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The changing nature of work compels corresponding changes in organization selection systems. In this chapter, we advocate for competency modeling and propose nine competencies that are becoming more instrumental for success in the modern workforce. We then propose predictor constructs and methods to measure these competencies and new ways to leverage technology in their assessment. Lastly, we discuss four challenges that organizations will face when advancing our solutions: (a) achieving buy-in for competency modeling; (b) the continued recognition of a criterion problem; (c) monitoring applicant reactions; and (d) acknowledging social and ethical issues that may arise with these proposed changes.
Indian country in the United States is incredibly poor. Indian nations desperately need to develop reservation economic activities. Most tribal governments, however, are primarily focused on developing tribally owned businesses. This chapter argues for Indian peoples and Indian governments to revive and regenerate their century old institutions that promoted, supported, and protected private sector economic development and economies. Indian country and Indian peoples need to develop economic enterprises and activities in their homelands to ensure their sustainability by creating living wage jobs and adequate housing. Developing private sector economies, in addition to tribal public sector economies, will help create economic diversification on reservations, new businesses and jobs, protect from economic downturns, slow the "brain drain" that all rural areas suffer, and promote more spending which will help Indian country benefit from the "multiplier effect" as more and more money is spent, and re-spent, on reservations.
Native nation economies have long been dominated by public sector activities - government programs and services and tribal government-owned businesses - which do not generate the same long-term benefits for local communities that the private sector does. In this work, editors Robert Miller, Miriam Jorgensen, Daniel Stewart, and a roster of expert authors address the underdevelopment of the private sector on American Indian reservations, with the goal of sustaining and growing Native nation communities, so that Indian Country can thrive on its own terms. Chapter authors provide the language and arguments to make the case to tribal politicians, Native communities, and allies about the importance of private sector development and entrepreneurship in Indigenous economies. This book identifies and addresses key barriers to expanding the sector, provides policy guidance, and describes several successful business models - thus offering students, practitioners, and policymakers the information they need to make change.
Although therapeutic treatments are intended to help alleviate symptoms associated with disease, safety must be carefully considered and monitored to confirm continued positive benefit/risk balance. The objective of MOBILITY was to study the long-term safety of onabotulinumtoxinA for treatment of various therapeutic indications.
A prospective, multicenter, observational, Phase IV Canadian study in patients treated with onabotulinumtoxinA for a therapeutic indication. Dosing was determined by the participating physician. Adverse events (AEs) were recorded throughout the study.
Patients (n = 1372) with adult focal spasticity, blepharospasm, cerebral palsy, cervical dystonia, hemifacial spasm, hyperhidrosis, or “other” diagnoses were enrolled into the safety cohort. Eighty-three patients (6%) reported 209 AEs; 44 AEs in 24 patients (2%) were considered treatment-related AEs. Seventy-two serious AEs were reported by 38 patients (3%); 10 serious AEs in 5 patients (0.4%) were considered treatment related. Most commonly reported treatment-related AEs were muscular weakness (n = 7/44) and dysphagia (n = 6/44).
In patients with follow-up for up to six treatments with onabotulinumtoxinA, treatment-related AEs were reported in <2% of the safety population over the course of nearly 5 years. Our findings from MOBILITY provide further evidence that onabotulinumtoxinA treatment is safe for long-term use across a variety of therapeutic indications.
The warm, equable, and ice-free early Eocene Epoch permits investigation of ecosystem function and macro-ecological patterns during a very different climate regime than exists today. It also provides insight into what the future may entail, as anthropogenic CO2 release drives Earth toward a comparable hothouse condition. Studying plant–insect herbivore food webs during hothouse intervals is warranted, because these account for the majority of nonmicrobial terrestrial biodiversity. Here, we report new plant and insect herbivore damage census data from two floodplain sites in the Wind River Basin of central Wyoming, one in the Aycross Formation (50–48.25 Ma) at the basin edge (WRE) and the second in the Wind River Formation in the interior of the basin (WRI). The WRI site is in stratigraphic proximity to a volcanic ash that is newly dated to 52.416 ± 0.016/0.028/0.063 (2σ). We compare the Wind River Basin assemblages to published data from a 52.65 Ma floodplain flora in the neighboring Bighorn (BH) Basin and find that only 5.6% of plant taxa occur at all three sites and approximately 10% occur in both basins. The dissimilar floras support distinct suites of insect herbivores, as recorded by leaf damage. The relatively low-diversity BH flora has the highest diversity of insect damage, contrary to hypotheses that insect herbivore diversity tracks floral diversity. The distinctiveness of the WRE flora is likely due to its younger age and cooler reconstructed paleotemperature, but these factors are nearly identical for the WRI and BH floras. Site-specific microenvironmental factors that cannot be measured easily in deep time may account for these differences. Alternatively, the Owl Creek Mountains between the two basins may have provided a formidable barrier to the thermophilic organisms that inhabited the basin interiors, supporting Janzen's hypothesis that mountain passes appear higher in tropical environments.
