bluuebunny/crossref_metadata_2025 huggingface dataset:
Why systems must explore the unknown to survive in VUCA environments
Authors: Bartscht Jan
Published: January 2015

Purpose

– The purpose of this paper is to explain why systems must make a habit of exploring the unknown and identify the complex and chaotic dynamics that drive modern volatile, uncertain, complex and ambiguous (VUCA) situations.

Design/methodology/approach

– Eight faculty staff from the “Thunderbird School of Global Management” were interviewed around the subject of “what does it take to be a successful 21st Century leader?” in spring 2012. These interviews were then analysed using Ricoeur’s Hermeneutic methodology which resulted in three behaviours being identified. Then, according to Ricoeur’s methodology, deep interpretation of the results took place to understand these research results through the lens of complexity science.

Findings

– Systems must make a habit of actively exploring the unknown to discover the patterns that cause complex chaos. This enables them to improve their capacity to generate useful situational understanding in VUCA environments and better position themselves in the fitness landscape. Finally, the idea of “epistemic stance” is introduced as an important way of managing identity and improving innovation.

Research limitations/implications

– The implication is that modern systems, e.g. leaders and organisations, must make a habit of exploring the unknown to find and understand the dynamics that drive the complex world if they are to build effective situational understanding of VUCA environments.

Practical implications

– If systems wish to innovate, they must ensure they have the appropriate epistemic stance in place so that they can change their identity to allow innovation to transform the identity.

Originality/value

– Whilst the behaviour of exploration is already known, this research focuses that behaviour on specifically identifying the patterns that cause complex chaos. Further, the epistemic stance is introduced which plays an important role in regulating how open a system is to changing its identity and therefore adapting and innovating.
Serum levels of anti‐Fcγ receptor IIB/C antibodies are increased in patients with systemic sclerosis
Authors: Kadono Takafumi , Tomita Manabu , Tamaki Zenshiro , Sato Shinichi , Asano Yoshihide
Published: January 2015

Systemic sclerosis (SSc) is a systemic autoimmune disorder that results in fibrosis of the skin and multiple internal organs. Although the precise mechanism is unknown, it appears to result from the overproduction of extracellular matrix proteins and aberrant immune activations. Receptors for the Fc region of immunoglobulin (Ig)G (FcγR) are members of the Ig superfamily that modulate both activation and inhibition of immune responses. FcγRIIB is the sole inhibitory member, which has an intrinsic cytoplasmic immunoreceptor tyrosine‐based inhibitory motif. The present study was undertaken to investigate the circulating concentrations of anti‐FcγRIIB/C antibodies (Ab) in patients with SSc. Serum levels of anti‐FcγRIIB/C Ab were significantly increased in patients with SSc compared to those in controls and in patients with localized scleroderma. Serum levels of anti‐FcγRIIB/C Ab in patients with limited cutaneous SSc were similar to those in patients with diffuse cutaneous SSc. Among SSc patients, serum levels of anti‐FcγRIIB/C Ab were increased in those with nail‐fold bleeding and decreased in those with diffuse pigmentation and calcinosis. These findings support the notion that increased serum anti‐FcγRIIB/C Ab levels are involved in aberrant immune responses in SSc.
An ecosystem services perspective on brush management: research priorities for competing land‐use objectives
Authors: Archer Steven R. , Predick Katharine I.
Published: January 2015

The vegetation of semi‐arid and arid landscapes is often comprised of mixtures of herbaceous and woody vegetation. Since the early 1900s, shifts from herbaceous to woody plant dominance, termed woody plant encroachment and widely regarded as a state change, have occurred world‐wide. This shift presents challenges to the conservation of grassland and savanna ecosystems and to animal production in commercial ranching systems and pastoral societies.

Dryland management focused on cattle and sheep grazing has historically attempted to reduce the abundance of encroaching woody vegetation (hereafter, ‘brush management’) with the intent of reversing declines in forage production, stream flow or groundwater recharge. Here, we assess the known and potential consequences of brush management actions, both positive and negative, on a broader suite of ecosystem services, the scientific challenges to quantifying these services and the trade‐offs among them.

Our synthesis suggests that despite considerable investments accompanying the application of brush management practices, the recovery of key ecosystem services may be short‐lived or absent. However, in the absence of such interventions, those and other ecosystem services may be compromised, and the persistence of grassland and savanna ecosystem types and their endemic plants and animals threatened.

Addressing the challenges posed by woody plant encroachment will require integrated management systems using diverse theoretical principles to design the type, timing and spatial arrangement of initial management actions and follow‐up treatments. These management activities will need to balance cultural traditions and preferences, socio‐economic constraints and potentially competing land‐use objectives.

