Servant Leadership Characteristics and Empathic Care: Developing a Culture of Empathy in the Healthcare Setting

The purpose of this study was to assess the degree to which servant leadership characteristics are exhibited in medical group practices, and the degree to which servant leadership characteristics correlated with measures of empathic care. This study featured an explanatory mixed methods research design embedded in appreciative inquiry. A total of 189 mid-level practitioners consisting of nurse practitioners, physician assistants, and practice mangers responded to a 32-item scale survey that featured a six-point Likert scale to measure servant leadership items and a 10-point continuous scale to assess measures of empathic care. The servant leadership items were based on the seven pillars of servant leadership. Data analyses included assessing means, standard deviations, and percentage distributions for servant leadership statements and empathic care statements. Additionally, bivariate correlation analysis and standard multiple regression analysis were conducted to assess the degree of influence of servant leadership characteristics on measures of empathic care. Findings from this study identified Pillar 1 (Persons of Character) as the servant leadership pillar most strongly exhibited in the medical group practices. Furthermore, Pillar 5 (Has Foresight) was the strongest correlate of reported empathic care within medical group practices as well as team members’ proclivity to practice servant leadership behaviors with patients more than with each other. The study also found that clinicians and non-clinicians significantly differed in their endorsement of all of the servant leadership pillars except Pillar 1 (Persons of Character). The findings of this dissertation point to strategies for promoting an environment of empathic care, and team building and organizational development and training in the medical group practices. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu

Thin film 2H .alpha.-SiC

Thin films of 2H .alpha.-silicon carbide are produced by pulsed laser ablation

An analysis of the Research Fellowship Scheme of the Royal College of Surgeons of England.

BACKGROUND: The Research Fellowship Scheme of the Royal College of Surgeons of England commenced in 1993 with the aim of exposing selected surgical trainees to research techniques and methodology, with the hope of having an impact on surgical research and increasing the cadre of young surgeons who might decide to pursue an academic career in surgery. Over 11 million pounds sterling (approximately US 20 million dollars) has been invested in 264 fellowships. The College wished to evaluate the impact of the Scheme on the careers of research fellows, surgical research, and patient care. As the 10th anniversary of the Scheme approached. STUDY DESIGN: Two-hundred and sixty research fellows whose current addresses were available were sent a questionnaire. Two-hundred and thirty-eight (91.5%) responded. RESULTS: Three-quarters of the research fellows conducted laboratory-based research, with most of the remainder conducting patient-based clinical research. One-third of the fellows who have reached consultant status have an academic component to their post. The total number of publications based on fellowship projects was 531, with a median impact factor of 3.5. Almost all fellows had been awarded a higher degree or were working toward this. Half of the fellows received subsequent funding for research, mostly awarded by national or international funding bodies. CONCLUSIONS: The Research Fellowship Scheme of the Royal College of Surgeons of England has successfully supported many trainee surgeons in the initial phase of their research career. It has helped surgical research by increasing the pool of surgeons willing to embark on an academic career. Indirectly, patient care has benefited by promoting an evidence-based culture among young surgeons. Such schemes are relevant to surgical training programs elsewhere if more young surgeons are to be attracted into academic surgery

