Employee empowerment, action research and organizational change: a case study

This article summarizes the results of a project designed and implemented by a cross-sectional design team of employees of a local government agency. We compare the project design to criteria associated with employee empowerment programs and action research models. Finally, we compare the outcomes of the project with important components of employee empowerment. The purpose of this article is to highlight how one such project was implemented in a field setting, and review what was learned by the participants regarding how management and employees can work more effectively together on issues of strategic importance to the organization. Both the process and the outcomes of this project illustrate important lessons with implications for future research and practice in this area

Potential antidepressant overtreatment associated with office use of brief depression symptom measures.

BackgroundUse of brief depression symptom measures for identifying or screening cases may help to address depression undertreatment, but whether it also leads to diagnosis and treatment of patients with few or no symptoms-a group unlikely to have major depression or benefit from antidepressants-is unknown. We examined the associations of use of a brief depression symptom measure with depression diagnosis and antidepressant recommendation and prescription among patients with few or no depression symptoms.MethodsWe conducted exploratory observational analyses of data from a randomized trial of depression engagement interventions conducted in primary care offices in California. Analyses focused on participants scoring <10 on a study-administered 9-item Patient Health Questionnaire (PHQ-9) (completed immediately before an office visit and not disclosed to the provider) with complete chart review data (n = 595). We reviewed visit notes for evidence of practice administration of a brief symptom measure (independent of the trial) and whether the provider (1) diagnosed depression or (2) recommended and/or prescribed an antidepressant.ResultsAmong the 545 patients without a practice-administered measure, 57 (10.5%) had a visit diagnosis of depression; 9 (1.6%) were recommended and another 21 (3.8%) prescribed an antidepressant. Among the 50 patients (8.4% of total sample) with a practice-administered measure, 10 (20%) had a visit diagnosis of depression; 6 (12%) were recommended and another 6 (12%) prescribed an antidepressant. Adjusting for nesting within providers, trial intervention, stratification variables, and sample weighting, use of a brief symptom measure was associated with depression diagnosis (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.2) and antidepressant recommendation and/or prescription (adjusted odds ratio, 3.80; 95% confidence interval, 1.0-13.9). Analyses using progressively lower PHQ-9 thresholds (<9 to <5) and examining antidepressant prescription alone yielded consistent findings. Analyses by practice-administered measure (PHQ-9 vs PHQ-2) indicated the study findings were largely associated with PHQ-9 use.ConclusionsThese exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure

Potential antidepressant overtreatment associated with office use of brief depression symptom measures.

BackgroundUse of brief depression symptom measures for identifying or screening cases may help to address depression undertreatment, but whether it also leads to diagnosis and treatment of patients with few or no symptoms-a group unlikely to have major depression or benefit from antidepressants-is unknown. We examined the associations of use of a brief depression symptom measure with depression diagnosis and antidepressant recommendation and prescription among patients with few or no depression symptoms.MethodsWe conducted exploratory observational analyses of data from a randomized trial of depression engagement interventions conducted in primary care offices in California. Analyses focused on participants scoring <10 on a study-administered 9-item Patient Health Questionnaire (PHQ-9) (completed immediately before an office visit and not disclosed to the provider) with complete chart review data (n = 595). We reviewed visit notes for evidence of practice administration of a brief symptom measure (independent of the trial) and whether the provider (1) diagnosed depression or (2) recommended and/or prescribed an antidepressant.ResultsAmong the 545 patients without a practice-administered measure, 57 (10.5%) had a visit diagnosis of depression; 9 (1.6%) were recommended and another 21 (3.8%) prescribed an antidepressant. Among the 50 patients (8.4% of total sample) with a practice-administered measure, 10 (20%) had a visit diagnosis of depression; 6 (12%) were recommended and another 6 (12%) prescribed an antidepressant. Adjusting for nesting within providers, trial intervention, stratification variables, and sample weighting, use of a brief symptom measure was associated with depression diagnosis (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.2) and antidepressant recommendation and/or prescription (adjusted odds ratio, 3.80; 95% confidence interval, 1.0-13.9). Analyses using progressively lower PHQ-9 thresholds (<9 to <5) and examining antidepressant prescription alone yielded consistent findings. Analyses by practice-administered measure (PHQ-9 vs PHQ-2) indicated the study findings were largely associated with PHQ-9 use.ConclusionsThese exploratory findings suggest administration of brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant recommendation and prescription among patients unlikely to have major depression. If these findings are confirmed, researchers should investigate the balance of benefits and risks (eg, overdiagnosis of depression and overtreatment with antidepressants) associated with use of a brief symptom measure

NGA-Sub ground motion database

This paper summarizes a ground-motion database developed for the NGA-Sub Project. The database consists of two- and three-component ground-motion recordings from selected earthquakes in subduction zones. The database also includes the supporting data such as source, path, and site metadata. The earthquakes are located in Japan, Taiwan, the Pacific Northwest region of North America, Alaska, Mexico, Central and South America, and New Zealand. The events in the database are classified as interface, intraslab, or outer-rise, and have magnitudes ranging from 4 to 9. The database includes more than 71,000 three-component recordings, most of which are from digital accelerograms. The database includes PGA, PGV, pseudo-spectral acceleration for eleven damping values between 0.5% and 30%, Fourier amplitude spectra for frequencies from 0.1 to 100 Hz, and significant-shaking durations based on Arias Intensity. These data are analyzed in the project to model various ground-motion properties

Nga-subduction research program

This paper provides an overview of NGA-Sub, a large multidisciplinary community-based research initiative to develop a comprehensive ground-motion database and multiple ground-motion models (GMMs) for subduction events. In the NGA-Sub project, we developed a database of ground motions recorded in worldwide subduction events. The database includes the processed recordings and supporting source, path, and site metadata from Japan, Taiwan, the US Pacific Northwest, Alaska, Latin America (including Mexico, Peru and Chile), and New Zealand. The NGASub database includes 1,570 events with moment magnitudes ranging from 4.0 to 9.1. The subduction events are classified as interface, intraslab, or outer-rise events. The NGA-Sub ground-motion database has over 214,000 individual ground-motion components. This is by far the largest ground-motion database that we have ever developed in any NGA project. Pseudo-spectral acceleration as well as Fourier amplitude spectra for frequencies from 0.1 to 100 Hz have been included in the database. Multiple GMMs are developed using the empirical ground-motion database and the supporting ground-motion simulations. The scope of the NGA-Sub GMMs is to develop models for horizontal components of ground motion for 5% damped pseudo-acceleration response spectra for period range of 0.01 to 10 sec. Following the tradition of previous NGA projects, the GMM modeling teams as well as database developers have had continuous technical interactions which resulted in a higher quality of the final products than each researcher or oneteam group could achieve individually. An overview of the NGA-Sub project is presented in this paper.,