Synthesis. Our ability to predict ecosystem responses to management aimed at recovering ecosystem services where grasslands and savannas have been invaded by native or exotic woody plants is limited for many attributes (e.g. primary production, land surface–atmosphere interactions, biodiversity conservation) and inconsistent for others (e.g. forage production, herbaceous diversity, water quality/quantity, soil erosion, carbon sequestration). The ecological community is challenged with generating robust information about the response of ecosystem services and their interactions if we are to position land managers and policymakers to make objective, science‐based decisions regarding the many trade‐offs and competing objectives for the conservation and dynamic management of grasslands and savannas.
Grass–woodland transitions: determinants and consequences for ecosystem functioning and provisioning of services
Authors: Sala Osvaldo E. , Maestre Fernando T.
Published: January 2015

A large fraction of grasslands world‐wide is undergoing a rapid shift from herbaceous to woody‐plant dominance, while in other parts of the world, the opposite transition from woodland to grassland is the dominant phenomenon. These shifts have received increasing attention in the ecological literature during the last two decades due to their global extent and their impacts on ecosystem functioning.

This Special Feature includes a series of contributions on key topics within the study of grass–woodland transitions, including three articles addressing the drivers of these vegetation shifts and another three evaluating their ecological consequences. These articles, which include reviews, modelling and empirical studies, highlight the multiplicity of approaches and spatial scales being currently used when studying grass–woodland transitions.

The first articles focus on the role of fire in driving the dynamics of mesic grasslands in the USA, on the effects of climate change on the transition zones between treeless vegetation, savanna and forest in tropical and subtropical Americas and on the role of the internal structure of vegetation as a determinant of grassland–woodland transitions. The articles devoted to exploring the consequences include a modelling study on the ecohydrological consequences of shrub removal in western North America and an empirical study aiming at understanding how abiotic and biotic attributes influence above‐ground net productivity across Patagonian grasslands and shrublands, as well as a review of the consequences of brush management on the provision of ecosystem services.

Synthesis. Identifying the best actions to avoid or take advantage of grass–woodland transitions requires a mechanistic understanding of both the drivers of these shifts and their ecological consequences. The collection of reviews, empirical and modelling studies included in this Special Feature contributes to forecasting how ongoing global change will affect grass–woodland transitions and their consequences for the provisioning of ecosystem services from drylands, which account for a large fraction of Earth's surface.
The Promises and Pitfalls of Prime Provider Models in Service Delivery: The Next Phase of Reform in Australia?
Authors: Gallet Wilma , O'Flynn Janine , Dickinson Helen , O'Sullivan Siobhan
Published: January 2015

At a time of fiscal restraint and reductions in the size of the public sector, governments in Australia are exploring new approaches to delivering public services. One model receiving attention is the prime provider approach. This is an approach where government contracts a lead or prime provider who in turn organizes and manages a group of sub‐contractors. In prime provider approaches, non‐government organizations take on a quasi‐government role and this brings a new complexity into the relationships between the various actors involved in developing and delivering public services. This article provides an overview of prime provider approaches and, drawing on the limited research to date, poses questions that we view as being critical to the current debate. The aim is to provoke further discussion on the potential impact of prime provider approaches.
Government with a Cast of Dozens: Policy Capacity Risks and Policy Work in the Northern Territory
Authors: Carson Dean , Wellstead Adam
Published: January 2015

There are a number challenges to maintaining high‐quality policy capacity in sparsely populated areas such as Australia's Northern Territory (e.g. natural resource dependent economy, prominence of Indigenous issues, provision of local services). Moreover, the Territory government has recently been undergoing a host of public sector changes. This paper utilises survey methodologies of policy workers that were recently developed in Canada and examines nine risk factors to policy work. A survey of 119 policy workers in the Northern Territory was conducted in 2013. The analysis examined four key policy‐work areas (policy activities, barriers, areas for improved policy capacity, nature of change in work environment). The survey findings offer some practical insights for managers. Formal policy‐work training is recognised as critical. Policy capacity may be increased through better inter‐departmental (and potentially inter‐governmental) cooperation and information sharing, more opportunities to engage with non‐governmental stakeholders, and more opportunities for those leaving the full‐time Northern Territory policy workforce to continue to contribute. From a conceptual point of view, the extent to which ‘policy capacity’ as commonly conceived in the literature is applicable to contexts, such as Australia's Northern Territory, warrants further examination.
NSW Workers’ Compensation Reform: A Parody of Evidence‐based Policy Making
Authors: Holley Sasha , Thornthwaite Louise , Markey Ray , O'Neill Sharron
Published: January 2015

The characteristics and evolution of evidence‐based policy making in Australia and other mature democracies have been mapped extensively in this journal. This article advances research on the use of evidence in policy making, examining changes in the New South Wales workers’ compensation system from 2012 to 2014. This analysis of two phases of policy change, legislative implementation and statutory review, highlights the limitations of building integrated, coherent evidence‐based policy in a contentious policy area. The article finds that the collection of wide and detailed evidence will not satisfy requirements of evidence‐based policy without political will, transparency, and accountability.
Unanimity and exposure in the EU Council of Ministers – or how the Dutch won and lost the ICTY debate
Authors: Smeets Sandrino
Published: January 2015

