Effective Physician Engagement Strategies for Improving Healthcare

Middle and senior-level healthcare managers lack physician engagement strategies to help avoid physician burnout. Many physicians leave the healthcare profession due to disengagement, which could cause a significant healthcare crisis. Grounded in the transformational leadership theory, the purpose of this qualitative single case study was to explore the engagement strategies healthcare middle and senior-level managers used to help avoid physician burnout. Participants comprised seven middle and senior-level healthcare managers with a minimum of five years of employee management experience who effectively used physician engagement strategies to help avoid physician burnout at a Central Pacific United States healthcare organization. Data were collected from semistructured interviews via telephone, reflective journal, and publicly available media and organizational documents. Thematic analysis was used to analyze the data. Three themes emerged: developing meaningful relationships, encouraging career progression and professional development, and fostering a culture of understanding. A key recommendation for middle and senior-level healthcare managers is to take the time initially to get to know the goals of each physician. The implication for positive social change includes implementing success strategies for increased physician engagement in helping to address socioeconomic disparities for patients within the community who can benefit from healthier lifestyle

Quantum correlations from local amplitudes and the resolution of the Einstein-Podolsky-Rosen nonlocality puzzle

The Einstein-Podolsky-Rosen nonlocality puzzle has been recognized as one of the most important unresolved issues in the foundational aspects of quantum mechanics. We show that the problem is resolved if the quantum correlations are calculated directly from local quantities which preserve the phase information in the quantum system. We assume strict locality for the probability amplitudes instead of local realism for the outcomes, and calculate an amplitude correlation function.Then the experimentally observed correlation of outcomes is calculated from the square of the amplitude correlation function. Locality of amplitudes implies that the measurement on one particle does not collapse the companion particle to a definite state. Apart from resolving the EPR puzzle, this approach shows that the physical interpretation of apparently `nonlocal' effects like quantum teleportation and entanglement swapping are different from what is usually assumed. Bell type measurements do not change distant states. Yet the correlations are correctly reproduced, when measured, if complex probability amplitudes are treated as the basic local quantities. As examples we discuss the quantum correlations of two-particle maximally entangled states and the three-particle GHZ entangled state.Comment: Std. Latex, 11 pages, 1 table. Prepared for presentation at the International Conference on Quantum Optics, ICQO'2000, Minsk, Belaru

Gaussian Processes for hearing threshold estimation using Auditory Brainstem Responses

The Auditory Brainstem Response (ABR) plays an important role in diagnosing and managing hearing loss, but can be challenging and time-consuming to measure. Test times are especially long when multiple ABR measurements are needed, e.g., when estimating hearing threshold at a range of frequencies. While many detection methods have been developed to reduce ABR test times, the majority were designed to detect the ABR at a single stimulus level and do not consider correlations in ABR waveforms across levels. These correlations hold valuable information, and can be exploited for more efficient hearing threshold estimation. This was achieved in the current work using a Gaussian Process (GP), i.e., a Bayesian approach method for non-linear regression. The function to estimate with the GP was the ABR's amplitude across stimulus levels, from which hearing threshold was ultimately inferred. Active learning rules were also designed to automatically adjust the stimulus level and efficiently locate hearing threshold. Simulation results show test time reductions of up to $\sim$50% for the GP compared to a sequentially applied Hotelling's T2 test, which does not consider correlations across ABR waveforms. A case study was also included to briefly assess the GP approach in ABR data from an adult volunteer

Envelope frequency following responses are stronger for high-pass than low-pass filtered vowels

Background: To assess hearing in response to speech, the envelope frequency following response (FFR) can be observed at the fundamental frequency of a vowel stimulus, and its harmonics. FFRs are complex non-linear phenomena, which require better understanding for allowing robust inferences on the assessment of hearing and hearing aid fitting. Objectives: To evaluate the effect of stimulus bandwidth on FFR detection rates using filtered vowel stimuli with equal sound levels. Design: FFRs were collected whilst presenting repeated vowels (in consonant-vowel-consonant format) filtered into different bandwidths. Eighty stimuli per word were presented at 70 dB SPL LAeq through insert earphones with an inter-stimulus interval of 1s. Responses were detected using frequency-domain Hotelling’s T2 (HT2) tests for individual multiples of the fundamental frequency (F0) and for combinations of F0 multiples. Study Sample: Eleven native English-speaking subjects with normal hearing thresholds. Results: Average detection rates are highest (69%) with stimuli high-pass filtered >1000 Hz, and significantly lower for low-pass filtered stimuli (40%). Conclusion: High-pass filtered vowels elicit stronger FFRs than low-pass filtered vowels at the same dB SPL LAeq. For testing hearing using band-limited speech, filtering effects (due to hearing loss, hearing aid setting or stimulus choice) on responses must be considered

