Search

Change management is a critical issue in the current fast-paced business environment. Organizations are being bombarded with global business change, innovations in communications, and rapidly evolving information systems capabilities. Since there exists a paucity of rigorous and relevant literature on change management, we chose to embark on an in-depth case study to explore how one organization manages radical change. We developed a set of theoretical propositions to guide the effort and act as a theoretical lens. Our specific research question is: how does an organization successfully manage projects that call for dramatic change to the way one normally conducts business? The case study allowed us to test the propositions in the business arena with one organization. It is hoped that this approach will offer insights and mechanisms to help other organizations effectively deal with change. [ABSTRACT FROM AUTHOR]

The purpose of the research was to examine the part a creative environment plays in creating the foundation for BPR efforts. A comparison between creative environments in US and Japanese companies was used to address the research question. The creative environment of each company was examined by looking at four categories of factors--people, process, output, and environment. These categories were used to organize and systematically analyze the data. In general, the researcher found that Japanese companies tend to adopt incremental business process improvement (BPI) rather than BPR. BPI is a way of life. Emphasis is placed on the 'group' rather than the individual. Since the group is emphasized, individual innovation and creativity is not generally nurtured by management. However, some Japanese companies are beginning to see the value of individual creativity. They are starting creativity training programmes for key employees. Nevertheless, it will take some time before a paradigm of individuality is generally accepted. Since US companies want to change quickly and radically to become more competitive, many are experimenting with BPR. However, a critical success factor of BPR is teamwork and cooperation. Although US companies have historically been very individualistic, teaming and nurturing is beginning to make its way into the culture of many organizations. Successful BPR hinges on changing to an environment conducive to change. Organizations that understand the importance of a change-oriented environment will have the best chance of success. It appears that US and Japanese companies are converging on similar paradigms of work. US companies are moving from "rugged" individualism to cooperation and teamwork. Japanese companies are moving from a group consensus paradigm to one that encourages individual creativity. Although US companies have a long way to go, it might be more difficult for Japanese companies. The culture in Japan is much more homogeneous. In addition, free flow of ideas has not been a part of the Japanese culture. Whether or not companies in the US embrace teamwork and individual creativity, the basic culture of the US has always been democratic and has encouraged free speech. [ABSTRACT FROM AUTHOR]

In 1992 Barnett Bank, one of the top 25 banks in the United States, embarked on a redesign of the direct consumer lending process. The redesign involved moving from 32 to two processing centres, and has reduced processing time from three to less than one day. This case study describes Barnett Bank's approach to BPR and managing the process of redesign itself. [ABSTRACT FROM AUTHOR]

Discusses the use of infixation and interposition in American English. Examples of infixed and interposed forms of words.

This work demonstrates the use of cluster analysis in detecting fair and unbiased novel discoveries. Given a sample population of elective spinal fusion patients, we identify two overarching subgroups driven by insurance type. The Medicare group, associated with lower socioeconomic status, exhibited an over-representation of negative risk factors. The findings provide a compelling depiction of the interwoven socioeconomic and racial disparities present within the healthcare system, highlighting their consequential effects on health inequalities. The results are intended to guide design of fair and precise machine learning models based on intentional integration of population stratification.

Since the advent of space exploration missions, various space agencies have been working to improve the quality of food and nutrition for crew members. Food processing, preservation, and packaging have evolved with the advancement of technology. Most of the food available on earth can be consumed in space by changing its form. Shelf life and food acceptability can be enhanced by using suitable packaging materials. Here we review space food, which has been categorized into bite-size food, rehydratable food, thermostabilized food, intermediate moisture food, and irradiated food. Additionally, packaging materials and different packaging forms for space food are reviewed. Finally, the review highlights the challenges in space food packaging and food packaging trends of the Defence research and development organization (DRDO), the Japan aerospace exploration agency (JAXA), and the National aeronautics and space administration (NASA)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023 The Committee on Space Research (COSPAR). Published by Elsevier B.V. All rights reserved.)