How are unanimity negotiations commonly settled in the EU Council of Ministers? Important contributions have been made to our understanding of the ‘consensual’ decision‐making dynamics in the Council, but most studies focus on explaining the sheer absence of votes in legislative decision making under the qualified majority rule. This study seeks to explain how vetoes are averted, or curtailed, in unanimity decision making. These unanimity negotiations are explained as attempts to induce or prevent high‐level exposure. The degree of exposure in turn depends on the degree of lower level contestation. A process tracing analysis of one prolonged debate is performed from the perspective of one Member State – the Netherlands – which played a very prominent obstructing role. By analysing when, why and where (at what level) the Dutch won or lost, one can come closer to understanding the dynamic interplay between the different Council levels.
Audit on surgical patients' understanding of their informed consent
Authors: Wong John , Chan Danny Tat‐Ming , Tam Yuk‐Him , Ng Simon Siu‐Man , Ip Philip Ching‐Tak , Leung Wing‐Wah , Lai Paul Bo‐San
Published: January 2015

Aim

The aim of the present study was to assess patients' understanding of their informed consent to surgery preoperatively. Appropriate completeness of essential items in the written consent form was also verified.

Patients and Methods

An audit was conducted from March to May 2013 at a university teaching hospital. All participants were adult surgical patients. Operations were confined to major category on elective basis performed under general anaesthesia. The first part of the audit consisted of a structured questionnaire with five questions concerning their understanding and perception of the surgery. In the second part of the audit, the completeness of all fundamental items entered into the standardized written consent form was verified.

Results

A total of 100 surgical patients were studied, with a median age of 61 years (range: 22–89). A total of 99 per cent of participants could state the correct name and site of the procedure, and 92 per cent could state the mode of anaesthesia. Only 39 per cent of patients received an information leaflet regarding the operation, of which 80 per cent claimed this could enhance their understanding of the procedure. Only 70 per cent of them could recall the potential surgical risks. Most essential items were completed in the consent forms. Witnesses were involved only in 24 per cent of cases. Illegible surgeons' handwriting was observed in 6 per cent of consent documents.

Conclusions

Most patients could understand the nature and site of the operation they were going to receive. The provision of relevant information to our patients preoperatively was insufficient. Patients had limited recall of the potential surgical risks. There is room for improvement in the present informed consent process.
Pyelolithotomy with endoscopic lithotripsy for staghorn calculi in a solitary kidney
Authors: Liu Bianjiang , Zhang Wei , Song Rijin , Li Pengchao , Zhang Jiexiu , Li Jie , Wang Zengjun , Yin Changjun
Published: January 2015

Aim

The aim of the present study was to present our experience on pyelolithotomy with simultaneous endoscopic lithotripsy for the treatment of staghorn calculi in a solitary kidney.

Patients and Methods

Five patients were recruited from January 2010 to April 2012. A small, oblique lumbar incision was used to expose the renal pelvis for pyelolithotomy. The cystoscope and/or ureteroscope was/were inserted through the pyelic incision to monitor holmium laser lithotripsy of calculi in renal pelvis and calyces.

Results

No complications were observed. The patients resumed activity 1 day postoperatively and were discharged 3 days postoperatively. The stone‐free rate was 100 per cent. The serum creatinine rate and glomerular filtration rate 6 months postoperatively were not different from preoperative levels. Stone recurrence was not observed during the follow up.

Conclusions

Pyelolithotomy with simultaneous endoscopic holmium laser lithotripsy combines the simplicity and safety of open surgery and the minimal invasion and efficient stone removal of endoscopic techniques.
CUMULATIVE DISADVANTAGE: EXAMINING RACIAL AND ETHNIC DISPARITY IN PROSECUTION AND SENTENCING
Authors: KUTATELADZE BESIKI L. , ANDILORO NANCY R. , JOHNSON BRIAN D. , SPOHN CASSIA C.
Published: January 2015

Current research on criminal case processing typically examines a single decision‐making point, so drawing reliable conclusions about the impact that factors such as defendants’ race or ethnicity exert across successive stages of the justice system is difficult. Using data from the New York County District Attorney's Office that tracks 185,275 diverse criminal cases, this study assesses racial and ethnic disparity for multiple discretionary points of prosecution and sentencing. Findings from multivariate logistic regression analyses demonstrate that the effects of race and ethnicity vary by discretionary point and offense category. Black and Latino defendants were more likely than White defendants to be detained, to receive a custodial plea offer, and to be incarcerated—and they received especially punitive outcomes for person offenses—but were more likely to benefit from case dismissals. The findings for Asian defendants were less consistent but suggest they were the least likely to be detained, to receive custodial offers, and to be incarcerated. These findings are discussed in the context of contemporary theoretical perspectives on racial bias and cumulative disadvantage in the justice system.
Real‐time assessment of hybridization between wolves and dogs: combining noninvasive samples with ancestry informative markers
Authors: Godinho Raquel , López‐Bao José Vicente , Castro Diana , Llaneza Luís , Lopes Susana , Silva Pedro , Ferrand Nuno
Published: January 2015

