Organizational culture associated with provider satisfaction

pre-printBackground: Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. Methods: This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Results: Providers were most satisfied with quality of care (mean, 4.14; scale of 1-5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P < .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Conclusions: Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended

The state of care transitions education: A survey of AGS teachers section members

posterCare transitions pose significant risks for older and more complex medical patients, including medication errors and rehospitalizations. Unfortunately, few medical schools and residency programs provide targeted care transitions training. Changes in the healthcare system, including coordination of care provisions in the Affordable Care Act and proposed CMS billing codes for care coordination underscore the need for future health professionals to perform care transitions effectively. Given the impact of care transitions on older adults, we sought to determine the extent to which geriatric educators currently address care transitions education

On the Role of Dust in the Lunar Ionosphere

Evidence suggests that electron concentrations above the dayside lunar surface can be significantly higher than expected from either the photo-ionization of exospheric neutrals or any other well-known process. The Luna 19 mission performed dual-frequency radio occultation experiments in order to determine electron column concentrations above the lunar limb as a function of tangent height (shown in the figure below), The resulting electron concentration profiles surprisingly indicated a peak of approx.500-1000/cu cm and scale heights of approx. 10-30 km. It has been suggested that electrically charged exospheric dust could contribute to these electron cnhancemcnts2 , Here we describe how to estimate the electrons produced by photo-charged dust, which is then used to predict electron concentrations from exospheric dust distribution models that are based on the "excess brightness" observed in Apollo 15 coronal photographs. The results indicate that radio occultation measurements likely provide a valuable perspective on the role of dust in the lunar environment

The Bacillus anthracis chromosome contains four conserved, excision-proficient, putative prophages

BACKGROUND: Bacillus anthracis is considered to be a recently emerged clone within the Bacillus cereus sensu lato group. The B. anthracis genome sequence contains four putative lambdoid prophages. We undertook this study in order to understand whether the four prophages are unique to B. anthracis and whether they produce active phages. RESULTS: More than 300 geographically and temporally divergent isolates of B. anthracis and its near neighbors were screened by PCR for the presence of specific DNA sequences from each prophage region. Every isolate of B. anthracis screened by PCR was found to produce all four phage-specific amplicons whereas none of the non-B. anthracis isolates, produced more than one phage-specific amplicon. Excision of prophages could be detected by a PCR based assay for attP sites on extra-chromosomal phage circles and for attB sites on phage-excised chromosomes. SYBR-green real-time PCR assays indicated that prophage excision occurs at very low frequencies (2 × 10(-5 )- 8 × 10(-8)/cell). Induction with mitomycin C increased the frequency of excision of one of the prophages by approximately 250 fold. All four prophages appear to be defective since, mitomycin C induced culture did not release any viable phage particle or lyse the cells or reveal any phage particle under electron microscopic examination. CONCLUSION: The retention of all four putative prophage regions across all tested strains of B. anthracis is further evidence of the very recent emergence of this lineage and the prophage regions may be useful for differentiating the B. anthracis chromosome from that of its neighbors. All four prophages can excise at low frequencies, but are apparently defective in phage production

Results From a Survey of American Geriatrics Society Members’ Views on Physician‐Assisted Suicide

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/1/jgs16245_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/2/jgs16245-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152741/3/jgs16245.pd

AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135987/1/jgs14586_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/135987/2/jgs14586.pd

Lunar Surface Electric Potential Changes Associated with Traversals through the Earth's Foreshock

We report an analysis of one year of Suprathermal Ion Detector Experiment (SIDE) Total Ion Detector (TID) resonance events observed between January 1972 and January 1973. The study includes only those events during which upstream solar wind conditions were readily available. The analysis shows that these events are associated with lunar traversals through the dawn flank of the terrestrial magnetospheric bow shock. We propose that the events result from an increase in lunar surface electric potential effected by secondary electron emission due to primary electrons in the Earth's foreshock region (although primary ions may play a role as well). This work establishes (1) the lunar surface potential changes as the Moon moves through the terrestrial bow shock, (2) the lunar surface achieves potentials in the upstream foreshock region that differ from those in the downstream magnetosheath region, (3) these differences can be explained by the presence of energetic electron beams in the upstream foreshock region and (4) if this explanation is correct, the location of the Moon with respect to the terrestrial bow shock influences lunar surface potential

A Fractal Model for the Capacitance of Lunar Dust and Lunar Dust Aggregates

Lunar dust grains and dust aggregates exhibit clumping, with an uneven mass distribution, as well as features that span many spatial scales. It has been observed that these aggregates display an almost fractal repetition of geometry with scale. Furthermore, lunar dust grains typically have sharp protrusions and jagged features that result from the lack of aeolian weathering (as opposed to space weathering) on the Moon. A perfectly spherical geometry, frequently used as a model for lunar dust grains, has none of these characteristics (although a sphere may be a reasonable proxy for the very smallest grains and some glasses). We present a fractal model for a lunar dust grain or aggregate of grains that reproduces (1) the irregular clumpy nature of lunar dust, (2) the presence of sharp points, and (3) dust features that span multiple scale lengths. We calculate the capacitance of the fractal lunar dust analytically assuming fixed dust mass (i.e. volume) for an arbitrary number of fractal levels and compare the capacitance to that of a non-fractal object with the same volume, surface area, and characteristic width. The fractal capacitance is larger than that of the equivalent non-fractal object suggesting that for a given potential, electrostatic forces on lunar dust grains and aggregates are greater than one might infer from assuming dust grains are sphericaL Consequently, electrostatic transport of lunar dust grains, for example lofting, appears more plausible than might be inferred by calculations based on less realistic assumptions about dust shape and associated capacitance

Rationing Limited Healthcare Resources in the COVID‐19 Era and Beyond: Ethical Considerations Regarding Older Adults

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155955/1/jgs16539_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155955/2/jgs16539.pd

AGS Position Statement: Resource Allocation Strategies and Age‐Related Considerations in the COVID‐19 Era and Beyond

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155900/1/jgs16537.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155900/2/jgs16537_am.pd