Purpose: To review current literature on texting as a sustainable intervention of case management in the outpatient setting., Findings: Texting, as a case management intervention, provides the medically complex client with a pathway to achieve care plan goals. Texting increases adherence, communication, and self-management. It can increase client enrollment in disease management programs, while providing support, flexibility, convenience, cost savings, and increased participation., Implications for Case Management Practice: In current practice, such as management of the coronavirus (COVID-19), other pandemics, or natural/environmental disasters, texting is a solution-focused intervention that can deliver and retrieve real-time information to a medically complex population. It can link patients to resources and increase outreach, efficiency, quality, and coordination of care. Texting can promote adherence to appointments, increase medication compliance and disease management interventions, and provide motivational change messages. However, there are legal and regulatory concerns that carry potential consequences and implications that should be approached judiciously (Mellette, 2015). Texting is not one size fits all; it can cause HIPAA breeches, hinder communication with certain populations, confuse health messaging, and replace human communication, thereby reducing staffing in practice., Competing Interests: The author reports no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The American Academy of Psychiatry and the Law (AAPL) has been devoted to the teaching of forensic psychiatry, and as AAPL celebrates its 50th Anniversary, it seems fitting to examine the history and the current status of forensic psychiatry teaching in general psychiatry residencies and forensic psychiatry fellowships. After a brief review of the history of AAPL and forensic psychiatry training, this article explores the current state of graduate medical education (GME) in the United States, the growing popularity of psychiatry as a specialty and forensic psychiatry as a subspecialty, the Accreditation Council for Graduate Medical Education's requirements for forensic training, and the methods currently used to teach forensic psychiatry to general psychiatry residents. This article also examines the current status of forensic psychiatry fellowship training in the United States. Finally, future challenges to forensic training in both residencies and fellowships will be discussed, as well as the need for AAPL and others in the profession to advocate for increased forensic teaching in a manner that leads to the production of both general and forensic psychiatrists who are competent to practice independently and who are sufficient in number to meet the growing demands for forensic expertise., (© 2020 American Academy of Psychiatry and the Law.)

Psychiatry residents' experiences in forensic psychiatry vary greatly across the country, and many psychiatry programs meet the Accreditation Council for Graduate Medical Education requirements for a forensic experience through general psychiatry rotations (e.g., on a consult-liaison service) or classroom-based activities. Forensic clinical experiences during psychiatry residency are important for preparing future general psychiatrists for practice with justice-involved patients, generating interest in forensic psychiatry, and easing the transition from "healer to evaluator" for future fellows. Unfortunately, residency programs interested in expanding their forensic training may face many challenges because of current regulatory frameworks, the nature of forensic practice, and competing demands within residency training programs. This article describes these challenges, and the experience of the authors at one institution with developing a novel forensic experience in a criminal justice diversion setting. The authors conclude with some practical considerations for educators interested in developing forensic experiences at their institutions., (© 2018 American Academy of Psychiatry and the Law.)

The election of President Trump has led to interest in his mental health and has resulted in heightened scrutiny regarding the American Psychiatric Association's Goldwater Rule, with its prohibition on opining psychiatrically on the mental health of public figures whom one has not examined in person. This article highlights the historic, methodological, forensic, and ethics challenges regarding psychiatric approaches to leadership analysis, and how these can offer policy makers options regarding national security decision-making., (© 2018 American Academy of Psychiatry and the Law.)

After adjudication by the courts that an individual is not criminally responsible for the offense committed, forensic psychiatrists/psychologists are tasked with evaluating an acquittees' ongoing risk of violence. These findings determine whether an acquittee is retained in a forensic hospital or transferred to a civil psychiatric setting or into the community. Better understanding of risk factors that affect decisions to retain or release acquittees from secure forensic facilities would increase clarity in decision-making, assist evaluators in identifying who may be successful outside of secure settings, and potentially assist in the development and implementation of targeted treatments to address risk factors before and after transfer. The current study evaluated which risk factors of the Historical-Clinical-Risk Management 20, Version 3 differentiated acquittees whom clinicians opined to have a dangerous mental disorder and required retention from those whom clinicians opined to be ready for transfer to a less secure setting. Results indicated that the Clinical and Risk Management scales predicted opinions regarding readiness for transfer, even after accounting for acts of violence in the hospital. These findings suggest clinicians are attuned to relevant and current risk factors in evaluations, rather than disproportionately focused on historical factors. Implications for practice and future research are discussed., (© 2018 American Academy of Psychiatry and the Law.)