Wolves and dogs provide a paradigmatic example of the ecological and conservation implications of hybridization events between wild and domesticated forms. However, our understanding of such implications has been traditionally hampered by both high genetic similarity and the difficulties in obtaining tissue samples (TS), which limit our ability to assess ongoing hybridization events. To assess the occurrence and extension of hybridization in a pack of wolf–dog hybrids in northwestern Iberia, we compared the power of 52 nuclear markers implemented onTSwith a subset of 13 ancestry informative markers (AIMs) typed in noninvasive samples (NIS). We demonstrate that the 13AIMs are as accurate as the 52 markers that were chosen without regard to the power to differentiate between wolves and dogs, also having the advantage of being rapidly screened onNIS. The efficiency ofAIMs significantly outperformed ten random sets of similar size and an additional commercial set of 18 markers. Bayesian clustering analysis implemented onAIMs andNISidentified nine hybrids, two wolves and two dogs. Four hybrids were unambiguously assigned to F1xWolf backcrosses. Our approach (AIMs +NIS) overcomes previous difficulties related to sample availability and informative power of markers, allowing a quick identification of wolf–dog hybrids in the first phases of hybridization episodes. This provides managers with a reliable tool to evaluate hybridization and estimate the success of their actions. This approach may be easily adapted for other pairs of wild/domesticated species, thus improving our understanding of the introgression of domestication genes into natural populations.
Degenerate adaptor sequences for detecting PCR duplicates in reduced representation sequencing data improve genotype calling accuracy
Authors: Tin M. M. Y. , Rheindt F. E. , Cros E. , Mikheyev A. S.
Published: January 2015

RAD‐tag is a powerful tool for high‐throughput genotyping. It relies on PCR amplification of the starting material, following enzymatic digestion and sequencing adaptor ligation. Amplification introduces duplicate reads into the data, which arise from the same template molecule and are statistically nonindependent, potentially introducing errors into genotype calling. In shotgun sequencing, data duplicates are removed by filtering reads starting at the same position in the alignment. However, restriction enzymes target specific locations within the genome, causing reads to start in the same place, and making it difficult to estimate the extent of PCR duplication. Here, we introduce a slight change to the Illumina sequencing adaptor chemistry, appending a unique four‐base tag to the first index read, which allows duplicate discrimination in aligned data. This approach was validated on the Illumina MiSeq platform, using double‐digest libraries of ants (Wasmannia auropunctata) and yeast (Saccharomyces cerevisiae) with known genotypes, producing modest though statistically significant gains in the odds of calling a genotype accurately. More importantly, removing duplicates also corrected for strong sample‐to‐sample variability of genotype calling accuracy seen in the ant samples. For libraries prepared from low‐input degraded museum bird samples (Mixornis gularis), which had low complexity, having been generated from relatively few starting molecules, adaptor tags show that virtually all of the genotypes were called with inflated confidence as a result of PCR duplicates. Quantification of library complexity by adaptor tagging does not significantly increase the difficulty of the overall workflow or its cost, but corrects for differences in quality between samples and permits analysis of low‐input material.
Latino Adolescent Perspectives Toward Sexually Transmitted Infection Educational Programs
Authors: Lee Young Me , Florez Elizabeth , Holm Karyn , Horwitz Jessica , Waters Rachel
Published: January 2015

Purpose

The study aims to identify knowledge about sexually transmitted infections (STIs) among Latino adolescents, to explore programmatic components that are essential for an effective educational program, and to explore gender differences regarding STI knowledge and essential components.

Methods

A naturalistic inquiry approach was used.

Findings

Knowledge of specific STIs was minimal. Themes including humor, fear, empowered decision‐making, peer educators, self‐protection, knowledge and information on STIs, and consistency of the sexual health education were identified as essential components for STI educational programs.

Conclusion

The findings of this study enhance the understanding of STIs, sexual behaviors, and essential components of an effective STI educational program as perceived by Latino adolescents.

Implications for Nursing Practice

It is essential for nurses to provide accurate information about STIs and safe sex to help decrease the transmission of STIs.
Influence of Society for Academic Emergency Medicine Grant Mechanisms on Postaward Academic Productivity
Authors: Safdar Basmah , Paradise Summer A. , McMillian Melissa , Holmes James F. ,   the 2011–2012 and 2012–2013 Society for Academic Emergency Medicine Grants Committees
Published: January 2015

Objectives

The Society for Academic Emergency Medicine (SAEM) provides research training grants, but the future productivity of award recipients and nonrecipients is unclear. The study objective was to assess the association of the two SAEM research training mechanisms with scholarly productivity and rates of subsequent funding between nonrecipients and recipients. A secondary goal was to evaluate the productivity metrics for fellows trained at the Institutional Research Training Grant (IRTG) programs.

Methods

The authors surveyed all 2002 through 2011 Research Training Grant (RTG; n = 64) and Institutional Research Training Grant (IRTG; n = 38) applicants. RTG outcomes were federal funding as a principal investigator (PI) or co‐PI using National Institutes of Health RePORTER and scholarly productivity using PubMed. IRTG outcomes were SAEM‐approved research fellowships and National Heart, Lung and Blood Institute K12 training awards. Sites applying for or receiving the IRTG multiple times were only counted once. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated.