Locating the LCROSS Impact Craters

The Lunar CRater Observations and Sensing Satellite (LCROSS) mission impacted a spent Centaur rocket stage into a permanently shadowed region near the lunar south pole. The Sheperding Spacecraft (SSC) separated \sim9 hours before impact and performed a small braking maneuver in order to observe the Centaur impact plume, looking for evidence of water and other volatiles, before impacting itself. This paper describes the registration of imagery of the LCROSS impact region from the mid- and near-infrared cameras onboard the SSC, as well as from the Goldstone radar. We compare the Centaur impact features, positively identified in the first two, and with a consistent feature in the third, which are interpreted as a 20 m diameter crater surrounded by a 160 m diameter ejecta region. The images are registered to Lunar Reconnaisance Orbiter (LRO) topographical data which allows determination of the impact location. This location is compared with the impact location derived from ground-based tracking and propagation of the spacecraft's trajectory and with locations derived from two hybrid imagery/trajectory methods. The four methods give a weighted average Centaur impact location of -84.6796\circ, -48.7093\circ, with a 1{\sigma} un- certainty of 115 m along latitude, and 44 m along longitude, just 146 m from the target impact site. Meanwhile, the trajectory-derived SSC impact location is -84.719\circ, -49.61\circ, with a 1{\sigma} uncertainty of 3 m along the Earth vector and 75 m orthogonal to that, 766 m from the target location and 2.803 km south-west of the Centaur impact. We also detail the Centaur impact angle and SSC instrument pointing errors. Six high-level LCROSS mission requirements are shown to be met by wide margins. We hope that these results facilitate further analyses of the LCROSS experiment data and follow-up observations of the impact region.Comment: Accepted for publication in Space Science Review. 24 pages, 9 figure

The deterrence effect of capital punishment in Malaysia / Mohd Hisham Ahmad Nazri, Mark Anthony Martin, Wan Abdul Rahim Wan Mahamood

The purpose of death penalty has always been for deterring the community from repeating crimes. Crimes that are punishable by death are considered the ultimate deterrent to the society. In Malaysia, crimes that are punishable by death are crimes of murder, drug related offences, threat against the country or the Yang Di-Pertuan Agong, kidnapping, possession and smuggling of illegal firearms and also waging war against the state and the country. In the case of R v Melnyk, Justice Gerein, define deterrence as a principle or objective of sentencing a person guilty of a crime which ensures that the punishment is sufficient to deter the guilty person, and others, from committing the same crime1. Moreover, In R v Morrissette, Justice Culliton wrote, in the context of a discussion on the factors to take into account when sentencing, he said, "Deterrence is also an important factor. The problem is different if the purpose of sentence is to deter the offender from repeating the offence from that if the purpose is to deter others who may be inclined to commit the same offence. In neither case does it necessarily follow that a long sentence is required to achieve the purpose

Resilience and stability of a pelagic marine ecosystem

The accelerating loss of biodiversity and ecosystem services worldwide has accentuated a long-standing debate on the role of diversity in stabilizing ecological communities and has given rise to a field of research on biodiversity and ecosystem functioning (BEF). Although broad consensus has been reached regarding the positive BEF relationship, a number of important challenges remain unanswered. These primarily concern the underlying mechanisms by which diversity increases resilience and community stability, particularly the relative importance of statistical averaging and functional complementarity. Our understanding of these mechanisms relies heavily on theoretical and experimental studies, yet the degree to which theory adequately explains the dynamics and stability of natural ecosystems is largely unknown, especially in marine ecosystems. Using modelling and a unique 60-year dataset covering multiple trophic levels, we show that the pronounced multi-decadal variability of the Southern California Current System (SCCS) does not represent fundamental changes in ecosystem functioning, but a linear response to key environmental drivers channelled through bottom-up and physical control. Furthermore, we show strong temporal asynchrony between key species or functional groups within multiple trophic levels caused by opposite responses to these drivers. We argue that functional complementarity is the primary mechanism reducing community variability and promoting resilience and stability in the SCCS

Direct and indirect effects based on changes-in-changes

We propose a novel approach for causal mediation analysis based on changes-in- changes assumptions restricting unobserved heterogeneity over time. This allows disentangling the causal effect of a binary treatment on a continuous outcome into an indirect effect operating through a binary intermediate variable (called mediator) and a direct effect running via other causal mechanisms. We identify average and quantile direct and indirect effects for various subgroups under the condition that the outcome is monotonic in the unobserved heterogeneity and that the distribution of the latter does not change over time conditional on the treatment and the mediator. We also provide a simulation study and an empirical application to the Jobs II programme

Efficient fat storage in premenopausal women and in early pregnancy: a role for estrogen

