression of 17β-hydroxysteroid dehydrogenase (17β-HSD) and G protein-coupled receptor 30 (GPR30) revealed changes not measured in the previous generation. Effects of the bifenthrin treatments were not observed until the F2 generation, which were exposed to the chemicals indirectly as germ cells. Our results indicate that effects of EDCs and their interactions with abiotic factors, may not be adequately represented by singular generation testing. These findings will contribute to the determination of the risk of EDC contamination to organisms inhabiting contaminated waterways under changing temperature regimes