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.     

Family structure and child outcomes: a high definition, wide angle “snapshot”

Using data from the National Survey of America??s Families (NSAF), this research investigates the relationships between a highly defined set of family structures and a broad set of child outcomes at a particular point in time in a child??s life. A detailed classification of family structures is constructed that clarifies key differences among various types of diverse families, and facilitates equivalencies testing and pairwise comparisons across nontraditional family structures. The NSAF contains a large number of observations for less common, but growing, family structures such as single-father families, grandparent-headed households and cohabiters, which makes such detailed analyses feasible and allows further stratification by child age, gender and race. The data also contains information on child behavioral, educational and physical health outcomes, as well as extensive household characteristics, economic resources and parental behaviors and inputs. Results suggest that differences across nontraditional family structures are particularly prominent for child health outcomes and that the gender of the resident parent is empirically important, more so than the presence of a cohabiting or married step-parent. Children in single father families have lesser access to health care yet enjoy better health outcomes than those in other families, even after controlling for economic resources (and inputs). In contrast, few differences are found between grandparent-headed families and other non-parent families. While we explore alternative explanations for these results, our cross-sectional data and complex set of family structure variables preclude isolating causal relationships; instead, our analyses yield empirically important distinctions that point to promising avenues for future research.     

Improving the detection of unusual observations in high‐dimensional settings

Multivariate control charts are used to monitor stochastic processes for changes and unusual observations. Hotelling's T² statistic is calculated for each new observation and an out‐of‐control signal is issued if it goes beyond the control limits. However, this classical approach becomes unreliable as the number of variables p approaches the number of observations n, and impossible when p exceeds n. In this paper, we devise an improvement to the monitoring procedure in high‐dimensional settings. We regularise the covariance matrix to estimate the baseline parameter and incorporate a leave‐one‐out re‐sampling approach to estimate the empirical distribution of future observations. An extensive simulation study demonstrates that the new method outperforms the classical Hotelling T² approach in power, and maintains appropriate false positive rates. We demonstrate the utility of the method using a set of quality control samples collected to monitor a gas chromatography–mass spectrometry apparatus over a period of 67 days.     

Empirical Prediction Intervals for County Population Forecasts

Population forecasts entail a significant amount of uncertainty, especially for long-range horizons and for places with small or rapidly changing populations. This uncertainty can be dealt with by presenting a range of projections or by developing statistical prediction intervals. The latter can be based on models that incorporate the stochastic nature of the forecasting process, on empirical analyses of past forecast errors, or on a combination of the two. In this article, we develop and test prediction intervals based on empirical analyses of past forecast errors for counties in the United States. Using decennial census data from 1900 to 2000, we apply trend extrapolation techniques to develop a set of county population forecasts; calculate forecast errors by comparing forecasts to subsequent census counts; and use the distribution of errors to construct empirical prediction intervals. We find that empirically-based prediction intervals provide reasonably accurate predictions of the precision of population forecasts, but provide little guidance regarding their tendency to be too high or too low. We believe the construction of empirically-based prediction intervals will help users of small-area population forecasts measure and evaluate the uncertainty inherent in population forecasts and plan more effectively for the future.     

“Men never cry”: Teaching Mormon Manhood in the Church of Jesus Christ of Latter-day Saints

We examine the ways Mormon leaders establish “what it means to be a man” for their followers. Based on content analysis of over 40 years of archival material, we analyze how Mormon leaders represent manhood as the ability to signify control over self and others as well as an inability to be controlled. Specifically, we demonstrate how these representations stress controlling the self, emotional and sexual expression, and others while emphasizing the development of self-reliance and independence from others’ control. We draw out implications for understanding (1) how religious leaders create ideal notions of manhood, (2) what the religious interpretations of secular constructions of manhood are, and (3) how these relate to the reproduction of gender inequalities.     

Best Practice to Order Authors in Multi/Interdisciplinary Health Sciences Research Publications

Misunderstanding and disputes about authorship are commonplace among members of multi/interdisciplinary health research teams. If left unmanaged and unresolved, these conflicts can undermine knowledge sharing and collaboration, obscure accountability for research, and contribute to the incorrect attribution of credit. To mitigate these issues, certain researchers suggest quantitative authorship distributions schemes (e.g., point systems), while others wish to replace or minimize the importance of authorship by using “contributorship”—a system based on authors’ self-reporting contributions. While both methods have advantages, we argue that authorship and contributorship will most likely continue to coexist for multiple ethical and practical reasons. In this article, we develop a five-step “best practice” that incorporates the distribution of both contributorship and authorship for multi/interdisciplinary research. This procedure involves continuous dialogue and the use of a detailed contributorship taxonomy ending with a declaration explaining contributorship, which is used to justify authorship order. Institutions can introduce this approach in responsible conduct of research training as it promotes greater fairness, trust, and collegiality among team members and ultimately reduces confusion and facilitates resolution of time-consuming disagreements.     

Stress,strain, coping and social support for affected family members attending the National Problem Gambling Clinic,London

Aims were: to compare burden experienced by affected family members (AFMs) attending a problem gambling treatment clinic in London, England with that of AFMs affected by substance problems; to examine socio-demographic correlates of AFM burden; to evaluate change following an intervention designed for AFMs; and to test the assumption of the stress-strain-coping-support (SSCS) model that change in AFM coping is important. AFMs (N = 215) completed a gambling version of the short questionnaire for family members affected by addiction (SQFM-AA) which assesses stressful impact, symptoms of ill health, ways of coping, social support and overall burden. All received a 5-Step Method workbook, based on the SSCS model. The SQFM-AA was repeated three to six months later (n = 96). T-test analyses showed that baseline burden and related variables were comparable to those of family members affected by substance problems, were greater for wives and those living in the same household as the gambling relative, and were significantly reduced at follow-up. Regression modelling indicated the importance, for AFMs’ health, of reduced levels of engaged-emotional coping. Family members affected by gambling, some subgroups especially, experience high levels of burden. They can benefit from a model-based intervention, and coping change may be an important process.