Results

Over 10 years, nine of 64 (14%) RTG and 10 of 38 (26%) IRTG applications were funded (two sites received multiple awards). Federal funding was obtained by seven of nine (78%) RTG recipients and 22 of 55 (40%) RTG nonrecipients (RR = 1.94, 95% CI = 1.21 to 3.13). All nine (100%, 95% CI = 72% to 100%) of RTG recipients had at least one manuscript, compared to 48 of the 55 (87%, 95% CI = 76% to 95%) nonrecipients. All nine (100%, 95% CI = 72% to 100%) RTG recipients remained in academics versus 44 of 55 (80%, 95% CI = 67% to 90%) nonrecipients. For the IRTG, four of seven awardees (57%, 95% CI = 18% to 90%) versus 0 of the 16 (0%, 95% CI = 0 to 17%) nonrecipients received National Heart, Lung and Blood Institute K12 awards (RR = 19.1, 95% CI = 1.16 to 314.0). Additionally, five of seven (71%, 95% CI = 29% to 96%) institutions became SAEM‐approved fellowships compared to one of 16 (6%, 95% CI = 0 to 30%) nonrecipients (RR = 11.4, 95% CI = 1.61 to 80.7).

Conclusions

SAEM RTG recipients were more likely to obtain federal funding postaward than nonrecipients. IRTG recipients were more likely to develop successful research training programs than nonrecipients.
Classification of Cardiopulmonary Resuscitation Chest Compression Patterns: Manual Versus Automated Approaches
Authors: Wang Henry E. , Schmicker Robert H. , Herren Heather , Brown Siobhan , Donnelly John P. , Gray Randal , Ragsdale Sally , Gleeson Andrew , Byers Adam , Jasti Jamie , Aguirre Christina , Owens Pam , Condle Joe , Leroux Brian
Published: January 2015

Objectives

New chest compression detection technology allows for the recording and graphical depiction of clinical cardiopulmonary resuscitation (CPR) chest compressions. The authors sought to determine the inter‐rater reliability of chest compression pattern classifications by human raters. Agreement with automated chest compression classification was also evaluated by computer analysis.

Methods

This was an analysis of chest compression patterns from cardiac arrest patients enrolled in the ongoing Resuscitation Outcomes Consortium (ROC) Continuous Chest Compressions Trial. Thirty CPR process files from patients in the trial were selected. Using written guidelines, research coordinators from each of eight participating ROC sites classified each chest compression pattern as 30:2 chest compressions, continuous chest compressions (CCC), or indeterminate. A computer algorithm for automated chest compression classification was also developed for each case. Inter‐rater agreement between manual classifications was tested using Fleiss's kappa. The criterion standard was defined as the classification assigned by the majority of manual raters. Agreement between the automated classification and the criterion standard manual classifications was also tested.

Results

The majority of the eight raters classified 12 chest compression patterns as 30:2, 12 as CCC, and six as indeterminate. Inter‐rater agreement between manual classifications of chest compression patterns was κ = 0.62 (95% confidence interval [CI] = 0.49 to 0.74). The automated computer algorithm classified chest compression patterns as 30:2 (n = 15), CCC (n = 12), and indeterminate (n = 3). Agreement between automated and criterion standard manual classifications was κ = 0.84 (95% CI = 0.59 to 0.95).

Conclusions

In this study, good inter‐rater agreement in the manual classification of CPR chest compression patterns was observed. Automated classification showed strong agreement with human ratings. These observations support the consistency of manual CPR pattern classification as well as the use of automated approaches to chest compression pattern analysis.
Underuse of Pregnancy Testing for Women Prescribed Teratogenic Medications in the Emergency Department
Authors: Goyal Monika K. , Hersh Adam L. , Badolato Gia , Luan Xianqun , Trent Maria , Zaoutis Theoklis , Chamberlain James M.
Published: January 2015

Objectives

The objectives were to estimate the frequency of pregnancy testing in emergency department (ED) visits by reproductive‐aged women administered or prescribed teratogenic medications (Food and Drug Administration categories D or X) and to determine factors associated with nonreceipt of a pregnancy test.

Methods

This was a retrospective cross‐sectional study using 2005 through 2009 National Hospital Ambulatory Medical Care Survey data of ED visits by females ages 14 to 40 years. The number of visits was estimated where teratogenic medications were administered or prescribed and pregnancy testing was not conducted. The association of demographic and clinical factors with nonreceipt of pregnancy testing was assessed using multivariable logistic regression.

Results

Of 39,859 sampled visits, representing an estimated 141.0 million ED visits by reproductive‐aged females nationwide, 10.1 million (95% confidence interval [CI] = 8.9 to 11.3 million) estimated visits were associated with administration or prescription of teratogenic medications. Of these, 22.0% (95% CI = 19.8% to 24.2%) underwent pregnancy testing. The most frequent teratogenic medications administered without pregnancy testing were benzodiazepines (52.2%; 95% CI = 31.1% to 72.7%), antibiotics (10.7%; 95% CI = 5.0% to 16.3%), and antiepileptics (7.7%; 95% CI = 0.12% to 15.5%). The most common diagnoses associated with teratogenic drug prescription without pregnancy testing were psychiatric (16.1%; 95% CI = 13.6% to 18.6%), musculoskeletal (12.7%; 95% CI = 10.8% to 14.5%), and cardiac (9.5%; 95% CI = 7.6% to 11.3%). In multivariable analyses, visits by older (adjusted odds ratio [AOR] = 0.57, 95% CI = 0.42 to 0.79), non‐Hispanic white females (AOR = 0.71; 95% CI = 0.54 to 0.93); visits in the Northeast region (AOR = 0.60; 95% CI = 0.42 to 0.86); and visits during which teratogenic medications were administered in the ED only (AOR = 0.74; 95% CI = 0.57 to 0.97) compared to prescribed at discharge only were less likely to have pregnancy testing.

