Managing people and performance:An evidence based framework applied to health service organizations

People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.

Accuracy of cornea and lens biometry using anterior segment optical coherence tomography

We assess the accuracy of the Visante anterior segment optical coherence tomographer (AS-OCT) and present improved formulas for measurement of surface curvature and axial separation. Measurements are made in physical model eyes. Accuracy is compared for measurements of corneal thickness (d1) and anterior chamber depth (d2) using-built-in AS-OCT software versus the improved scheme. The improved scheme enables measurements of lens thickness (d 3) and surface curvature, in the form of conic sections specified by vertex radii and conic constants. These parameters are converted to surface coordinates for error analysis. The built-in AS-OCT software typically overestimates (mean±standard deviation(SD)]d1 by +62±4 μm and d2 by +4±88μm. The improved scheme reduces d1 (-0.4±4 μm) and d2 (0±49 μm) errors while also reducing d3 errors from +218±90 (uncorrected) to +14±123 μm (corrected). Surface x coordinate errors gradually increase toward the periphery. Considering the central 6-mm zone of each surface, the x coordinate errors for anterior and posterior corneal surfaces reached +3±10 and 0±23 μm, respectively, with the improved scheme. Those of the anterior and posterior lens surfaces reached +2±22 and +11±71 μm, respectively. Our improved scheme reduced AS-OCT errors and could, therefore, enhance pre- and postoperative assessments of keratorefractive or cataract surgery, including measurement of accommodating intraocular lenses. © 2007 Society of Photo-Optical Instrumentation Engineers.

Techniques for determining bias and stability in satellite altimeters

The case for monitoring large-scale sea level variability is established in the context of the estimation of the extent of anthropogenic climate change. Satellite altimeters are identified as having the potential to monitor this change with high resolution and accuracy. Possible sources of systematic errors and instabilities in these instruments which would be hurdles to the most accurate monitoring of such ocean signals are examined. Techniques for employing tide gauges to combat such inaccuracies are proposed and developed. The tide gauge at Newhaven in Sussex is used in conjunction with the nearby satellite laser ranger and high-resolution ocean models to estimate the absolute bias of the TOPEX, Poseidon, ERS 1 and ERS 2 altimeters. The theory which underlies the augmentation of altimeter measurements with tide gauge data is developed. In order to apply this, the tide gauges of the World Ocean Circulation Experiment are assessed and their suitability for altimeter calibration is determined. A reliable subset of these gauges is derived. A method of intra-altimeter calibration is developed using these tide gauges to remove the effect of variability over long time scales. In this way the long-term instability in the TOPEX range measurement is inferred and the drift arising from the on-board ultra stable oscillator is thus detected. An extension to this work develops a method for inter-altimeter calibration, allowing the systematic differences between unconnected altimeters to be measured. This is applied to the TOPEX and ERS 1 altimeters.

Uncertainty and topographic visualisations

This thesis is a study of low-dimensional visualisation methods for data visualisation under certainty of the input data. It focuses on the two main feed-forward neural network algorithms which are NeuroScale and Generative Topographic Mapping (GTM) by trying to make both algorithms able to accommodate the uncertainty. The two models are shown not to work well under high levels of noise within the data and need to be modified. The modification of both models, NeuroScale and GTM, are verified by using synthetic data to show their ability to accommodate the noise. The thesis is interested in the controversy surrounding the non-uniqueness of predictive gene lists (PGL) of predicting prognosis outcome of breast cancer patients as available in DNA microarray experiments. Many of these studies have ignored the uncertainty issue resulting in random correlations of sparse model selection in high dimensional spaces. The visualisation techniques are used to confirm that the patients involved in such medical studies are intrinsically unclassifiable on the basis of provided PGL evidence. This additional category of ‘unclassifiable’ should be accommodated within medical decision support systems if serious errors and unnecessary adjuvant therapy are to be avoided.

Enhancing student learning experience through a novel electronic coursework assessment and feedback management system

Recent National Student Surveys revealed that many U.K. university students are dissatisfied with the timeliness and usefulness of the feedback received from their tutors. Ensuring timeliness in marking often results in a reduction in the quality of feedback. In Computer Science where learning relies on practising and learning from mistakes, feedback that pin-points errors and explains means of improvement is important to achieve a good student learning experience. Though suitable use of Information and Communication Technology should alleviate this problem, existing Virtual Learning Environments and e-Assessment applications such as Blackboard/WebCT, BOSS, MarkTool and GradeMark are inadequate to support a coursework assessment process that promotes timeliness and usefulness of feedback while maintaining consistency in marking involving multiple tutors. We have developed a novel Internet application, called eCAF, for facilitating an efficient and transparent coursework assessment and feedback process. The eCAF system supports detailed marking scheme editing and enables tutors to use such schemes to pin-point errors in students' work so as to provide helpful feedback efficiently. Tutors can also highlight areas in a submitted work and associate helpful feedback that clearly links to the identified mistakes and the respective marking criteria. In light of the results obtained from a recent trial of eCAF, we discuss how the key features of eCAF may facilitate an effective and efficient coursework assessment and feedback process.

