A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. Conclusions: (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.     

ARE WORKERS WILLING TO PAY TO JOIN A BETTER TEAM?

Using data from the Major League Baseball free‐agent market, this study is the first to show that the productivity expected of the team a worker will join produces a significant, negative compensating wage differential. The younger workers in the sample drive this result, trading 25% of their wages to join teams with an expected productivity one standard deviation higher. This investment can be recouped if a reasonable increase in human capital occurs. These results are robust to contract length‐wage simultaneity and indicate that investment in human capital motivates the observed tradeoff, suggesting a new pathway through which human capital accumulation can affect wages. Reliable measures of workers' own past productivity and the productivity expected of a worker's future team provide key advantages to identifying these effects. (JEL J31, J24, M54)     

Evidence that Two‐Year‐Old Children are Sensitive to Information Presented in Arguments

Preschoolers are more likely to endorse testimony supported by strong arguments than by weak, circular ones. Two‐year‐olds exchange arguments with others, but no experiment has demonstrated that they are sensitive to information presented as argument. In the first phase of this study, 2‐year‐olds were shown ambiguous pictures—for instance a bird–fish hybrid—and asked what they thought the picture represented. An informant then contradicted them, providing either a strong argument, a circular argument, or no argument, and the children were asked what they now thought the hybrid was. The second phase was identical to the first, with new hybrids, except that the informant never provided any argument for her position. Finally, in the third phase, the informant left the room and the children were asked again to tell what the hybrids from the first two phases were. On the whole, there was an effect of the amount of information provided in the argument so that children were more likely to endorse labels provided by the informant who had supported her answer with a strong argument in the first phase. Moreover, they generalized the trust granted to informants who provided strong arguments. These results constitute the first experimental demonstration that 2‐year‐olds possess some argument evaluation skills.     

Occupational Engagement and Academic Major Satisfaction: Vocational Identity's Mediating Role

This study examined vocational identity as a mediator of the relationship between occupational engagement (i.e., participation in a breadth of activities and interactions) and academic major satisfaction. Furthermore, the authors evaluated whether satisfaction with academic major related to academic success (i.e., grade point average). The mediational model was tested in a sample of undergraduate students (N = 215). Results indicated that occupational engagement significantly predicted academic major satisfaction and that vocational identity fully mediated that relationship. These findings support occupational engagement as an important contributor to adaptive career decision making and encourage research on occupational engagement as an intervention point for career counselors.     

Demographic change and shifting views about marine resources and the coastal environment in Downeast Maine

Connections to the sea often define the character of coastal towns. However, as migrants arrive and economic diversification occurs, views about the use of marine resources and the ocean environment can change. Using survey data from Maine, we examined whether shifting demographics affect public perceptions of marine resource uses and coastal environmental concerns. We tested resource use and environmental items against a common set of demographic, background, and place-related variables. Results indicate that the level of education and the county of residence predict Mainers?? views about different marine resource uses and ocean-related environmental issues. Political party affiliation strongly influences environmental concern but not views about the use of marine resources. Migration history, on the other hand, has little effect. Understanding community contexts as well as individual background and ideological orientations will be critical as managers attempt to balance alternative uses of marine resources and resolve coastal environmental problems.     

Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach

Accessibility and satisfaction related to healthcare services are conceived as multidimensional concepts. These concepts can be studied using objective and subjective measures. In this study, we created two indices: a composite healthcare accessibility index (CHCA) and a composite healthcare satisfaction index (CHCS). To calculate the CHCA index we used three indicators based on three components of multidimensional healthcare accessibility: availability, acceptability and accessibility. In the indicator based on the component of accessibility, we included an innovative perceived time-decay parameter. The three indicators of the CHCA index were weighted through the application of a principal components analysis. To calculate the CHCS index, we used three indicators: the waiting time after the patient arrives at the healthcare service, the quality of the healthcare, and the healthcare service supply. These three indicators making up the CHCA index were weighted by applying an analytical hierarchy process. Three kinds of regressions were subsequently applied in order to explain the CHCA and CHCS indices: namely the Linear Least Squares, Ordinal Logistic, and Random Forests regressions. In these regressions, we used different independent social and health-related variables. These variables represented the predisposing, enabling, and need factors of people´s behaviors related to healthcare. All the calculations were applied to a study area: the city of Quito, Ecuador. Results showed that there are health-related inequalities in regard to healthcare accessibility and healthcare satisfaction in our study area. We also identified specific social factors that explained the indices developed. The present work is a mixed-methods approach to evaluate multidimensional healthcare accessibility and healthcare satisfaction, incorporating a pluralistic perspective, as well as a multidisciplinary framework. The results obtained can also be considered as tools for healthcare and urban planners, for more integrative social analyses that can improve the quality of life in urban residents.     

It's About Time! Examining Received Dosage and Program Duration as Predictors of Change Among Non‐Distressed and Distressed Married Couple and Relationship Education Participants

Although Couple and Relationship Education (CRE) programs were intended to be preventive in nature, an emerging reality is that relationally distressed couples are attending programs. This has raised questions about both its general usefulness and what is known regarding predictors of change in CRE for distressed couples particularly. Previous work has identified dosage and duration as important moderators of changes, and there are myriad program contexts offered, highlighting the need to examine these among distressed couples. This study utilized a sample of community CRE participants and examined received dosage and program duration as predictors of change. Comparing results for distressed and non‐distressed participants, we found several group differences. Findings suggest that it is important to consider distress level and time spent in programs when placing participants. In addition, research should continue to examine these groups separately (or comparatively) to find out what works for whom.     

Interviewing children versus tossing coins: accurately assessing the diagnosticity of children's disclosures of abuse

We describe a Bayesian approach to evaluating children's abuse disclosures and review research demonstrating that children's disclosure of genital touch can be highly probative of sexual abuse, with the probative value depending on disclosure spontaneity and children's age. We discuss how some commentators understate the probative value of children's disclosures by: confusing the probability of abuse given disclosure with the probability of disclosure given abuse, assuming that children formally questioned about sexual abuse have a low prior probability of sexual abuse, misstating the probative value of abuse disclosure, and confusing the distinction between disclosure and nondisclosure with the distinction between true and false disclosures. We review interviewing methods that increase the probative value of disclosures, including interview instructions, narrative practice, noncontingent reinforcement, and questions about perpetrator/caregiver statements and children's reactions to the alleged abuse.     

Bayesian adaptive dose‐escalation designs for simultaneously estimating the optimal and maximum safe dose based on safety and efficacy

The main purpose of dose‐escalation trials is to identify the dose(s) that is/are safe and efficacious for further investigations in later studies. In this paper, we introduce dose‐escalation designs that incorporate both the dose‐limiting events and dose‐limiting toxicities (DLTs) and indicative responses of efficacy into the procedure. A flexible nonparametric model is used for modelling the continuous efficacy responses while a logistic model is used for the binary DLTs. Escalation decisions are based on the combination of the probabilities of DLTs and expected efficacy through a gain function. On the basis of this setup, we then introduce 2 types of Bayesian adaptive dose‐escalation strategies. The first type of procedures, called “single objective,” aims to identify and recommend a single dose, either the maximum tolerated dose, the highest dose that is considered as safe, or the optimal dose, a safe dose that gives optimum benefit risk. The second type, called “dual objective,” aims to jointly estimate both the maximum tolerated dose and the optimal dose accurately. The recommended doses obtained under these dose‐escalation procedures provide information about the safety and efficacy profile of the novel drug to facilitate later studies. We evaluate different strategies via simulations based on an example constructed from a real trial on patients with type 2 diabetes, and the use of stopping rules is assessed. We find that the nonparametric model estimates the efficacy responses well for different underlying true shapes. The dual‐objective designs give better results in terms of identifying the 2 real target doses compared to the single‐objective designs.