Seven steps to successful change: How a large academic medical center prepared patients for organizational change

Vanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step approach to preparing patients for the impacts of the transition, which led to a return to pre-implementation patient satisfaction scores in about half the time of its peer institutions. The article explores these seven steps in detail and offers recommendations for how healthcare organizations facing large-scale change can use a similar structured approach to mitigate negative impacts to patients. Experience Framework This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Future Dominance by Quaking Aspen Expected Following Short-Interval, Compounded Disturbance Interaction

The spatial overlap of multiple ecological disturbances in close succession has the capacity to alter trajectories of ecosystem recovery. Widespread bark beetle outbreaks and wildfire have affected many forests in western North America in the past two decades in areas of important habitat for native ungulates. Bark beetle outbreaks prior to fire may deplete seed supply of the host species, and differences in fire‐related regeneration strategies among species may shift the species composition and structure of the initial forest trajectory. Subsequent browsing of postfire tree regeneration by large ungulates, such as elk (Cervus canadensis), may limit the capacity for regeneration to grow above the browse zone to form the next forest canopy. Five stand‐replacing wildfires burned ~60,000 ha of subalpine forest that had previously been affected by severe ( \u3e90% mortality) outbreaks of spruce beetle (SB, Dendroctonus rufipennis) in Engelmann spruce (Picea engelmannii) in 2012–2013 in southwestern Colorado. Here we examine the drivers of variability in abundance of newly established conifer tree seedlings [spruce and subalpine fir (Abies lasiocarpa)] and resprouts of quaking aspen (Populus tremuloides) following the short‐interval sequence of SB outbreaks and wildfire (2–8 yr between SB outbreak and fire) at sites where we previously reconstructed severities of SB and fire. We then examine the implications of ungulate browsing for forest recovery. We found that abundances of postfire spruce seedling establishment decreased substantially in areas of severe SB outbreak. Prolific aspen resprouting in stands with live aspen prior to fire will favor an initial postfire forest trajectory dominated by aspen. However, preferential browsing of postfire aspen resprouts by ungulates will likely slow the rate of canopy recovery but browsing is unlikely to alter the species composition of the future forest canopy. Collectively, our results show that SB outbreak prior to fire increases the vulnerability of spruce–fir forests to shifts in forest type (conifer to aspen) and physiognomic community type (conifer forest to non‐forest). By identifying where compounded disturbance interactions are likely to limit recovery of forests or tree species, our findings are useful for developing adaptive management strategies in the context of warming climate and shifting disturbance regimes

Putting lives in danger? Tinker, tailor, journalist, spy: the use of journalistic cover

The Anglo-American intelligence agencies’ use of journalists as spies or propagandists and the practice of providing intelligence agents in the field with journalistic cover have been a source of controversy for many decades. This paper examines the extent to which these covert practices have taken place and whether they have put journalists’ lives in danger. This paper, drawing on various methodologies, examines a number of cases where the arrest, murder or kidnap of journalists was justified on the grounds that the journalist was a ‘spy’. This has been followed through with research using a range of sources that shows there have been many occasions when the distinction between spies and journalists has been opaque. The paper concludes that widespread use of journalistic cover by spies has put lives in danger but the extent is unquantifiable

Researcher as Artist/Artist as Researcher

This is a postmodern article that is nontraditional in its form, content, and mode of representation. Upon recognizing that we share interests and common experiences as artists, we decided to collect life history information from each other about our artistic experiences. Thus we have become, simultaneously, "the researched" and "the re searcher." In these conversations, we explore the ways in which we were each guided by our past, very strong aesthetic and artistic experiences. We also include the voices of other researchers and artists in our conversations as we explore the influences of art in the formation of our worldviews.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68774/2/10.1177_107780049500100107.pd