Effects of syllable structure in aphasic errors:implications for a new model of speech production

Current models of word production assume that words are stored as linear sequences of phonemes which are structured into syllables only at the moment of production. This is because syllable structure is always recoverable from the sequence of phonemes. In contrast, we present theoretical and empirical evidence that syllable structure is lexically represented. Storing syllable structure would have the advantage of making representations more stable and resistant to damage. On the other hand, re-syllabifications affect only a minimal part of phonological representations and occur only in some languages and depending on speech register. Evidence for these claims comes from analyses of aphasic errors which not only respect phonotactic constraints, but also avoid transformations which move the syllabic structure of the word further away from the original structure, even when equating for segmental complexity. This is true across tasks, types of errors, and, crucially, types of patients. The same syllabic effects are shown by apraxic patients and by phonological patients who have more central difficulties in retrieving phonological representations. If syllable structure was only computed after phoneme retrieval, it would have no way to influence the errors of phonological patients. Our results have implications for psycholinguistic and computational models of language as well as for clinical and educational practices.

24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations

Although theory on team membership is emerging, limited empirical attention has been paid to the effects of different types of team membership on outcomes. We propose that an important but overlooked distinction is that between membership of real teams and membership of co-acting groups, with the former being characterized by members who report that their teams have shared objectives, and structural interdependence and engage in team reflexivity. We hypothesize that real team membership will be associated with more positive individual- and organizational-level outcomes. These predictions were tested in the English National Health Service, using data from 62,733 respondents from 147 acute hospitals. The results revealed that individuals reporting the characteristics of real team membership, in comparison with those reporting the characteristics of co-acting group membership, witnessed fewer errors and incidents, experienced fewer work related injuries and illness, were less likely to be victims of violence and harassment, and were less likely to intend to leave their current employment. At the organizational level, hospitals with higher proportions of staff reporting the characteristics of real team membership had lower levels of patient mortality and sickness absence. The results suggest the need to clearly delineate real team membership in order to advance scientific understanding of the processes and outcomes of organizational teamwork.

Phonological simplifications, apraxia of speech and the interaction between phonological and phonetic processing

Research on aphasia has struggled to identify apraxia of speech (AoS) as an independent deficit affecting a processing level separate from phonological assembly and motor implementation. This is because AoS is characterized by both phonological and phonetic errors and, therefore, can be interpreted as a combination of deficits at the phonological and the motoric level rather than as an independent impairment. We apply novel psycholinguistic analyses to the perceptually phonological errors made by 24 Italian aphasic patients. We show that only patients with relative high rate (>10%) of phonetic errors make sound errors which simplify the phonology of the target. Moreover, simplifications are strongly associated with other variables indicative of articulatory difficulties - such as a predominance of errors on consonants rather than vowels -but not with other measures - such as rate of words reproduced correctly or rates of lexical errors. These results indicate that sound errors cannot arise at a single phonological level because they are different in different patients. Instead, different patterns: (1) provide evidence for separate impairments and the existence of a level of articulatory planning/programming intermediate between phonological selection and motor implementation; (2) validate AoS as an independent impairment at this level, characterized by phonetic errors and phonological simplifications; (3) support the claim that linguistic principles of complexity have an articulatory basis since they only apply in patients with associated articulatory difficulties.

Target/error overlap in jargonaphasia:the case for a one-source model, lexical and non-lexical summation, and the special status of correct responses

We present three jargonaphasic patients who made phonological errors in naming, repetition and reading. We analyse target/response overlap using statistical models to answer three questions: 1) Is there a single phonological source for errors or two sources, one for target-related errors and a separate source for abstruse errors? 2) Can correct responses be predicted by the same distribution used to predict errors or do they show a completion boost (CB)? 3) Is non-lexical and lexical information summed during reading and repetition? The answers were clear. 1) Abstruse errors did not require a separate distribution created by failure to access word forms. Abstruse and target-related errors were the endpoints of a single overlap distribution. 2) Correct responses required a special factor, e.g., a CB or lexical/phonological feedback, to preserve their integrity. 3) Reading and repetition required separate lexical and non-lexical contributions that were combined at output.

The fevered novel from Balzac to Bernanos:frenetic Catholicism in crisis, delirium and revolution