Conclusions

A minority of ED visits by reproductive‐aged women included pregnancy testing when patients were prescribed category D or X medications. Interventions are needed to ensure that pregnancy testing occurs before women are prescribed potentially teratogenic medications, as a preventable cause of infant morbidity.
Costs Associated with Ambulatory Care Sensitive Conditions Across Hospital‐based Settings
Authors: Galarraga Jessica E. , Mutter Ryan , Pines Jesse M.
Published: January 2015

Objectives

Ambulatory care sensitive conditions (ACSCs) are acute care diagnoses that could potentially be prevented through improved primary care. This study investigated how payments and charges for these ACSC visits differ by three hospital‐based settings (outpatient, emergency department [ED], and inpatient) and examined differences in payments and charges by their physician and facility components.

Methods

This was a secondary analysis of data (2005 through 2010) from the Medical Expenditure Panel Survey. Multiple linear regression models were used to assess differences in the mean‐adjusted payments and charges for ACSC visits by clinical setting and further divided payments and charges into physician and facility components.

Results

Of all ACSC visits from 2005 through 2010, 41% were outpatient visits, 36% were ED visits, and 23% were hospital admissions. After adjusting for patient demographics and comorbid conditions, charges for an inpatient ACSC visit were four times higher ($11,414 vs. $2,563) and payments were five times higher ($4,325 vs. $859) when compared to an ED visit. By comparison, charges for an ACSC ED visit were two times higher ($2,563 vs. $1,084) and payments 2.5 times higher ($859 vs. $341) relative to an ACSC visit managed in an outpatient hospital‐based clinic. Across all clinical settings, hospital facility fees account for 77% to 94% of the charge differences and 81% to 93% of the payment differences.

Conclusions

For hospital‐based ACSC visits, inpatient hospitalizations are by far the most expensive. Finding ways to expand outpatient resources and improve the health management of the chronically ill may avoid conditions that lead to more expensive hospital‐based encounters. Across all hospital‐based settings, facility fees are the major contributor of expense.
Dissemination and Implementation Research in Emergency Medicine
Authors: Bernstein Steven L. , Stoney Catherine M. , Rothman Richard E.
Published: January 2015

Published medical research takes years to change clinical practice. The reasons for this evidence‐to‐practice gap are many. To address this gap, in recent years the field of dissemination and implementation (D&I) science has grown dramatically. D&I studies design and test strategies to accelerate the movement of new evidence‐based diagnostic and therapeutic maneuvers into real‐world clinical practice. This article summarizes the proceedings of sessions at the 2011 and 2012 annual meetings of the Society for Academic Emergency Medicine that discussed D&I studies in emergency medicine. Examples of current studies are provided, along with a review of D&I methods, funding opportunities, and suggestions for future research.
Macroanatomical Aspects of the Lumbar Plexus and its Branches in the Sparrowhawk
Authors: Balkaya H. , Ozudogru Z.
Published: January 2015

This study examined the plexus lumbalis and its branches in the sparrowhawk (Accipiter nisus). Fifteen sparrowhawks were used in this study. After administering an anaesthetic to the birds, the body cavities were opened. The birds were fixed with formaldehyde after draining of the blood. The nerves of the plexus lumbalis were dissected separately and photographed. The plexus lumbalis was formed by the union of the branches of the synsacral spinal nerves, which left from the ventrolaterale of os lumbosacrale. The plexus consisted of three (2nd, 3rd and 4th) synsacral spinal nerves. The cranial and caudal nerves originating from the plexus lumbalis were the nervus cutaneous femoris, nervus coxalis cranialis, nervus femoralis, nervus saphenus and nervus obturatorius. The general macroanatomical shape of the plexus lumbalis and the distribution of the nerves originating from this plexus were similar to those of other bird species.
Double jeopardy: bark harvest for malaria treatment and poor regeneration threaten tree population in a tropical forest of Uganda
Authors: Galabuzi Charles , Nabanoga Gorettie N. , Ssegawa Paul , Obua Joseph , Eilu Gerald
Published: January 2015

