Coexisting Values in Healthcare and the Leadership Practices That Were Found to Inspire Followership Among Healthcare Practitioners

Healthcare delivery in the United States has a storied history that has led the American public to expect that their Health Care Practitioners (HCPs) will personally and professionally enact values such as altruism, benevolence, equality, and capability. A progressive set of events that involves the implementation of the market-based solution in the Patient Protection and Affordable Care Act has led healthcare organizations to become increasingly concerned with a conceptually different set of values. It has become more necessary for healthcare organizations to dedicate attention to market values (e.g., competition; productivity) as they operate in an environment that is commonly described as a $3.3T industry. There is significant concern that important care values are being sacrificed as the U.S. health system becomes increasingly commercialized. It is also believed that HCPs are experiencing increasing levels of demoralization and burnout as a result of their inability to realize their personal and professional care value preferences. A qualitative investigation into the experiences of a selection of HCPs served to reveal how the administration in a large health system fosters compatibility among personal, professional, and market value priorities via an application of the tenets of values-based leadership. Study outcomes also feature implications for both the servant leadership and transformational leadership constructs

Analytic Calculation of 1-Jettiness in DIS at O(αs)\mathcal O(\alpha_s)

We present an analytic $\mathcal O(\alpha_s)$ calculation of cross sections in deep inelastic scattering (DIS) dependent on an event shape, 1-jettiness, that probes final states with one jet plus initial state radiation. This is the first entirely analytic calculation for a DIS event shape cross section at this order. We present results for the differential and cumulative 1-jettiness cross sections, and express both in terms of structure functions dependent not only on the usual DIS variables $x$, $Q^2$ but also on the 1-jettiness $\tau$. Combined with previous results for log resummation, predictions are obtained over the entire range of the 1-jettiness distribution.Comment: 40 pages, 8 figure

Coexisting Values in Healthcare and the Leadership Practices That Were Found to Inspire Followership Among Healthcare Practitioners

Healthcare delivery in the United States has a storied history that has led the American public to expect that their Health Care Practitioners (HCPs) will personally and professionally enact values such as altruism, benevolence, equality, and capability. A progressive set of events that involves the implementation of the market-based solution in the Patient Protection and Affordable Care Act has led healthcare organizations to become increasingly concerned with a conceptually different set of values. It has become more necessary for healthcare organizations to dedicate attention to market values (e.g., competition; productivity) as they operate in an environment that is commonly described as a $3.3T industry. There is significant concern that important care values are being sacrificed as the U.S. health system becomes increasingly commercialized. It is also believed that HCPs are experiencing increasing levels of demoralization and burnout as a result of their inability to realize their personal and professional care value preferences. A qualitative investigation into the experiences of a selection of HCPs served to reveal how the administration in a large health system fosters compatibility among personal, professional, and market value priorities via an application of the tenets of values-based leadership. Study outcomes also feature implications for both the servant leadership and transformational leadership constructs

Adaptive grid methods for Q-tensor theory of liquid crystals : a one-dimensional feasibility study

This paper illustrates the use of moving mesh methods for solving partial differential equation (PDE) problems in Q-tensor theory of liquid crystals. We present the results of an initial study using a simple one-dimensional test problem which illustrates the feasibility of applying adaptive grid techniques in such situations. We describe how the grids are computed using an equidistribution principle, and investigate the comparative accuracy of adaptive and uniform grid strategies, both theoretically and via numerical examples

Hypertension in mice lacking 11beta-hydroxysteroid dehydrogenase type 2

Deficiency of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) in humans leads to the syndrome of apparent mineralocorticoid excess (SAME), in which cortisol illicitly occupies mineralocorticoid receptors, causing sodium retention, hypokalemia, and hypertension. However, the disorder is usually incompletely corrected by suppression of cortisol, suggesting additional and irreversible changes, perhaps in the kidney. To examine this further, we produced mice with targeted disruption of the 11β-HSD2 gene. Homozygous mutant mice (11β-HSD2(–/–)) appear normal at birth, but ∼50% show motor weakness and die within 48 hours. Both male and female survivors are fertile but exhibit hypokalemia, hypotonic polyuria, and apparent mineralocorticoid activity of corticosterone. Young adult 11β-HSD2(–/–) mice are markedly hypertensive, with a mean arterial blood pressure of 146 ± 2 mmHg, compared with 121 ± 2 mmHg in wild-type controls and 114 ± 4 mmHg in heterozygotes. The epithelium of the distal tubule of the nephron shows striking hypertrophy and hyperplasia. These histological changes do not readily reverse with mineralocorticoid receptor antagonism in adulthood. Thus, 11β-HSD2(–/–) mice demonstrate the major features of SAME, providing a unique rodent model to study the molecular mechanisms of kidney resetting leading to hypertension. J. Clin. Invest. 103:683–689 (1999

