Providing Feedback Following Leadership Walkrounds is Associated with Better Patient Safety Culture, Higher Employee Engagement and Lower Burnout

Background There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. Methods This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. Results 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70). Conclusion This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent

When data are not missing at random: implications for measuring health conditions in the Behavioral Risk Factor Surveillance System

Objectives To examine the effect on estimated levels of health conditions produced from large-scale surveys, when either list-wise respondent deletion or standard demographic item-level imputation is employed. To assess the degree to which further bias reduction results from the inclusion of correlated ancillary variables in the item imputation process. Design Large cross-sectional (US level) household survey. Participants 218 726 US adults (18 years and older) in the 2006 Behavioral Risk Factor Surveillance System Survey. This survey is the largest US telephone survey conducted by the Centers for Disease Control and Prevention. Primary and secondary outcome measures Estimated rates of severe depression among US adults. Results The use of list-wise respondent deletion and/or demographic imputation results in the underestimation of severe depression among adults in the USA. List-wise deletion produces underestimates of 9% (8.7% vs 9.5%). Demographic imputation produces underestimates of 7% (8.9% vs 9.5%). Both of these differences are significant at the 0.05 level. Conclusion The use of list-wise deletion and/or demographic-only imputation may produce significant distortion in estimating national levels of certain health conditions

Kinetic energy and microcanonical nonanalyticities in finite and infinite systems

In contrast to the canonical case, microcanonical thermodynamic functions can show nonanalyticities also for finite systems. In this paper we contribute to the understanding of these nonanalyticities by working out the relation between nonanalyticities of the microcanonical entropy and its configurational counterpart. If the configurational microcanonical entropy $\omega_N^c(v)$ has a nonanalyticity at $v=v_c$, then the microcanonical entropy $\omega_N(\epsilon)$ has a nonanalyticity at the same value $\epsilon=v_c$ of its argument for any finite value of the number of degrees of freedom $N$. The presence of the kinetic energy weakens the nonanalyticities such that, if the configurational entropy is $p$ times differentiable, the entropy is $p+\lfloor N/2 \rfloor$-times differentiable. In the thermodynamic limit, however, the behaviour is very different: The nonanalyticities do not longer occur at the same values of the arguments, but the nonanalyticity of the microcanonical entropy is shifted to a larger energy. These results give a general explanation of the peculiar behaviour previously observed for the mean-field spherical model. With the hypercubic model we provide a further example illustrating our results.Comment: 14 pages, 2 figures; v2: minor corrections, final versio

Social and Cultural Dynamics of Non-Native Invasive Species

Invasive species and their management represent a complex issue spanning social and ecological systems. Invasive species present existing and potential threats to the nature of ecosystems and the products and services that people receive from them. Humans can both cause and address problems through their complex interactions with ecosystems. Yet, public awareness of invasive species and their impact is highly uneven, and public support for management and control of invasive species can be variable. Public perceptions often differ markedly from the perspectives of concerned scientists, and perceptions and support for management are influenced by a wide range of social and ecological values. In this chapter, we present a broad survey of social science research across a diversity of ecosystems and stakeholders in order to provide a foundation for understanding the social and cultural dimensions of invasive species and plan more effective management approaches. This chapter also addresses tribal perspectives on invasive species, including traditional ecological knowledge, unique cultural dimensions for tribes, and issues critical to engaging tribes as partners and leaders in invasive species management. Recognizing that natural resource managers often seek to change people’s perceptions and behaviors, we present and discuss some promising approaches that are being used to engage human communities in ways that empower and enlist stakeholders as partners in management

Mutation location on the RAS oncogene affects pathologic features and survival after resection of colorectal liver metastases

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136316/1/cncr30351_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136316/2/cncr30351.pd

Cosmogenic ^(10)Be and ^(36)Cl geochronology of offset alluvial fans along the northern Death Valley fault zone: Implications for transient strain in the eastern California shear zone

The northern Death Valley fault zone (NDVFZ) has long been recognized as a major right-lateral strike-slip fault in the eastern California shear zone (ECSZ). However, its geologic slip rate has been difficult to determine. Using high-resolution digital topographic imagery and terrestrial cosmogenic nuclide dating, we present the first geochronologically determined slip rate for the NDVFZ. Our study focuses on the Red Wall Canyon alluvial fan, which exposes clean dextral offsets of seven channels. Analysis of airborne laser swath mapping data indicates ∼297 ± 9 m of right-lateral displacement on the fault system since the late Pleistocene. In situ terrestrial cosmogenic ^(10)Be and ^(36)Cl geochronology was used to date the Red Wall Canyon fan and a second, correlative fan also cut by the fault. Beryllium 10 dates from large cobbles and boulders provide a maximum age of 70 +22/−20 ka for the offset landforms. The minimum age of the alluvial fan deposits based on ^(36)Cl depth profiles is 63 ± 8 ka. Combining the offset measurement with the cosmogenic ^(10)Be date yields a geologic fault slip rate of 4.2 +1.9/−1.1 mm yr^(−1), whereas the ^(36)Cl data indicate 4.7 +0.9/−0.6 mm yr^(−1) of slip. Summing these slip rates with known rates on the Owens Valley, Hunter Mountain, and Stateline faults at similar latitudes suggests a total geologic slip rate across the northern ECSZ of ∼8.5 to 10 mm yr^(−1). This rate is commensurate with the overall geodetic rate and implies that the apparent discrepancy between geologic and geodetic data observed in the Mojave section of the ECSZ does not extend north of the Garlock fault. Although the overall geodetic rates are similar, the best estimates based on geology predict higher strain rates in the eastern part of the ECSZ than to the west, whereas the observed geodetic strain is relatively constant

Recurrent Modification of a Conserved Cis-Regulatory Element Underlies Fruit Fly Pigmentation Diversity

The development of morphological traits occurs through the collective action of networks of genes connected at the level of gene expression. As any node in a network may be a target of evolutionary change, the recurrent targeting of the same node would indicate that the path of evolution is biased for the relevant trait and network. Although examples of parallel evolution have implicated recurrent modification of the same gene and cis-regulatory element (CRE), little is known about the mutational and molecular paths of parallel CRE evolution. In Drosophila melanogaster fruit flies, the Bric-à-brac (Bab) transcription factors control the development of a suite of sexually dimorphic traits on the posterior abdomen. Female-specific Bab expression is regulated by the dimorphic element, a CRE that possesses direct inputs from body plan (ABD-B) and sex-determination (DSX) transcription factors. Here, we find that the recurrent evolutionary modification of this CRE underlies both intraspecific and interspecific variation in female pigmentation in the melanogaster species group. By reconstructing the sequence and regulatory activity of the ancestral Drosophila melanogaster dimorphic element, we demonstrate that a handful of mutations were sufficient to create independent CRE alleles with differing activities. Moreover, intraspecific and interspecific dimorphic element evolution proceeded with little to no alterations to the known body plan and sex-determination regulatory linkages. Collectively, our findings represent an example where the paths of evolution appear biased to a specific CRE, and drastic changes in function were accompanied by deep conservation of key regulatory linkages. © 2013 Rogers et al