A normative method to analyse workarounds in a healthcare environment: motivations, consequences, and constraints

Healthcare information systems have the potential to enhance productivity, lower costs, and reduce medication errors by automating business processes. However, various issues such as system complexity and system abilities in a relation to user requirements as well as rapid changes in business needs have an impact on the use of these systems. In many cases failure of a system to meet business process needs has pushed users to develop alternative work processes (workarounds) to fill this gap. Some research has been undertaken on why users are motivated to perform and create workarounds. However, very little research has assessed the consequences on patient safety. Moreover, the impact of performing these workarounds on the organisation and how to quantify risks and benefits is not well analysed. Generally, there is a lack of rigorous understanding and qualitative and quantitative studies on healthcare IS workarounds and their outcomes. This project applies A Normative Approach for Modelling Workarounds to develop A Model of Motivation, Constraints, and Consequences. It aims to understand the phenomenon in-depth and provide guidelines to organisations on how to deal with workarounds. Finally the method is demonstrated on a case study example and its relative merits discussed.

Neural and psychological maturation of decision-making in adolescence and young adulthood

We examined the maturation of decision-making from early adolescence to mid-adulthood using fMRI of a variant of the Iowa gambling task. We have previously shown that performance in this task relies on sensitivity to accumulating negative outcomes in ventromedial PFC and dorsolateral PFC. Here, we further formalize outcome evaluation (as driven by prediction errors [PE], using a reinforcement learning model) and examine its development. Task performance improved significantly during adolescence, stabilizing in adulthood. Performance relied on greater impact of negative compared with positive PEs, the relative impact of which matured from adolescence into adulthood. Adolescents also showed increased exploratory behavior, expressed as a propensity to shift responding between options independently of outcome quality, whereas adults showed no systematic shifting patterns. The correlation between PE representation and improved performance strengthened with age for activation in ventral and dorsal PFC, ventral striatum, and temporal and parietal cortices. There was a medial-lateral distinction in the prefrontal substrates of effective PE utilization between adults and adolescents: Increased utilization of negative PEs, a hallmark of successful performance in the task, was associated with increased activation in ventromedial PFC in adults, but decreased activation in ventrolateral PFC and striatum in adolescents. These results suggest that adults and adolescents engage qualitatively distinct neural and psychological processes during decision-making, the development of which is not exclusively dependent on reward-processing maturation.

Pragmatic deficits with syntactic consequences?: L2 pronominal subjects and the syntax–pragmatics interface

Contemporary acquisition theorizing has placed a considerable amount of attention on interfaces, points at which different linguistic modules interact. The claim is that vulnerable interfaces cause particular difficulties in L1, bilingual and adult L2 acquisition (e.g. Platzack, 2001; Montrul, 2004; Müller and Hulk, 2001; Sorace, 2000, 2003, 2004, 2005). Accordingly, it is possible that deficits at the syntax–pragmatics interface cause what appears to be particular non-target-like syntactic behavior in L2 performance. This syntax-before-discourse hypothesis is examined in the present study by analyzing null vs. overt subject pronoun distribution in L2 Spanish of English L1 learners. As ultimately determined by L2 knowledge of the Overt Pronoun Constraint (OPC) (Montalbetti, 1984), the data indicate that L2 learners at the intermediate and advanced levels reset the Null Subject Parameter (NSP), but only advanced learners have acquired a more or less target null/overt subject distribution. Against the predictions of Sorace (2004) and in line with Montrul and Rodríguez-Louro (2006), the data indicate an overuse of both overt and null subject pronouns. As a result, this behavior cannot be from L1 interference alone, suggesting that interface-conditioned properties are simply more complex and therefore, harder to acquire. Furthermore, the data from the advanced learners demonstrate that the syntax–pragmatics interface is not a predetermined locus for fossilization (in contra e.g. Valenzuela, 2006).

Postnatal development of the mucosal immune system and consequences on health in adulthood

The intestinal microbiota is a dynamic multifaceted ecosystem which has evolved a complex and mutually beneficial relationship with the mammalian host. The contribution to host fitness is evident, but in recent years it has become apparent that these commensal microorganisms may exert far more influence over health and disease than previously thought. The gut microbiota are implicated in many aspects of biological function, such as metabolism, angiogenesis and immune development: disruption, especially during the neonatal period, which may impose life-long penalty. Elimination of the microbiota appears difficult, but manipulation of the ratios and dominance of composite populations can be achieved by alterations in diet, rearing environment, antibiotics and/or probiotics. Components of the intestinal microbiota are frequently documented to affect normal function of the mucosal immune system in experimental animals and in domesticated, agricultural species. However, it is not always clear that the effects described are sufficiently well understood to provide a sound basis for commercial intervention. Some microbial interventions may be beneficial to the host under particular circumstances, while detrimental during others. It is essential that we further our understanding of the complex and intricate host-commensal relationship to avoid causing more long-term damage than advantage

Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance - Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT)

Background Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making. Methods/Design Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550). Discussion MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.