Book Review: The Fevered Novel from Balzac to Bernanos: Frenetic Catholicism in Crisis, Delirium and Revolution. By Francesco Manzini. (IGRS Books). London: Institute of Germanic and Romance Studies, 2011. 264 pp. Full text: This monograph is an important and compelling account of a novelistic tradition that stretches from Georges Bernanos back to Balzac, by way of Léon Bloy, Joris-Karl Huysmans, and Barbey d'Aurevilly. Depending on a master plot that evokes Maistrean themes of blood, sacrifice, and redemption, working in a feverish female body, this canon combines Romantic freneticism and anti-Enlightenment religion to create a compound that Francesco Manzini calls ‘frenetic Catholicism’. The theme of fever, Manzini tells us, was commented on by Huysmans in writing about Barbey d'Aurevilly. When André Gide read Bernanos's Sous le soleil de Satan, he dismissed it as a rehash of Bloy and Barbey. In this present work Manzini aims to make us aware once more of the gradually intensifying themacity of fever in writings more usually classed in theologo-literary categories. His analysis encompasses (though is not restricted to) Balzac's Ursule Mirouët, Barbey d'Aurevilly's Un prêtre marié, Huysmans's En rade, Bloy's Le Désespéré and La Femme pauvre, and Bernanos's Nouvelle histoire de Mouchette. Thus, as Manzini argues in his conclusion, between the freneticism of the Romantics and that of the surrealists this corpus represents an intermediary wave of freneticism, foregrounding fever, hyperconsciousness, dreamlike episodes, and female automatism. Manzini's knowledge of, and ease amidst, the sources is constantly impressive. Much like Richard Griffiths before him (The Reactionary Revolution: The Catholic Revival in French Literature, 1870–1914 (London: Constable, 1966)), he has read both the bad novels and the good ones. For that we are in his debt. His commentary thrives on the oddities of his subjects. He points quite rightly to the peculiar hubris of writers whose contempt for the secular excesses of scientism leads them down a cul-de-sac of primitive medical quackery. Likewise, he underlines how Zola's attempt to unwrite Barbey — exorcising the former's anti-Romantic animus, as much as scratching his anticlerical itch — leads him to recapitulate Barbey's religious authoritarianism in the secular vernacular of patriarchy. Les espèces qui se rapprochent se mangent, to paraphrase Bernanos (Les Grands Cimetières sous la lune). In spite of all Manzini's tightly organized analysis, however, this reader wonders whether the fevered novel ‘best allowed contemporaries — and now […] literary critics and historians — to imagine the issues at stake in the amorphous scientistic, religious, and political debates’ of the period (p. 17). Below the ideological clashes of nineteenth-century science and religion, the two contending dynamics of anthropocentrism and theocentrism are attested and, it can be argued, even more perfectly dramatized in other Catholic literature (Charles Péguy's poetry, for example). In these terms, what distinguishes the Catholic frenetics from their Romantic or surrealist counterparts is that their fevered subject represents an attempt to build a road out of what Canadian philosopher Charles Taylor calls ‘buffered’ individuality, and back towards the theocentric porous subject who is open to divine influence. By way of minor corrections, nuns do not take holy orders (p. 94) but make religious profession by taking vows. Also, the last Eucharistic host is not extreme unction (p. 119) but viaticum.

Concurrent codes:a holographic-type encoding robust against noise and loss

Concurrent coding is an encoding scheme with 'holographic' type properties that are shown here to be robust against a significant amount of noise and signal loss. This single encoding scheme is able to correct for random errors and burst errors simultaneously, but does not rely on cyclic codes. A simple and practical scheme has been tested that displays perfect decoding when the signal to noise ratio is of order -18dB. The same scheme also displays perfect reconstruction when a contiguous block of 40% of the transmission is missing. In addition this scheme is 50% more efficient in terms of transmitted power requirements than equivalent cyclic codes. A simple model is presented that describes the process of decoding and can determine the computational load that would be expected, as well as describing the critical levels of noise and missing data at which false messages begin to be generated.

Trait emotional intelligence and translation:a study of professional translators

A study of 155 professional translators was carried out to examine the relationship between trait emotional intelligence (trait EI) and literary translation, job satisfaction and career success. Participants were surveyed and their answers were correlated with scores from an emotional intelligence measure, the TEIQue. The analysis revealed that literary and non-literary translators have different trait EI profiles. Some significant correlations were found between trait EI and the variables of job satisfaction, career success, and literary translation experience. This is the first study to examine the effect of EI on translator working practices. Findings illustrate that trait EI may be predictive of some aspects of translator behaviour and highlight the relevance of exploring the emotional intelligence of professional translators.

Pharmacology and the safe prescribing of drugs

Understanding the pharmacological principles and safe use of drugs is just as important in surgical practice as in any other medical specialty. With an ageing population with often multiple comorbidities and medications, as well as an expanding list of new pharmacological treatments, it is important that surgeons understand the implications of therapeutic drugs on their daily practice. The increasing emphasis on high quality and safe patient care demands that doctors are aware of preventable adverse drug reactions (ADRs) and interactions, try to minimize the potential for medication errors, and consider the benefits and harms of medicines in their patients. This chapter examines these aspects from the view of surgical practice and expands on the implications of some of the most common medical conditions and drug classes in the perioperative period. The therapeutic care of surgical patients is obvious in many circumstances – for example, antibacterial prophylaxis, thromboprophylaxis, and postoperative analgesia. However, the careful examination of other drug therapies is often critical not only to the sustained treatment of the associated medical conditions but to the perioperative outcomes of patients undergoing surgery. The benefit–harm balance of many therapies may be fundamentally altered by the stress of an operation in one direction or the other; this is not a decision that should wait until the anaesthetist arrives for a preoperative assessment or one that should be left to junior medical or nursing staff on the ward.