Healthcare database analyses (claims, electronic health records) have been identified by various regulatory initiatives, including the 21 st Century Cures Act and Prescription Drug User Fee Act ("PDUFA"), as useful supplements to randomized clinical trials to generate evidence on the effectiveness, harm, and value of medical products in routine care. Specific applications include accelerated drug approval pathways and secondary indications for approved medical products. Such real-world data ("RWD") analyses reflect how medical products impact health outside a highly controlled research environment. A constant stream of data from the routine operation of modern healthcare systems that can be analyzed in rapid cycles enables incremental evidence development for regulatory decision-making. Key evidentiary needs by regulators include 1) monitoring of medication performance in routine care, including the effectiveness, safety and value; 2) identifying new patient strata in which a drug may have added value or unacceptable harms; and 3) monitoring targeted utilization. Four broad requirements have been proposed to enable successful regulatory decision-making based on healthcare database analyses (collectively, "MVET"): Meaningful evidence that provides relevant and context-informed evidence sufficient for interpretation, drawing conclusions, and making decisions; valid evidence that meets scientific and technical quality standards to allow causal interpretations; expedited evidence that provides incremental evidence that is synchronized with the decision-making process; and transparent evidence that is audible, reproducible, robust, and ultimately trusted by decision-makers. Evidence generation systems that satisfy MVET requirements to a high degree will contribute to effective regulatory decision-making. Rapid-cycle analytics of healthcare databases is maturing at a time when regulatory overhaul increasingly demands such evidence. Governance, regulations, and data quality are catching up as the utility of this resource is demonstrated in multiple contexts.

The United States' health care system is mired in uncertainty. Public opinion on the Patient Protection and Affordable Care Act ("ACA") is undeniably mixed and politicized. The individual mandate, tax subsidies, and Medicaid expansion dominate the discussion. This Article argues that the ACA and reform discourse have given short shrift to a more static problem: the law of emergency care. The Emergency Medical Treatment and Active Labor Act of 1986 ("EMTALA") requires most hospitals to screen patients for emergency medical conditions and provide stabilizing treatment regardless of patients' insurance status or ability to pay. Remarkably, this law strengthened the health safety net in a country that has no universal health care. But it is an unfunded mandate that responded to the problem of emergency care in a flawed fashion and contributed to the supposed "free rider" problem that the ACA attempted to cure. But the ACA has also not been effective at addressing the issue of emergency care. The ACA's architects reduced funding for hospitals that serve a disproportionate percentage of the medically indigent but did not anticipate the Supreme Court's ruling in NFIB v. Sebelius, which made Medicaid expansion optional. Public and non-profit hospitals now face a scenario of less funding and potentially higher emergency room utilization due to continued uninsurance or underinsurance. Alternatives to the ACA have been insufficiently attentive to the importance of emergency care in our health system. This Article contends that any proposal that does not seriously consider EMTALA is incomplete and bound to produce some of the same problems that have dogged the American health care system for the past few decades. Moreover, the Article shows how notions of race, citizenship, and deservingness have filtered into this health care trajectory, and in the context of reform, have the potential to exacerbate existing health inequality. The paper concludes with normative suggestions on how to the mitigate EMTALA's problems in ways that might improve population health.

The current political economic crisis in the United States places in sharp relief the tensions and contradictions of racial capitalism as it manifests materially in health care and in knowledge-producing practices. Despite nearly two decades of investment in research on racial inequality in disease, inequality persists. While the reasons for persistence of inequality are manifold, little attention has been directed to the role of medical education. Importantly, medical education has failed to foster critical theorizing on race and racism to illuminate the often-invisible ways in which race and racism shape biomedical knowledge and clinical practice. Medical students across the nation are advocating for more critical anti-racist education that centers the perspectives and knowledge of marginalized communities. This Article examines the contemporary resurgence in explicit forms of white supremacy in light of growing student activism and research that privileges notions of innate differences between races. It calls for a theoretical framework that draws on Critical Race Theory and the Black Radical Tradition to interrogate epistemological practices and advocacy initiatives in medical education.

The need for high-quality evidence to support decision making about health and health care by patients, physicians, care providers, and policy-makers is well documented. However, serious shortcomings in evidence persist. Pragmatic clinical trials that use novel techniques including emerging information and communication technologies to explore important research questions rapidly and at a fraction of the cost incurred by more "traditional" research methods promise to help close this gap. Nevertheless, while pragmatic clinical trials can bridge clinical practice and research, they may also raise difficult ethical and regulatory challenges. In this article, the authors briefly survey the current state of evidence that is available to inform clinical care and other health-related decisions and discuss the potential for pragmatic clinical trials to improve this state of affairs. They then propose a new working definition for pragmatic research that centers upon fitness for informing decisions about health and health care. Finally, they introduce a project, jointly undertaken by the National Institutes of Health Health Care Systems Research Collaboratory and the National Patient-Centered Clinical Research Network (PCORnet), which addresses 11 key aspects of current systems for regulatory and ethical oversight of clinical research that pose challenges to conducting pragmatic clinical trials. In the series of articles commissioned on this topic published in this issue of Clinical Trials, each of these aspects is addressed in a dedicated article, with a special focus on the interplay between ethical and regulatory considerations and pragmatic clinical research aimed at informing "real-world" choices about health and health care., (© The Author(s) 2015.)

