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The challenges that face scientists in the bourgeoning field of hydropedology include many of those that face investigations in complex systems. We suggest hierarchy theory as being particularly helpful in teasing through complexity in hydropedological investigations. We present a brief overview of hierarchy theory highlighting the importance of defining levels of analysis, the role of theory in prediction, and the importance of narrative in science. These concepts are highlighted by references from the hydropological literature. We point out several issues common to scientists faced with complex systems analysis, and suggest several strategies to help hydropedologists deal with them. In order to help bridge the gap between theory and application, we present several specific examples of how hierarchical treatments have helped scientists deal with the modeling and analysis of complex systems related to hydropedology. We conclude that hierarchy theory offers many powerful tools with which to tackle the complexity inherent in soil water interactions, and that its use would benefit a more systematic and robust integration of the hydrologic and soil sciences. [ABSTRACT FROM AUTHOR]

Background: Long length of stays (LOS) in emergency departments (ED) negatively affect quality of care. Ordering of inappropriate diagnostic tests contributes to long LOS and reduces quality of care. One strategy to change practice patterns is to use performance feedback dashboards for physicians. While this strategy has proven to be successful in multiple settings, the most effective ways to deliver such interventions remain unknown. Involving end-users in the process is likely important for a successful design and implementation of a performance dashboard within a specific workplace culture. This mixed methods study aimed to develop design requirements for an ED performance dashboard and to understand the role of culture and social networks in the adoption process., Methods: We performed 13 semi-structured interviews with attending physicians in different roles within a single public ED in the U.S. to get an in-depth understanding of physicians' needs and concerns. Principles of human-centered design were used to translate these interviews into design requirements and to iteratively develop a front-end performance feedback dashboard. Pre- and post- surveys were used to evaluate the effect of the dashboard on physicians' motivation and to measure their perception of the usefulness of the dashboard. Data on the ED culture and underlying social network were collected. Outcomes were compared between physicians involved in the human-centered design process, those with exposure to the design process through the ED social network, and those with limited exposure., Results: Key design requirements obtained from the interviews were ease of access, drilldown functionality, customization, and a visual data display including monthly time-trends and blinded peer-comparisons. Identified barriers included concerns about unintended consequences and the veracity of underlying data. The surveys revealed that the ED culture and social network are associated with reported usefulness of the dashboard. Additionally, physicians' motivation was differentially affected by the dashboard based on their position in the social network., Conclusions: This study demonstrates the feasibility of designing a performance feedback dashboard using a human-centered design approach in the ED setting. Additionally, we show preliminary evidence that the culture and underlying social network are of key importance for successful adoption of a dashboard.

Thirteen patients were found to have giant-cell tumors during a study of 91 primary tumors of the sacrum. This tumor was second only to the chordoma in incidence. Giant-cell tumor is by far the commonest benign lesion of the sarcrum, yet it has a bad prognosis. Recurrences occurred in seven patients and five died of disease or a complication. All were histologically benign when first seen, but one developed a malignant giant-cell tumor and died within two years, and one developed a radiation-induced sarcoma 10 years following treatment. Computed tomography in two recent patients proved to be the most valuable single examination. Arteriography is helpful in showing the degree of vascularity of the tumor and the exact position of the large vessels, particularly important when surgical resection is planned.