IMPROVING OUTCOMES ASSESSMENT THROUGH SILO INTEGRATION

The purpose of this action research study was to leverage the experiences and perceptions of academic administrators at Mountain State University to disrupt the negative aspects of silo-based decision-making within closing the loop assessment practices. Siloed operations naturally begin to operate in contradiction to one another and often to the detriment of the organization. Focusing specifically on siloed operations across academic schools at Mountain State University, this study reveals issues of inefficiency and redundancy, and develops intervention strategies in an effort to improve closing the loop assessment efforts. These strategies include structural changes leading to a more integrated assessment model calling for greater attention around the use of assessment results. Implications for siloed assessment practices in academic settings are discussed

IMPROVING OUTCOMES ASSESSMENT THROUGH SILO INTEGRATION

The purpose of this action research study was to leverage the experiences and perceptions of academic administrators at Mountain State University to disrupt the negative aspects of silo-based decision-making within closing the loop assessment practices. Siloed operations naturally begin to operate in contradiction to one another and often to the detriment of the organization. Focusing specifically on siloed operations across academic schools at Mountain State University, this study reveals issues of inefficiency and redundancy, and develops intervention strategies in an effort to improve closing the loop assessment efforts. These strategies include structural changes leading to a more integrated assessment model calling for greater attention around the use of assessment results. Implications for siloed assessment practices in academic settings are discussed

Impacts of disturbance on the terrestrial carbon budget of North America

Because it is an important regulator of terrestrial carbon cycling in North America, extensive research on natural and human disturbances has been carried out as part of the North American Carbon Program and the CarboNA project. A synthesis of various components of this research was carried out, and the results are presented in the papers contained in this special section. While the synthesis primarily focused on the impacts of fire, insects/disease, and harvesting on terrestrial carbon cycling in forests, several groups focused on impacts of disturbance on woody encroachment in western U. S. dry lands and on soil carbon present in northern high-latitude regions. Here, we present a summary of the results from these papers, along with the findings and recommendations from the disturbance synthesis. Citation: Kasischke, E. S., B. D. Amiro, N. N. Barger, N. H. F. French, S. J. Goetz, G. Grosse, M. E. Harmon, J. A. Hicke, S. Liu, and J. G. Masek (2013), Impacts of disturbance on the terrestrial carbon budget of North America, J. Geophys. Res. Biogeosci., 118, 303-316, doi:10.1002/jgrg.20027.Keywords: Permafrost thaw, United States, Mountain pine beetle, Boreal forest, Canada, Climate change, Dynamics, Fire severity, Ice storm damage, Forest gap model

The density and peculiar velocity fields of nearby galaxies

We review the quantitative science that can be and has been done with redshift and peculiar velocity surveys of galaxies in the nearby universe. After a brief background setting the cosmological context for this work, the first part of this review focuses on redshift surveys. The practical issues of how redshift surveys are carried out, and how one turns a distribution of galaxies into a smoothed density field, are discussed. Then follows a description of major redshift surveys that have been done, and the local cosmography out to 8,000 km/s that they have mapped. We then discuss in some detail the various quantitative cosmological tests that can be carried out with redshift data. The second half of this review concentrates on peculiar velocity studies, beginning with a thorough review of existing techniques. After discussing the various biases which plague peculiar velocity work, we survey quantitative analyses done with peculiar velocity surveys alone, and finally with the combination of data from both redshift and peculiar velocity surveys. The data presented rule out the standard Cold Dark Matter model, although several variants of Cold Dark Matter with more power on large scales fare better. All the data are consistent with the hypothesis that the initial density field had a Gaussian distribution, although one cannot rule out broad classes of non-Gaussian models. Comparison of the peculiar velocity and density fields constrains the Cosmological Density Parameter. The results here are consistent with a flat universe with mild biasing of the galaxies relative to dark matter, although open universe models are by no means ruled out.Comment: In press, Physics Reports. 153 pages. gzip'ed postscript of text plus 20 embedded figures. Also available via anonymous ftp at ftp://eku.ias.edu/pub/strauss/review/physrep.p

Hypnosis Antenatal Training for Childbirth (HATCh): a randomised controlled trial [NCT00282204]