On the measurement of achievement goals: critique, illustration, and application

The authors identified several specific problems with the measurement of achievement goals in the current literature and illustrated these problems, focusing primarily on A. J. Elliot and H. A. McGregor's (2001) Achievement Goal Questionnaire (AGQ). They attended to these problems by creating the AGQ-Revised and conducting a study that examined the measure's structural validity and predictive utility with 229 (76 male, 150 female, 3 unspecified) undergraduates. The hypothesized factor and dimensional structures of the measure were confirmed and shown to be superior to a host of alternatives. The predictions were nearly uniformly supported with regard to both the antecedents (need for achievement and fear of failure) and consequences (intrinsic motivation and exam performance) of the 4 achievement goals. In discussing their work, the authors highlight the importance and value of additional precision in the area of achievement goal measurement. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

A 3 × 2 achievement goal model

In the present research, a 3 × 2 model of achievement goals is proposed and tested. The model is rooted in the definition and valence components of competence, and encompasses 6 goal constructs: task-approach, task-avoidance, self-approach, self-avoidance, other-approach, and other-avoidance. The results from 2 studies provided strong support for the proposed model, most notably the need to separate task-based and self-based goals. Studies 1 and 2 yielded data establishing the 3 × 2 structure of achievement goals, and Study 2 documented the antecedents and consequences of each of the goals in the 3 × 2 model. Terminological, conceptual, and applied issues pertaining to the 3 × 2 model are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

On the transfer of prior tests or study events to subsequent study

Tests, as learning events, are often more effective than are additional study opportunities, especially when recall is tested after a long retention interval. To what degree, though, do prior test or study events support subsequent study activities? We set out to test an implication of Bjork and Bjork’s (1992) new theory of disuse—that, under some circumstances, prior study may facilitate subsequent study more than does prior testing. Participants learned English–Swahili translations and then underwent a practice phase during which some items were tested (without feedback) and other items were restudied. Although tested items were better recalled after a 1-week delay than were restudied items, this benefit did not persist after participants had the opportunity to study the items again via feedback. In fact, after this additional study opportunity, items that had been restudied earlier were better recalled than were items that had been tested earlier. These results suggest that measuring the memorial consequences of testing requires more than a single test of retention and, theoretically, a consideration of the differing status of initially recallable and nonrecallable items.

A longitudinal study of child sleep in high and low risk families: relationship to early maternal settling strategies and child psychological functioning

Objectives To investigate whether sleep disturbances previously found to characterise high risk infants: (a) persist into childhood; (b) are influenced by early maternal settling strategies and (c) predict cognitive and emotional/behavioural functioning. Methods Mothers experiencing high and low levels of psychosocial adversity (risk) were recruited antenatally and longitudinally assessed with their children. Mothers completed measures of settling strategies and infant sleep postnatally, and at 12 and 18 months, infant age. At five years, child sleep characteristics were measured via an actigraphy and maternal report; IQ and child adjustment were also assessed. Results Sleep disturbances observed in high-risk infants persisted at five years. Maternal involvement in infant settling was greater in high risk mothers, and predicted less optimal sleep at five years. Poorer five year sleep was associated with concurrent child anxiety/depression and aggression, but there was limited evidence for an influence of early sleep problems. Associations between infant/child sleep characteristics and IQ were also limited. Conclusions Early maternal over-involvement in infant settling is associated with less optimal sleep in children, which in turn, is related to child adjustment. The findings highlight the importance of supporting parents in the early development of good settling practices, particularly in high-risk populations.

A grounded investigation of Chinese employees' psychological capital

Purpose – This paper explores the “Western” concept of psychological capital in the People's Republic of China (PRC) and highlights critical areas of divergence and notable dimensions of similarity. Design/methodology/approach – This is an empirical study conducted in a wide range of Chinese organisational forms, employing an inductive approach based on critical incident technique. Findings – This research showed that the concept of psychological capital appears to have a degree of applicability and salience in China. A series of dimensions common in Western organisations were found in our research, including Optimism, Creativity, Resiliency, Self-confidence, Forgiveness and Gratitude, Courage and Ambition (Hope). These were found to be common types of psychological capital both in China and in the West. However, the dimensions of Courtesy and Humility (Qian-gong-you-li in Chinese), Self-possession and Sincerity fell into the “different” category. Originality/value – This paper is a first attempt to examine psychological capital in a range of organisational forms and industrial sectors in China using a grounded theory approach. It not only reports various dimensions of Chinese psychological capital, some unique to this research, but also compares and contrasts these dimensions between China and the West, highlighting further research opportunities.

The distributional consequences of a fiscal food policy: evidence from the UK

The literature on fiscal food policies focuses on their effectiveness in altering diets and improving health, while this paper focuses on their welfare costs. A formal welfare economics framework is developed to calculate the combined individualistic and distributional impacts of a tax-subsidy. Distributional characteristics of foods targeted by a tax tend to be concentrated in lower-income households. Further, consumption of fruit and vegetables tends to be concentrated in higher-income households; therefore, a subsidy on such foods increases regressivity. Aggregate welfare changes that result from a fiscal food policy are found to range from an increase of 1.41 per cent to a reduction of 2.06 per cent according to whether a subsidy is included, the degree of inequality aversion, and whether substitution among foods is allowed.

Potential-based achievement goals

Background: Self-based achievement goals use one’s own intrapersonal trajectory as a standard of evaluation, and this intrapersonal trajectory may be grounded in one’s past (past-based goals) or one’s future potential potential-based goals). Potential-based goals have been overlooked in the literature to date. Aims: The primary aim of the present research is to address this oversight within the context of the 3 x 2 achievement goal framework. Samples: The Study 1 sample was 381 U.S. undergraduates; the Study 2 sample was 310 U.S. undergraduates. Methods: In Study 1, we developed scales to assess otential-approach and potential-avoidance goals, and tested their factorial validity with exploratory and confirmatory factor analyses. In Study 2, we used confirmatory factor analysis to test both the separability of past-based and potential-based goals and their higher order integration within the self-based category. Results: Study 1 supported the factorial validity of the potential-approach and potential-avoidance goal scales. Study 2 supported the separability of past-based and potential-based goals, as well as their higher order integration within the self-based category. Conclusions: This research documents the utility of the proposed distinction, and paves the way for subsequent work on antecedent and consequences of potential-approach and potential-avoidance goals. It highlights the importance