The MSR Mass and the O(ΛQCD){\cal O}(\Lambda_{\rm QCD}) Renormalon Sum Rule

We provide a detailed description and analysis of a low-scale short-distance mass scheme, called the MSR mass, that is useful for high-precision top quark mass determinations, but can be applied for any heavy quark $Q$. In contrast to earlier low-scale short-distance mass schemes, the MSR scheme has a direct connection to the well known $\overline{\rm MS}$ mass commonly used for high-energy applications, and is determined by heavy quark on-shell self-energy Feynman diagrams. Indeed, the MSR mass scheme can be viewed as the simplest extension of the $\overline{\rm MS}$ mass concept to renormalization scales $\ll m_Q$. The MSR mass depends on a scale $R$ that can be chosen freely, and its renormalization group evolution has a linear dependence on $R$, which is known as R-evolution. Using R-evolution for the MSR mass we provide details of the derivation of an analytic expression for the normalization of the ${\cal O}(\Lambda_{\rm QCD})$ renormalon asymptotic behavior of the pole mass in perturbation theory. This is referred to as the ${\cal O}(\Lambda_{\rm QCD})$ renormalon sum rule, and can be applied to any perturbative series. The relations of the MSR mass scheme to other low-scale short-distance masses are analyzed as well.Comment: 42 pages + appendices, 6 figures, v2: Refs and Appendix B added, Fig.3 changed from nl=4 to nl=5, v3: journal versio

Depression and Anxiety Screens as Predictors of 8-Year Incidence of Myocardial Infarction and Stroke in Primary Care Patients

Because depression and anxiety are typically studied in isolation, our purpose was to examine the relative importance of these overlapping emotional factors in predicting incident cardiovascular disease (CVD). Methods We examined depression and anxiety screens, and their individual items, as predictors of incident hard CVD events, myocardial infarction, and stroke over eight years in a diverse sample of 2,041 older primary care patients initially free of CVD. At baseline, participants completed self-report depression and anxiety screens. Data regarding CVD events were obtained from an electronic medical record system and the Centers for Medicare and Medicaid Services analytic files. Results During follow-up, 683 (33%) experienced a CVD event. Cox proportional hazards models – adjusted for demographic and CVD risk factors – revealed that a positive anxiety screen, but not a positive depression screen, was associated with an increased risk of a hard CVD event in separate models (Years 0–3: Anxiety HR=1.54, p<.001; Years 3+: Anxiety HR=0.99, p=.93; Depression HR=1.10, p=.41), as well as when entered into the same model (Years 0–3: Anxiety HR=1.53, p<.001; Years 3+: Anxiety HR=0.99, p=.99; Depression HR=1.03, p=.82). Analyses examining individual items and secondary outcomes showed that the anxiety-CVD association was largely driven by the feeling anxious item and the myocardial infarction outcome. Conclusions Anxiety, especially feeling anxious, is a unique risk factor for CVD events in older adults, independent of conventional risk factors and depression. Anxiety deserves increased attention as a potential factor relevant to CVD risk stratification and a potential target of CVD primary prevention efforts

Acetaminophen use and risk of asthma, rhinoconjunctivitis and eczema in adolescents : ISAAC Phase Three

Rationale: There is epidemiological evidence that the use of acetaminophen may increase the risk of developing asthma. Objectives: To investigate the risk of asthma and other allergic disorders associated with the current use of acetaminophen in 13- to 14-year-old children in different populations worldwide. Methods: As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, 13- to 14-year-old children completed written and video questionnaires obtaining data on current symptoms of asthma, rhinoconjunctivitis, and eczema, and a written environmental questionnaire obtaining data on putative risk factors, including acetaminophen use in the past 12 months. Measurements and Main Results: The primary outcome measure was the odds ratio (OR) of current asthma symptoms associated with acetaminophen use calculated by logistic regression. A total of 322,959 adolescent children from 113 centers in 50 countries participated. In the multivariate analyses the recent use of acetaminophen was associated with an exposure-dependent increased risk of current asthma symptoms (OR, 1.43 [95% confidence interval, 1.33–1.53] and 2.51 [95% confidence interval, 2.33–2.70] for medium and high versus no use, respectively). Acetaminophen use was also associated with an exposure-dependent increased risk of current symptoms of rhinoconjunctivitis and eczema. Conclusions: Acetaminophen use may represent an important risk factor for the development and/or maintenance of asthma, rhinoconjunctivitis, and eczema in adolescent children.peer-reviewe