Generalized Quantum Theory: Overview and Latest Developments

The main formal structures of Generalized Quantum Theory are summarized. Recent progress has sharpened some of the concepts, in particular the notion of an observable, the action of an observable on states (putting more emphasis on the role of proposition observables), and the concept of generalized entanglement. Furthermore, the active role of the observer in the structure of observables and the partitioning of systems is emphasized.Comment: 14 pages, update in reference

Dichotomic Functions and Bell's Theorems

It is shown that correlations of dichotomic functions can not conform to results from Quantum Mechanics. Also, it is seen that the assumptions attendant to optical tests of Bell's Inequalities actually are consistent with classical physics so that in conclusion, Bell's Theorems do not preclude hidden variable interpretations of Quantum Mechanics

Extensive winter subglacial water storage beneath the Greenland Ice Sheet

This is the final version of the article. Available from AGU via the DOI in this record.Surface meltwater that reaches the base of the Greenland Ice Sheet exerts a fundamental impact on ice flow, but observations of catchment-wide movement and distribution of subglacial water remain limited. Using radar-sounding data from two seasons, we identify the seasonal distribution of subglacial water in western Greenland. Our analysis provides evidence of widespread subglacial water storage beneath Greenland in the wintertime. The winter storage is located primarily on bedrock ridges with higher bed elevations in excess of 200 m. During the melt season water moves to the subglacial troughs. This inverse relationship with topography indicates that the material properties of the glacier bed strongly influence subglacial drainage development. Both the spatial variations in bed properties and the initial state of the subglacial hydrology system at the start of the melt season lead to differing glacier dynamical responses to surface melting across the Greenland Ice Sheet.W.C. is a recipient of the NASA Earth and Space Science Fellowship. D.M.S. is supported by a grant from the NASA Cryospheric Sciences Program. H.S. is supported by grants from the NASA Cryospheric Sciences and Sea Level Rise Programs. T.T.C and R.E.B are supported by grants from National Science Foundation (NSF) and NASA Cryospheric Sciences. S.P. is supported by the Natural Environment Research Council’s Centre for Polar Observatio

Stratigraphic hierarchy and three‐dimensional evolution of an exhumed submarine slope channel system

Submarine slope channel systems have complicated three‐dimensional geometries and facies distributions, which are challenging to resolve using subsurface data. Outcrop analogues can provide sub‐seismic‐scale detail, although most exhumed systems only afford two‐dimensional constraints on the depositional architecture. A rare example of an accessible fine‐grained slope channel complex set situated in a tectonically quiescent basin that offers seismic‐scale, down‐dip and across‐strike exposures is the Klein Hangklip area, Tanqua‐Karoo Basin, South Africa. This study investigates the three‐dimensional architecture of this channel complex set to characterise the stratigraphic evolution of a submarine channel‐fill and the implications this has for both sediment transport to the deep‐oceans and reservoir quality distribution. Correlated sedimentary logs and mapping of key surfaces across a 3 km2 area reveal that: (i) the oldest channel elements in channel complexes infill relatively deep channel cuts and have low aspect‐ratios. Later channel elements are bound by comparatively flat erosion surfaces and have high aspect‐ratios; (ii) facies changes across depositional strike are consistent and predictable; conversely, facies change in successive down depositional dip positions indicating longitudinal variability in depositional processes; (iii) stratigraphic architecture is consistent and predictable at seismic‐scale both down‐dip and across‐strike in three‐dimensions; (iv) channel‐base‐deposits exhibit spatial heterogeneity on one to hundreds of metres length‐scales, which can inhibit accurate recognition and interpretations drawn from one‐dimensional or limited two‐dimensional datasets; and (v) channel‐base‐deposit character is linked to sediment bypass magnitude and longevity, which suggests that time‐partitioning is biased towards conduit excavation and maintenance rather than the fill‐phase. The data provide insights into the stratigraphic evolution and architecture of slope channel‐fills on fine‐grained continental margins and can be utilised to improve predictions derived from lower resolution and one‐dimensional well data