Bounded by repertoires and roles : communication through multiple ICTs in a health care organization

Health care has become the largest employer in the United States, and health care organizations are looking to ICTs as a solution to facilitate interprofessional communication and patient care. Yet extant findings show mixed results on the efficacy of ICT use for coordination, and little is known about how health care professionals use their collection of ICTs, as opposed to a singular device, to communicate. Inspired by the theoretical underpinnings of communication media repertoires and boundary theory, this dissertation provides an empirical link between the use of multiple ICTs, that are both organizationally-issued and personally-owned, and the complexities of coordinating patient care. Drawing on qualitative data collected from observations, interviews, and focus groups at a pediatric hospital in the Southern U.S., this research investigates the communicative practices of different teams of allied health professionals—an underexplored population making up approximately 60% of the health care workforce. Differences in technological access, managerial expectations, and workflows emerged within and across the professional groups in the health care organization studied. The findings reveal how allied health professionals experienced repertoire misalignment, a situation where ICTs and routines of use clashed. Furthermore, many people were overloaded by learning which ICTs their colleagues used and how they used them— defined as communication load issues—which impeded the efficiency and quality of their work. This dissertation further shows how ICT repertoires are situated at the crossroad of multiple role boundaries, complicated by organizational rules and norms that were inconsistent across teams. These allied health professionals held strong professional identities, and they were asked—or required—to use personal mobile phones for work purposes. When organizational, professional, and personal boundaries were at odds, employees did not feel empowered to enact their ICTs in ways that privileged professionalism or personal preferences. Thus, although the use of ICT repertoires can facilitate communication within and across professional teams, this dissertation exposes how health care professionals’ work practices are being challenged and constrained by organizational demands for ICT repertoire useCommunication Studie

Bring Your Own Mobile Device (BYOD) to the Hospital: Layered Boundary Barriers and Divergent Boundary Management Strategies

This study examined how one US hospital implemented a mobile communication app to improve workplace communication. The hospital did not provide the technology, instead they asked their workers to use their own personal mobiles at work, through a permissive bring your own device to work (BYOD) policy. Using boundary theory, we conducted a constant-comparative analysis to examine the layers of boundary management issues. At the organizational level, the key issues were policy legacy, communicating the policy, control, dead zones, and mobile costs. At the group level, different hospital units created their own formal and informal policies. At the individual level, themes included personal mobile device use, job role expectations, and decision-making autonomy. The discussion presents examples of how healthcare workers enacted segregator and integrator boundaries. Our findings explain why it is not easy to tell hospital employees, “Go ahead and use your mobiles for patient care,” and have them embrace this practice

Phytoplankton Response to Intrusions of Slope Water on the West Florida Shelf: Models and Observations

Previous hypotheses had suggested that upwelled intrusions of nutrient-rich Gulf of Mexico slope water onto the West Florida Shelf (WFS) led to formation of red tides of Karenia brevis. However, coupled biophysical models of (1) wind- and buoyancy-driven circulation, (2) three phytoplankton groups (diatoms, K. brevis, and microflagellates), (3) these slope water supplies of nitrate and silicate, and (4) selective grazing stress by copepods and protozoans found that diatoms won in one 1998 case of no light limitation by colored dissolved organic matter (CDOM). The diatoms lost to K. brevis during another CDOM case of the models. In the real world, field data confirmed that diatoms were indeed the dominant phytoplankton after massive upwelling in 1998, when only a small red tide of K. brevis was observed. Over a 7-month period of the CDOM-free scenario the simulated total primary production of the phytoplankton community was ∼1.8 g C m−2 d−1 along the 40-m isobath of the northern WFS, with the largest accumulation of biomass on the Florida Middle Ground (FMG). Despite such photosynthesis, these models of the WFS yielded a net source of CO2 to the atmosphere during spring and summer and suggested a small sink in the fall. With diatom losses of 90% of their daily carbon fixation to herbivores the simulation supported earlier impressions of a short, diatom-based food web on the FMG, where organic carbon content of the surficial sediments is tenfold those of the surrounding seabeds. Farther south, the simulated near-bottom pools of ammonium were highest in summer, when silicon regeneration was minimal, leading to temporary Si limitation of the diatoms. Termination of these upwelled pulses of production by diatoms and nonsiliceous microflagellates mainly resulted from nitrate exhaustion in the model, however, mimicking most del15PON observations in the field. Yet, the CDOM-free case of the models failed to replicate the observed small red tide in December 1998, tagged with the del15N signature of nitrogen fixation. A large red tide of K. brevis did form in the CDOM-rich case, when estuarine supplies of CDOM favored the growth of the shade-adapted, ungrazed dinoflagellates. The usual formation of large harmful algal blooms of \u3e1 ug chl L−1 (105 cells L−1) in the southern part of the WFS, between Tampa Bay and Charlotte Harbor, must instead depend upon local aeolian and estuarine supplies of nutrients and CDOM sun screen, not those from the shelf break. In the absence of slope water supplies, local upwelling instead focuses nitrate-poor innocula of co-occurring K. brevis and nitrogen fixers at coastal fronts for both aggregation and transfer of nutrients between these phytoplankton groups

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication