Subsequence Rational Ergodicity of Rank-One Transformations

We show that all rank-one transformations are subsequence boundedly rationally ergodic and that there exist rank-one transformations that are not weakly rationally ergodic.Comment: Added references, minor update

BREAKING BAD NEWS IN HEALTHCARE ORGANIZATIONS: APPLICATION OF THE SPIKES PROTOCOL

Organizational downsizing has increased exponentially worldwide and is also affecting the healthcare industry. It is one thing to speak abstractly of the need to reduce costs and quite another to actually tell a worker the bad news that he or she has been laid off. This paper offers practical advice to healthcare managers on conducting unpleasant conversations with employees based on a widely used medical model—the SPIKES protocol. This strategy has been extensively employed by physicians and other health care professionals who frequently communicate negative information to patients and is offered as an approach that can be easily and effectively adapted by healthcare managers when they must tell a person they have been terminated. Although breaking the bad news of a cutback will never be easy, having a plan of action that entails sound business and medical advice and is also the necessary thing to do can help firms carefully manage and execute reorganizations for the well-being of the organization and the terminated worker

Vegetation classification and mapping project report: Great Sand Dunes National Park and Preserve

NPS 140/101150.February 2010.Natural Resource Report NPS/ROMN/NRR--2010/179.Includes bibliographical references

Teacher Evaluation in Practice: Implementing Chicago's REACH Students

Historically, teacher evaluation in Chicago has fallen short on two crucial fronts: It has not provided administrators with measures that differentiated among strong and weak teachers -- in fact, 93 percent of teachers were rated as Excellent or Superior -- and it has not provided teachers with useful feedback they could use to improve their instruction. Chicago is not unique -- teacher evaluation systems across the country have experienced the exact same problems.Recent national policy has emphasized overhauling these systems to include multiple measures of teacher performance, such as student outcomes, and structuring the evaluations so they are useful from both talent management and teacher professional development perspectives. Principals and teachers need an evaluation system that provides teachers with specific, practice-oriented feedback they can use to improve their instruction and school leaders need to be able to identify strong and weak teachers. Required to act by a new state law and building off lessons learned from an earlier pilot of an evidence-based observation tool, Chicago Public Schools (CPS) rolled out its new teacher evaluation system -- Recognizing Educators Advancing Chicago's Students (REACH Students) -- in the 2012-13 school year. The REACH system seeks to provide a measure of individual teacher effectiveness that can simultaneously support instructional improvement. It incorporates teacher performance ratings based on multiple classroom observations together with student growth measured on two different types of assessments. While the practice of using classroom observations as an evaluation tool is not completely new, REACH requires teachers and administrators to conceptualize classroom observations more broadly as being part of instructional improvement efforts as well as evaluation; evaluating teachers based on student test score growth has never happened before in the district. REACH implementation was a massive undertaking. It required a large-scale investment of time and energy from teachers, administrators, CPS central office staff, and the teachers union. District context played an important role and provided additional challenges as the district was introducing other major initiatives at the same time as REACH. Furthermore, the school year began with the first teacher strike in CPS in over 25 years. Teacher evaluation was one of several contentious points in the protracted negotiation, and the specific issue of using student growth on assessments to evaluate teachers received considerable coverage in the media. This report focuses on the perceptions and experiences of teachers and administrators during the first year of REACH implementation, which was in many ways a particularly demanding year. These experiences can be helpful to CPS and to other districts across the country as they work to restructure and transform teacher evaluation

Adverse health effects of nighttime lighting: comments on american medical association policy statement.

The American Medical Association House of Delegates in June of 2012 adopted a policy statement on nighttime lighting and human health. This major policy statement summarizes the scientific evidence that nighttime electric light can disrupt circadian rhythms in humans and documents the rapidly advancing understanding from basic science of how disruption of circadian rhythmicity affects aspects of physiology with direct links to human health, such as cell cycle regulation, DNA damage response, and metabolism. The human evidence is also accumulating, with the strongest epidemiologic support for a link of circadian disruption from light at night to breast cancer. There are practical implications of the basic and epidemiologic science in the form of advancing lighting technologies that better accommodate human circadian rhythmicity

Nonconservative Lagrangian mechanics II: purely causal equations of motion

This work builds on the Volterra series formalism presented in [D. W. Dreisigmeyer and P. M. Young, J. Phys. A \textbf{36}, 8297, (2003)] to model nonconservative systems. Here we treat Lagrangians and actions as `time dependent' Volterra series. We present a new family of kernels to be used in these Volterra series that allow us to derive a single retarded equation of motion using a variational principle

Case mix, outcome and activity for patients admitted to intensive care units requiring chronic renal dialysis: a secondary analysis of the ICNARC Case Mix Programme Database

INTRODUCTION: This report describes the case mix, outcome and activity for admissions to intensive care units (ICUs) of patients who require prior chronic renal dialysis for end-stage renal failure (ESRF), and investigates the effect of case mix factors on outcome. METHODS: This was a secondary analysis of a high-quality clinical database, namely the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, which includes 276,731 admissions to 170 adult ICUs across England, Wales and Northern Ireland from 1995 to 2004. RESULTS: During the eight year study period, 1.3% (n = 3,420) of all patients admitted to ICU were receiving chronic renal dialysis before ICU admission. This represents an estimated ICU utilization of six admissions (32 bed-days) per 100 dialysis patient-years. The ESRF group was younger (mean age 57.3 years versus 59.5 years) and more likely to be male (60.2% versus 57.9%) than those without ESRF. Acute Physiology and Chronic Health Evaluation II score and Acute Physiology Score revealed greater severity of illness on admission in patients with ESRF (mean 24.7 versus 16.6 and 17.2 versus 12.6, respectively). Length of stay in ICU was comparable between groups (median 1.9 days versus 1.8 days) and ICU mortality was only slightly elevated in the ESRF group (26.3% versus 20.8%). However, the ESRF group had protracted overall hospital stay (median 25 days versus 17 days), and increased hospital mortality (45.3% versus 31.2%) and ICU readmission (9.0% vs. 4.7%). Multiple logistic regression analysis adjusted for case mix identified the increased hospital mortality to be associated with increasing age, emergency surgery and nonsurgical cases, cardiopulmonary resuscitation before ICU admission and extremes of physiological norms. The adjusted odds ratio for ultimate hospital mortality associated with chronic renal dialysis was 1.24 (95% confidence interval 1.13 to 1.37). CONCLUSION: Patients with ESRF admitted to UK ICUs are more likely to be male and younger, with a medical cause of admission, and to have greater severity of illness than the non-ESRF population. Outcomes on the ICU were comparable between the two groups, but those patients with ESRF had greater readmission rates, prolonged post-ICU hospital stay and increased post-ICU hospital mortality. This study is by far the largest comparative outcome analysis to date in patients with ESRF admitted to the ICU. It may help to inform clinical decision-making and resource requirements for this patient population