Bedside Manners: Play and Workbook

[Excerpt] Our goal in the play was to create a balanced work. In Bedside Manners, the reader will find people who communicate poorly and those who communicate well. Although the play focuses primarily on physicians and nurses and the acute-care hospital setting, we have tried to expand the cast of characters to include others on the health care team and to include other settings. As the safety literature documents, poor communication between members of the health care team is not simply an individual problem—a question of a few bad apples spoiling the barrel—but is rather a system problem that stems from how health care has historically developed. Although it is beyond the scope of this commentary to describe that historical development, suffice it to say that the problems of contemporary health care team relationships have a long history and are shaped not only by economics but also by gender, culture, religion, ethnicity, and many other factors. Although our play is meant to stimulate discussion about health care teamwork and suggest ways that doctors, nurses, and others in health care can develop the skills necessary to create and sustain genuine interprofessional teams, it is primarily a work of theater. Its goal is to help those who work in health care approach a very hot topic in a way that is both interesting and even, dare I say it, fun. To accompany the play and make it more user-friendly, Scott Reeves, Lisa Hayes, and I have also written a workbook, which explains the various ways it can be performed, how to mount a performance, and how to lead a discussion or workshop after the play is over. We also explain how to use the play as part of an interprofessional curriculum. Although some in our audiences have scoffed at such a touchy feely or unconventional way to present a serious issue, our experience has convinced us that theater is a useful tool to enhance teamwork, patient safety, and also to create more satisfying workplace relationships. Theater has been with humankind since almost the beginning of our history precisely because it is such a powerful tool. It can be used by those in health care who spend their days working with sick, frightened, anxious people, people who are, by definition, not at their best. Under the best of circumstances, their work is beyond difficult. Good communication and teamwork not only produces good patient outcomes; it helps health care professionals care for one another

Biological Systems from an Engineer’s Point of View

Mathematical modeling of the processes that pattern embryonic development (often called biological pattern formation) has a long and rich history [1,2]. These models proposed sets of hypothetical interactions, which, upon analysis, were shown to be capable of generating patterns reminiscent of those seen in the biological world, such as stripes, spots, or graded properties. Pattern formation models typically demonstrated the sufficiency of given classes of mechanisms to create patterns that mimicked a particular biological pattern or interaction. In the best cases, the models were able to make testable predictions [3], permitting them to be experimentally challenged, to be revised, and to stimulate yet more experimental tests (see review in [4]). In many other cases, however, the impact of the modeling efforts was mitigated by limitations in computer power and biochemical data. In addition, perhaps the most limiting factor was the mindset of many modelers, using Occam’s razor arguments to make the proposed models as simple as possible, which often generated intriguing patterns, but those patterns lacked the robustness exhibited by the biological system. In hindsight, one could argue that a greater attention to engineering principles would have focused attention on these shortcomings, including potential failure modes, and would have led to more complex, but more robust, models. Thus, despite a few successful cases in which modeling and experimentation worked in concert, modeling fell out of vogue as a means to motivate decisive test experiments. The recent explosion of molecular genetic, genomic, and proteomic data—as well as of quantitative imaging studies of biological tissues—has changed matters dramatically, replacing a previous dearth of molecular details with a wealth of data that are difficult to fully comprehend. This flood of new data has been accompanied by a new influx of physical scientists into biology, including engineers, physicists, and applied mathematicians [5–7]. These individuals bring with them the mindset, methodologies, and mathematical toolboxes common to their own fields, which are proving to be appropriate for analysis of biological systems. However, due to inherent complexity, biological systems seem to be like nothing previously encountered in the physical sciences. Thus, biological systems offer cutting edge problems for most scientific and engineering-related disciplines. It is therefore no wonder that there might seem to be a “bandwagon” of new biology-related research programs in departments that have traditionally focused on nonliving systems. Modeling biological interactions as dynamical systems (i.e., systems of variables changing in time) allows investigation of systems-level topics such as the robustness of patterning mechanisms, the role of feedback, and the self-regulation of size. The use of tools from engineering and applied mathematics, such as sensitivity analysis and control theory, is becoming more commonplace in biology. In addition to giving biologists some new terminology for describing their systems, such analyses are extremely useful in pointing to missing data and in testing the validity of a proposed mechanism. A paper in this issue of PLoS Biology clearly and honestly applies analytical tools to the authors’ research and obtains insights that would have been difficult if not impossible by other means [8]

Into the wild: challenges and opportunities for field trial methods

Field trials of experimental systems `in the wild' have developed into a standard method within HCI - testing new systems with groups of users in relatively unconstrained settings outside of the laboratory. In this paper we discuss methodological challenges in running user trials. Using a `trial of trials' we examined the practices of investigators and participants - documenting `demand characteristics', where users adjust their behaviour to fit the expectations of those running the trial, the interdependence of how trials are run and the result they produce, and how trial results can be dependent on the insights of a subset of trial participants. We develop three strategies that researchers can use to leverage these challenges to run better trials