There is a sexual dimorphism in body fat in humans. Adipose tissue increases with puberty and early pregnancy in women, suggesting gonadal steroids can influence body fat. Previously, we have observed that oral estrogen, compared with transdermal estrogen, reduced postprandial lipid oxidation and increased body fat, possibly due to suppressed hepatic lipid oxidation. If estrogen effects lipid oxidation, we predicted that subjects with significantly different endogenous estrogen production would oxidize lipids at different rates. The aim of this study was to compare energy metabolism in 12 pregnant (19 wk gestation, 29 ± 1 yr, 1.66 ± 0.02 m, 73.5 ± 2.4 kg), 11 nonpregnant premenopausal (29 ± 2 yr, 1.68 ± 0.02 m, 63.1 ± 1.8 kg), and 28 postmenopausal (58 ± 1 yr, 1.62 ± 0.01 m, 69.9 ± 1.0 kg) women who were not receiving estrogen, and to relate these findings to endogenous estrogen concentrations. All women underwent indirect calorimetry under identical situations in the basal and postprandial state following a standard mixed meal. Basal (5998 ± 184 vs. 5712 ± 184 vs. 5800 ± 121 kJ·24 h, respectively) and postprandial energy expenditure (7172 ± 239 vs. 6964 ± 210 vs. 6955 ± 147 kJ·24 h) was similar among groups. However, basal lipid oxidation was reduced in pregnant (45.3 ± 6.1 mg/min, P < 0.05) and nonpregnant women (44.5 ± 6.3 mg/min, P < 0.05) compared with postmenopausal women (58.4 ± 2.9 mg/min). Postprandial lipid oxidation differed among groups, being least in pregnant women (8.8 ± 6.2 mg/min) compared with nonpregnant (28.9 ± 6.4 mg/min, P < 0.04) and postmenopausal (48.1 ± 4.0 mg/min, P = 0.0001) women. There was a significant reciprocal increase in postprandial carbohydrate oxidation. Mean postprandial glucose levels were slightly but nonsignificantly higher in pregnant women. Insulin levels were significantly higher in postmenopausal compared nonpregnant, but not pregnant, women. In a multiple regression analysis, serum estradiol (log transformed) correlated negatively with postprandial lipid oxidation (r = -0.66, P = 0.0001) and positively with postprandial nonesterified free fatty acid levels, whereas no correlation was found with postprandial insulin, glucose, fat free mass, and fat mass. In summary, postprandial lipid oxidation is reduced in pregnancy compared with that in healthy nonpregnant women, who in turn have lower postprandial lipid oxidation than postmenopausal women. This implies that the premenopausal years and early pregnancy are states of efficient fat storage, possibly mediated through reduced lipid oxidation due to estrogen, therefore increasing body fat for reproduction, thus supporting the notion that fat mass can be regulated

Addition of rituximab to CHOP-like chemotherapy in first line treatment of primary mediastinal B-cell lymphoma

Background: The addition of rituximab (R) to CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) -like therapy has improved survival in primary mediastinal B-cell lymphoma (PMBCL) patients. However, these results were obtained in young low risk patients and a reevaluation in an unselected patient cohort is warranted. Methods: In this study, we analyzed 80 PMBCL patients treated with a CHOP-based regimen with and without rituximab. Results: In the non-rituximab cohort 10-year progression free survival (PFS) was 67% and 10-year overall survival (OS) was 72% versus a PFS of 95% and a OS of 92% in the rituximab group, PFS P = 0.001, OS P = 0.023. A subgroup PFS analysis by international prognostic index (IPI) risk revealed that all risk groups benefit from addition of rituximab to induction chemotherapy. In addition, OS probability was higher in the group of non-low risk patients who were treated with rituximab compared to those patients who did not receive rituximab (P = 0.035). In multivariate analysis, only addition of rituximab to induction chemotherapy and reaching complete remission (CR) after first line therapy had a beneficial effect on both PFS and OS, whereas IPI, age, upfront high dose (HD) chemotherapy/autologous blood stem cell transplantation (ABSCT) and rituximab maintenance had no impact on survival. Conclusions: Our data demonstrate a survival benefit in unselected PMBCL patients treated with CHOP-like induction regimen and additional rituximab independently of the IPI risk score