Several forest plants known to supply medicine are under pressure worldwide. We carried out a study of four tree species (Warburgia ugandensis Sprague, Fleroya rubrostipulata (K.Schum.) Y.F.Deng, Syzygium guineense DC. and Zanthoxylum chalybeum Engl.) that are highly demanded for malaria treatment. The study was undertaken between 2006 and 2009 in the Sango Bay Forest Reserve, southern Uganda. The aim was to determine the conservation status of trees targeted for malaria treatment. We assessed the level of damage inflicted on trees during harvesting of medicinal parts and determined the population density of target species in the forest. We used 95 plots established along nineteen transects. Survival of the most preferred species, F. rubrostipulata, is of particular concern as its population suffered from a combination of extensive damage due to poor methods of harvesting and poor regeneration. The density of trees with diameter ≥5 cm differed between species and sites, demonstrating different recruitment and survival strategies. Management of Protected Areas should augment strategies to monitor the legal and illegal harvest of medicinal plants, by adopting low impact harvesting methods, and designating the temporal and spatial patterns of harvesting. This might reduce tree damage and mortality.
Foraging ecologies of giraffe (Giraffa camelopardalis reticulata) and camels (Camelus dromedarius) in northern Kenya: effects of habitat structure and possibilities for competition?
Authors: O'Connor David A. , Butt Bilal , Foufopoulos Johannes B.
Published: January 2015

The foraging ecologies of reticulated giraffe (Giraffa camelopardalis reticulata) and domestic camels (Camelus dromedarius) were examined in the Laikipia District of Kenya, where these species have recently become sympatric. Camels increased popularity in the region has lead to concerns about their environmental impacts and possible competition with wild giraffe for resources. We gathered foraging data on both species using 2‐min group scans that recorded feeding heights and plant food preferences. Transects sampled the vegetation in areas where foraging observations were recorded. Giraffe females feed at lower elevations than males, while female camels feed below both sexes of giraffe. There was very little observed overlap in food preferences between the species. However, habitat type has an effect on foraging ecologies of both giraffe sexes, but habitat did not influence camel foraging. Camel herder husbandry techniques also influence camel foraging dynamics. These findings have important implications in achieving the twin objectives of wildlife conservation and pastoralist livestock production in northern Kenya.
Predictors of rural practice location for James Cook University MBBS graduates at postgraduate year 5
Authors: Woolley Torres , Sen Gupta Tarun , Murray Richard , Hays Richard
Published: January 2015

Objective

To describe factors predicting James Cook University (JCU) medical graduates having a rural practice location at postgraduate year (PGY) 5.

Participants

JCU MBBS graduates who had completed their PGY 5 in Australia (n = 260).

Design

Multiple logistic regression analysis involving graduates' application data (age, gender, location of hometown, School Leaving Score, interview score, ethnicity), undergraduate data (scholarship awarded, honours program), and postgraduation data (internship location, specialty training undertaken).

Main outcome measure

Predictors of practice in a ‘rural’ town (Australian Standard Geographic Classification Remoteness Area (ASGC‐RA)) 3–5 at PGY 5.

Results

Practice in a ‘rural’ town in PGY 5 was predicted by ‘internship in an ASGC‐RA 3–5 location’ (prevalence odds ratios (POR) = 3.9, P < 0.001), ‘undertaken postgraduate training as a general practitioner or rural generalist’ (POR = 3.4, P < 0.001), ‘hometown at application located in ASGC‐RA 3–5 area’ (POR = 2.9, P = 0.023), ‘Aboriginal & Torres Strait Islander ancestry’ (POR = 5.6, P = 0.031), and NOT undertaken postgraduate training in surgery (POR = 5.4, P = 0.055).

Conclusions

This study provides evidence that likelihood of early career rural medical practice in Australia is enhanced by education strategies, such as providing rurally located internship places, supporting rural general practice, and selecting applicants with rural origins, Aboriginal or Torres Strait Islander ancestry, and/or a genuine interest in rural, remote, Indigenous, and tropical medicine. This early evidence supports the proposition that investing in rural medical education will produce an appropriately trained medical workforce to meet the needs of rural Australia. Findings also suggest rural workforce may be further enhanced with additional specialty training opportunities in rural tertiary hospitals, in particular, surgery.
Rural patients' experiences of the open disclosure of adverse events
Authors: Piper Donella , Iedema Rick , Bower Kate
Published: January 2015

Objective

To analyse rural patients' and their families' experiences of open disclosure and offer recommendations to improve disclosure in rural areas.

Design

Retrospective qualitative study based on a subset of 13 semistructured, in‐depth interviews with rural patients from a larger dataset. The larger data set form a nationwide, multisite, retrospective‐qualitative study that included 100 semistructured, in‐depth interviews with 119 patients and family members who were involved in high‐severity health care incidents and incident disclosure. The larger study is known as the ‘100 Patient Stories’ study. Interviews were transcribed verbatim and analysed by one analyst (D.P.) for recurrent experiences and concerns.

Setting

Acute care.

Participants

A sub‐set of 13 of the 100 participants from the '100 Patient Stories' study who identified as experiencing an adverse incident in a rural or regional area.

Main outcome measures

Patients' and family members' perceptions and experiences of health care incident disclosure, as expressed in interviews.

Results

Rural patients and clinicians experience additional challenges to metropolitan patients and clinicians in their experiences of health care incidents. These additional barriers include: a lack of resources at small hospitals; delays in diagnosis and transfer; distance between services; and a lack of communication between providers. These challenges impact not only upon how patients and their families experience incidents, but also how open disclosure is implemented.