BACKGROUND: Although medical interventions play an important role in preserving lives and maternal comfort they have become increasingly routine in normal childbirth. This may increase the risk of associated complications and a less satisfactory birth experience. Antenatal hypnosis is associated with a reduced need for pharmacological interventions during childbirth. This trial seeks to determine the efficacy or otherwise of antenatal group hypnosis preparation for childbirth in late pregnancy. METHODS/DESIGN: A single centre, randomised controlled trial using a 3 arm parallel group design in the largest tertiary maternity unit in South Australia. Group 1 participants receive antenatal hypnosis training in preparation for childbirth administered by a qualified hypnotherapist with the use of an audio compact disc on hypnosis for re-enforcement; Group 2 consists of antenatal hypnosis training in preparation for childbirth using an audio compact disc on hypnosis administered by a nurse with no training in hypnotherapy; Group 3 participants continue with their usual preparation for childbirth with no additional intervention. Women > 34 and < 39 weeks gestation, planning a vaginal birth, not in active labour, with a singleton, viable fetus of vertex presentation, are eligible to participate. Allocation concealment is achieved using telephone randomisation. Participants assigned to hypnosis groups commence hypnosis training as near as possible to 37 weeks gestation. Treatment allocations are concealed from treating obstetricians, anaesthetists, midwives and those personnel collecting and analysing data. Our sample size of 135 women/group gives the study 80% power to detect a clinically relevant fall of 20% in the number of women requiring pharmacological analgesia – the primary endpoint. We estimate that approximately 5–10% of women will deliver prior to receiving their allocated intervention. We plan to recruit 150 women/group and perform sequential interim analyses when 150 and 300 participants have been recruited. All participant data will be analysed, by a researcher blinded to treatment allocation, according to the "Intention to treat" principle with comprehensive pre-planned cost- benefit and subgroup analyses. DISCUSSION: If effective, hypnosis would be a simple, inexpensive way to improve the childbirth experience, reduce complications associated with pharmacological interventions, yield cost savings in maternity care, and this trial will provide evidence to guide clinical practice

Impacts of disturbance on the terrestrial carbon budget of North America

Because it is an important regulator of terrestrial carbon cycling in North America, extensive research on natural and human disturbances has been carried out as part of the North American Carbon Program and the CarboNA project. A synthesis of various components of this research was carried out, and the results are presented in the papers contained in this special section. While the synthesis primarily focused on the impacts of fire, insects/disease, and harvesting on terrestrial carbon cycling in forests, several groups focused on impacts of disturbance on woody encroachment in western U.S. dry lands and on soil carbon present in northern high-latitude regions. Here, we present a summary of the results from these papers, along with the findings and recommendations from the disturbance synthesis. Key Points A synthesis of impacts of disturbance on terrestrial carbon cyclin

Prospective Testing and Redesign of a Temporal Biomarker Based Risk Model for Patients With Septic Shock: Implications for Septic Shock Biology

The temporal version of the pediatric sepsis biomarker risk model (tPERSEVERE) estimates the risk of a complicated course in children with septic shock based on biomarker changes from days 1 to 3 of septic shock. We validated tPERSEVERE performance in a prospective cohort, with an a priori plan to redesign tPERSEVERE if it did not perform well. Biomarkers were measured in the validation cohort (n = 168) and study subjects were classified according to tPERSEVERE. To redesign tPERSEVERE, the validation cohort and the original derivation cohort (n = 299) were combined and randomly allocated to training (n = 374) and test (n = 93) sets. tPERSEVERE was redesigned using the training set and CART methodology. tPERSEVERE performed poorly in the validation cohort, with an area under the curve (AUC) of 0.67 (95% CI: 0.58–0.75). Failure analysis revealed potential confounders related to clinical characteristics. The redesigned tPERSEVERE model had an AUC of 0.83 (0.79–0.87) and a sensitivity of 93% (68–97) for estimating the risk of a complicated course. Similar performance was seen in the test set. The classification tree segregated patients into two broad endotypes of septic shock characterized by either excessive inflammation or immune suppression

Corticosteroids and pediatric septic shock outcomes: a risk stratified analysis.

The potential benefits of corticosteroids for septic shock may depend on initial mortality risk.We determined associations between corticosteroids and outcomes in children with septic shock who were stratified by initial mortality risk.We conducted a retrospective analysis of an ongoing, multi-center pediatric septic shock clinical and biological database. Using a validated biomarker-based stratification tool (PERSEVERE), 496 subjects were stratified into three initial mortality risk strata (low, intermediate, and high). Subjects receiving corticosteroids during the initial 7 days of admission (n = 252) were compared to subjects who did not receive corticosteroids (n = 244). Logistic regression was used to model the effects of corticosteroids on 28-day mortality and complicated course, defined as death within 28 days or persistence of two or more organ failures at 7 days.Subjects who received corticosteroids had greater organ failure burden, higher illness severity, higher mortality, and a greater requirement for vasoactive medications, compared to subjects who did not receive corticosteroids. PERSEVERE-based mortality risk did not differ between the two groups. For the entire cohort, corticosteroids were associated with increased risk of mortality (OR 2.3, 95% CI 1.3-4.0, p = 0.004) and a complicated course (OR 1.7, 95% CI 1.1-2.5, p = 0.012). Within each PERSEVERE-based stratum, corticosteroid administration was not associated with improved outcomes. Similarly, corticosteroid administration was not associated with improved outcomes among patients with no comorbidities, nor in groups of patients stratified by PRISM.Risk stratified analysis failed to demonstrate any benefit from corticosteroids in this pediatric septic shock cohort