Into the wild: challenges and opportunities for field trial methods

Field trials of experimental systems `in the wild' have developed into a standard method within HCI - testing new systems with groups of users in relatively unconstrained settings outside of the laboratory. In this paper we discuss methodological challenges in running user trials. Using a `trial of trials' we examined the practices of investigators and participants - documenting `demand characteristics', where users adjust their behaviour to fit the expectations of those running the trial, the interdependence of how trials are run and the result they produce, and how trial results can be dependent on the insights of a subset of trial participants. We develop three strategies that researchers can use to leverage these challenges to run better trials

Use of main channel and shallow-water habitat by larval fishes in the lower Missouri River

The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file.Title from title screen of research.pdf file (viewed on August 7, 2007)Vita.Thesis (Ph. D.) University of Missouri-Columbia 2006.I developed a series of research objectives organized in a spatial hierarchy to characterize larval fish nursery habitat within the lower Missouri River. Native carpsucker spp./buffalo spp. (Carpiodes spp./Ictiobus spp.) and chub spp. (Macrhybopsis spp.) catch-per-unit-effort (CPUE) was higher within sandbar aquatic terrestrial transition zone (ATTZ) than main channel. Local-environmental factors accounted for the greatest proportion of variance in larval fish CPUE within sandbar ATTZ, followed by hydrologic and finally geomorphic factors at macro- and meso-habitat scales. At the microhabitat scale, the larval fish assemblage and carpsucker spp./buffalo spp. selected areas [lesser than or equal to] 10 cm deep with current velocities [lesser than or equal to] 5 cm/s. Silver/bighead carp (Hypophthalmichthys molitrix/nobilus) exhibited no selection based on water depth or current velocity. Chub spp. selected depths between 20-50 cm and areas 2-3 m from the waters edge. The larval fish assemblage and several taxa exhibited a significant nocturnal increase in CPUE within the primary channel and sandbar ATTZ at the macrohabitat scale in contrast to previous research indicating turbid rivers lacked a diel cycle in larval fish drift.Includes bibliographical reference

Designing an Alternate Mission Operations Control Room

The Huntsville Operations Support Center (HOSC) is a multi-project facility that is responsible for 24x7 real-time International Space Station (ISS) payload operations management, integration, and control and has the capability to support small satellite projects and will provide real-time support for SLS launches. The HOSC is a serviceoriented/ highly available operations center for ISS payloads-directly supporting science teams across the world responsible for the payloads. The HOSC is required to endure an annual 2-day power outage event for facility preventive maintenance and safety inspection of the core electro-mechanical systems. While complete system shut-downs are against the grain of a highly available sub-system, the entire facility must be powered down for a weekend for environmental and safety purposes. The consequence of this ground system outage is far reaching: any science performed on ISS during this outage weekend is lost. Engineering efforts were focused to maximize the ISS investment by engineering a suitable solution capable of continuing HOSC services while supporting safety requirements. The HOSC Power Outage Contingency (HPOC) System is a physically diversified compliment of systems capable of providing identified real-time services for the duration of a planned power outage condition from an alternate control room. HPOC was designed to maintain ISS payload operations for approximately three continuous days during planned HOSC power outages and support a local Payload Operations Team, International Partners, as well as remote users from the alternate control room located in another building. This paper presents the HPOC architecture and lessons learned during testing and the planned maiden operational commissioning. Additionally, this paper documents the necessity of an HPOC capability given the unplanned HOSC Facility power outage on April 27th, 2011, as a result of the tornado outbreak that damaged the electrical grid to such a degree that significantly inhibited the Tennessee Valley Authority's ability to transmit electricity throughout the North Alabama region

Interprofessional collaboration in sports medicine : findings from a scoping review

BACKGROUND Sports medicine has grown from a special interest area in healthcare to an established profession in its own right. Containing many specialties and a range of professional inputs there are complex dynamics at work which often dictate the provision of care. Whilst interprofessional interventions have been successfully applied in more mainstream healthcare contexts there has been no equivalent application in sports medicine. PURPOSE We seek to map the literature to explore interprofessional collaboration, interaction and tension in sports medicine. METHOD The study utilised a scoping review methodology followed by a thematic analysis. DISCUSSION & CONCLUSIONS The review located 13 studies which provided an insight into a number of key themes which affect interprofessional collaboration (IPC) in a variety of athletic contexts. All of these themes relate to IPC. The structured introduction of interprofessional education programmes for sports medicine professionals and others, will enable a response to the numerous challenges identified in the review