Conclusions

This analysis of 13 of the 100 Patient Stories interviews provides guidance to rural health services on how to conduct open disclosure.
The EuroPrevall outpatient clinic study on food allergy: background and methodology
Authors: Fernández‐Rivas M. , Barreales L. , Mackie A. R. , Fritsche P. , Vázquez‐Cortés S. , Jedrzejczak‐Czechowicz M. , Kowalski M. L. , Clausen M. , Gislason D. , Sinaniotis A. , Kompoti E. , Le T.‐M. , Knulst A. C. , Purohit A. , de Blay F. , Kralimarkova T. , Popov T. , Asero R. , Belohlavkova S. , Seneviratne S. L. , Dubakiene R. , Lidholm J. , Hoffmann‐Sommergruber K. , Burney P. , Crevel R. , Brill M. , Fernández‐Pérez C. , Vieths S. , Clare Mills E. N. , van Ree R. , Ballmer‐Weber B. K.
Published: January 2015

Background

The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socio‐economic impact and to complement the EuroPrevall population‐based surveys, a cross‐sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol.

Methods

Patients referred for immediate food adverse reactions underwent a consistent and standardized allergy work‐up that comprised collection of medical history; assessment of sensitization to 24 foods, 14 inhalant allergens and 55 allergenic molecules; and confirmation of clinical reactivity and food thresholds by standardized double‐blind placebo‐controlled food challenges (DBPCFCs) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach.

Results

A standardized methodology for a comprehensive evaluation of food allergy was developed and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFCs were performed.

Conclusions

This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardized evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods and to analyse the socio‐economic impact of food allergy.
Beyond the Bright Side: Dark Personality at Work
Authors: Harms P.D. , Spain Seth M.
Published: January 2015

Despite the long history of the psychological study of dark personality characteristics and the recent surge of interest in the topic, much work remains to fully understand the breadth and depth of the impact of dark personality in the workplace. This commentary briefly covers the history of dark personality, discusses the place of this special issue within that history, and then proposes a number of avenues for future research in terms of defining, measuring, and providing a more comprehensive theoretical framework for the study of dark personality.
Pattern and chronology of glacial Lake Peace shorelines and implications for isostacy and ice‐sheet configuration in northeastern British Columbia, Canada
Authors: Hickin Adrian S. , Lian Olav B. , Levson Victor M. , Cui Yao
Published: January 2015

Recognition of positions of glacial lakes along the margin of continental ice sheets is critical in reconstructing ice configuration during deglaciation. Advances in remote sensing technology (e.g. LiDAR) have enabled the generation of accurate digital‐elevation models (DEMs) that reveal unprecedented geomorphic detail. Combined with geographical information systems, these tools have considerably advanced the mapping and correlation of geomorphic features such as relict shorelines. Shorelines of glacial Lake Peace (GLP) developed between the Laurentide and Cordilleran ice sheets in northeastern British Columbia and northwestern Alberta. Shoreline mapping from high resolution DEMs produced more than 55 500 elevation data points from 3231 shorelines, enabling the identification of four major phases of GLP: Phase I (altitude 960–990 m a.s.l.); Phase II (890–915 m a.s.l.); Phase III (810–865 m a.s.l.); and Phase IV (724–733 m a.s.l.). The timing of Phase II of GLP is estimated by two optical ages of <16.0±2.5 and 14.2±0.5 ka BP. Extensive mapping of the shorelines allows for measuring of glacial isostatic adjustment as ice retreated. Shorelines currently dip to the northeast at around 0.4–0.5 m km−1. This slope reflects the asynchronous retreat of the Cordilleran (CIS) and Laurentide (LIS) ice sheets. The relative uplift in the southwest of the study area within the Rocky Mountains and foothills suggests that the Late Wisconsinan (MIS 2) CIS persisted in the foothill after the LIS lost mass and retreated, or that the Late Wisconsinan CIS was very thick and caused deep crustal loading, which resulted in more uplift in the southwest before reaching equilibrium during, or shortly after deglaciation.
Entrepreneurial Orientation, Social Networks, and Creative Performance: Middle Managers as Corporate Entrepreneurs
Authors: Chen Ming‐Huei , Chang Yu‐Yu , Chang Yuan‐Chieh
Published: January 2015

Though previous research has highlighted how important it is for middle managers to contribute to corporate entrepreneurship, little work has been done to explore how they produce creative performance by examining the direct, curvilinear and moderating effects of their entrepreneurial orientation and social networks. A total of 337 middle managers conducting marketing, R&D and project management in Taiwan are studied. The results suggest that middle managers' disposition towards proactiveness and innovativeness is positively related to their creative performance, and their internal bonding networks and upper management networks are found to strengthen the effects of entrepreneurial orientation on creative performance. However, middle managers' external bridging networks are found to have an inverted U‐shaped curvilinear relationship with their creative performance, and to weaken the effect of entrepreneurial orientation on creative performance. These findings echo the interactionist perspective of creativity, implying that middle managers should manage their social networks more carefully, as social interaction with network actors may either facilitate or inhibit their creativity at work.