Most forensic psychiatrists occasionally face complex situations in forensic work in which ethics dilemmas cause discomfort. They want to determine the most ethical action, but the best choice is unclear. Fostering justice is primary in forensic roles, but secondary duties such as traditional biomedical ethics and personal values like helping society, combating racism, and being sensitive to cultural issues can impinge on or even outweigh the presumptive primary duty in extreme cases. Similarly, in treatment the psychiatrists' primary duty is to patients, but that can be outweighed by secondary duties such as protecting children and the elderly or maintaining security. The implications of one's actions matter. In forensic work, if the psychiatrist determines that he should not assist the party who wants to hire him, despite evidence clearly supporting its side, the only ethical option becomes not to accept the case at all, because the evidence does not support the better side. Sometimes it can be ethical to accept cases only for one side. In ethics-related dilemmas, I call the method of prioritizing and balancing all types of conflicting principles, duties, and personal and societal values in a dialectic to resolve conflicts among them dialectical principlism. This approach is designed to help determine the most ethical action. It is aspirational and is not intended to get the psychiatrist into trouble., (© 2015 American Academy of Psychiatry and the Law.)

Objective: This study examined the association between language access programming and quality of psychiatric care received by persons with limited English proficiency (LEP)., Methods: In 1999, the California Department of Mental Health required county Medicaid agencies to implement a "threshold language access policy" to meet the state's Title VI obligations. This policy required Medi-Cal agencies to provide language access programming, including access to interpreters and translated written material, to speakers of languages other than English if the language was spoken by at least 3,000, or 5%, of the county's Medicaid population. Using a longitudinal study design with a nonequivalent control group, this study examined the quality of care provided to Spanish speakers with LEP and a severe mental illness before and after implementation of mandatory language access programming. Quality was measured by receipt of at least two follow-up medication visits within 90 days or three visits within 180 days of an initial medication visit over a period of 38 quarter-years., Results: On average, only 40% of Spanish-speaking clients received at least three medication follow-up visits within 180 days. In multivariate analyses, language access programming was not associated with receipt of at least two medication follow-up visits within 90 days or at least three visits within 180 days., Conclusions: This study found no evidence that language access programming led to increased rates of follow-up medication visits for clients with LEP.

Objective: Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers., Methods: Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD., Results: There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention., Conclusions: Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

Purpose: The purpose of this study was to describe the epidemiology of consumer product (CP) related eye injuries presenting to US emergency departments (EDs) stratified by age., Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (CPSC-NEISS) database was used to derive national, weighted estimates of nonfatal Emergency Department visits for eye injuries by patients' age, gender, diagnosis, injured body part, locale of incidence, and related CP., Results: The CPs causing the highest proportion of injury visits varied among the different age groups: chemicals in the very young (0-4 yr), household items in 5-9 year olds, sports products in 10-24 year olds, cutting and construction tools in 25-64 year olds, and chemicals in the elderly (65+). Patients aged 0-4 also represented the age interval with the highest rate of injury visits (92 visits per 10,000)., Conclusion: This study identified the CPs responsible for the most eye injury visits by age groups. Further research is needed on how to effectively change the behavior of individuals and their environment so that we can minimize preventable eye injuries from consumer products.

Comprehensive surveys conducted at 5-yr intervals were used to estimate sulfur dioxide (SO,) and nitrogen oxides (NO.) emissions from U.S. pulp and paper mills for 1980, 1985, 1990, 1995, 2000, and 2005. Over the 25-yr period, paper production increased by 50%, whereas total SO, emissions declined by 60% to 340,000 short tons (t) and total NO, emissions decreased approximately 15% to 230,000 t. The downward emission trends resulted from a combination of factors, including reductions in oil and coal use, steadily declining fuel sulfur content, lower pulp and paper production in recent years, increased use of flue gas desulfurization systems on boilers, growing use of combustion modifications and add-on control systems to reduce boiler and gas turbine NO, emissions, and improvements in kraft recovery furnace operations.