Habitable Zones in the Universe

Habitability varies dramatically with location and time in the universe. This was recognized centuries ago, but it was only in the last few decades that astronomers began to systematize the study of habitability. The introduction of the concept of the habitable zone was key to progress in this area. The habitable zone concept was first applied to the space around a star, now called the Circumstellar Habitable Zone. Recently, other, vastly broader, habitable zones have been proposed. We review the historical development of the concept of habitable zones and the present state of the research. We also suggest ways to make progress on each of the habitable zones and to unify them into a single concept encompassing the entire universe.Comment: 71 pages, 3 figures, 1 table; to be published in Origins of Life and Evolution of Biospheres; table slightly revise

Accounting for Ecosystem Alteration Doubles Estimates of Conservation Risk in the Conterminous United States

Previous national and global conservation assessments have relied on habitat conversion data to quantify conservation risk. However, in addition to habitat conversion to crop production or urban uses, ecosystem alteration (e.g., from logging, conversion to plantations, biological invasion, or fire suppression) is a large source of conservation risk. We add data quantifying ecosystem alteration on unconverted lands to arrive at a more accurate depiction of conservation risk for the conterminous United States. We quantify ecosystem alteration using a recent national assessment based on remote sensing of current vegetation compared with modeled reference natural vegetation conditions. Highly altered (but not converted) ecosystems comprise 23% of the conterminous United States, such that the number of critically endangered ecoregions in the United States is 156% higher than when calculated using habitat conversion data alone. Increased attention to natural resource management will be essential to address widespread ecosystem alteration and reduce conservation risk

Comparison of mantle lithosphere beneath early Triassic kimberlite fields in Siberian craton reconstructed from deep-seated xenocrysts

Mantle xenocrysts from Early Triassic kimberlite pipes from Kharamai, Ary Mastakh and Kuranakh fields in the Anabar shield of Siberia revealing similar compositional trends were studied to estimate the superplume influence on the SCLM. PT reconstructions using monomineral thermobarometry for 5 phases show division of the SCLM beneath the Kharamai field into 6 units: pyroxenitic Fe-rich (1-2 GPa) and Mg-rich (2-3 GPa) layers; middle with two levels of Gar -Sp pyroxenites at ∼3 and 4 -5 GPa; Ga- dunite –harzburgites ∼ 4.5-6.5 GPa subjected to Ilm-Px vein metasomatism, and a Mg-rich dunite lower part. In the Anabar shield (Ary Mastakh, Dyuken and Kuranakh fields) mantle lithosphere is composed of three large units divided into two parts: upper part with amphiboles and phlogopite; two levels of pyroxenites and eclogites at 3 and 4 GPa, and a lower part composed of refertilized dunites. Diagrams showing P- Fe#Gar clusters for garnets and omphacites illustrate the differences between SCLM of these localities. Differences of Triassic SCLM from Devonian SCLM are in simple layering; abundance of Na-Cr-amphiboles and metasomatism in the upper SCLM part, thick pyroxenite - eclogite layer and lower part depletion, heated from SCLM base to 5.0 GPa. Kharamai mantle clinopyroxenes represent three geochemical types: 1) harzburgitic with inclined linear REE, HFSE troughs and elevated Th, U; 2) lherzolitic or pyroxenitic with round TRE patterns and decreasing incompatible elements; 3) eclogitic with Eu troughs, Pb peak and high LILE content. Calculated parental melts for garnets with humped REE patterns suggest dissolution of former Cpx and depression means Cpx and garnets extraction. Clinopyroxenes from Ary Mastakh fields show less inclined REE patterns with HMREE troughs and an increase of incompatible elements. Clinopyroxenes from Kuranakh field show flatter spoon-like REE patterns and peaks in Ba, U, Pb and Sr, similar to those in ophiolitic harzburgites. The PT diagrams for the mantle sections show high temperature gradients in the uppermost SCLM accompanied by an increase of P-Fe#Ol upward and slightly reduced thickness of the mantle keel of the Siberian craton, resulting from the influence of the Permian -Triassic superplume, but with no signs of delamination