Understanding the properties of time averaging (age mixing) in a stratigraphic layer is essential for properly interpreting the paleofauna preserved in the geologic record. This work assesses the age and quantifies the scale and structure of time averaging of land snail-rich colluvial sediments from the Madeira Archipelago (Portugal) by dating individual shells using amino acid racemization calibrated with graphite-target and carbonate-target accelerator mass spectrometry radiocarbon methods. Gastropod shells of Actinella nitidiuscula were collected from seven sites on the volcanic islands of Bugio and Deserta Grande (Desertas Islands), where snail shells are abundant and well preserved in Quaternary colluvial deposits. Results show that the shells ranged in age from modern to ~48 cal ka BP (calibrated radiocarbon age), covering the last glacial and present interglacial periods. Snail shells retrieved from two of the colluvial sites exhibit multimillennial age mixing (>6 ka), which significantly exceeds the analytical error from dating methods and calibration. The observed multimillennial mixing of these assemblages should be taking into consideration in upcoming paleoenvironmental and paleoecological studies in the region. The extent of age mixing may also inform about the time span of colluvial deposition, which can be useful in future geomorphological studies. In addition, this study presents the first carbonate-target radiocarbon results for land snail shells and suggests that this novel, rapid, and more affordable dating method offers reliable age estimates for small land snail shells younger than ~20 cal ka BP.
Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) or atrial flutter (AFL). However, OAC initiation rates in patients discharged directly from the emergency department (ED) are low. We aimed to address this care gap by implementing a quality improvement intervention.
The study was performed in four Canadian urban EDs between 2015 and 2016. Patients were included if they had an electrocardiogram (ECG) documenting AF/AFL in the ED, were directly discharged from the ED, and were alive after 90 days. Baseline rates of OAC initiation were determined prior to the intervention. Between June and December 2016, we implemented our intervention in two EDs (ED-intervention), with the remaining sites acting as controls (ED-control). The intervention included a reminder statement prompting OAC initiation according to guideline recommendations, manually added to ECGs with a preliminary interpretation of AF/AFL, along with a decision-support algorithm that included a referral sheet. The primary outcome was the rate of OAC initiation within 90 days of the ED visit.
Prior to the intervention, 37.2% OAC-naïve patients with ECG-documented AF/AFL were initiated on OAC. Following implementation of the intervention, the rate of OAC initiation increased from 38.6% to 47.5% (absolute increase of 8.5%; 95% CI, 0.3% to 16.7%, p=0.04) among the ED-intervention sites, whereas the rate remained unchanged in ED-control sites (35.3% to 35.9%, p=0.9).
Implementation of a quality improvement intervention consisting of a reminder and decision-support tool increased initiation of OAC in high-risk patients. This support package can be readily implemented in other jurisdictions to improve OAC rates for AF/AFL.
As the IAU heads towards its second century, many changes have simultaneously transformed Astronomy and the human condition world-wide. Amid the amazing recent discoveries of exoplanets, primeval galaxies, and gravitational radiation, the human condition on Earth has become blazingly interconnected, yet beset with ever-increasing problems of over-population, pollution, and never-ending wars. Fossil-fueled global climate change has begun to yield perilous consequences. And the displacement of people from war-torn nations has reached levels not seen since World War II.
Apathy is a very common behavioural and psychological symptom across brain disorders. In the last decade, there have been considerable advances in research on apathy and motivation. It is thus important to revise the apathy diagnostic criteria published in 2009. The main objectives were to: a) revise the definition of apathy; b) update the list of apathy dimensions; c) operationalise the diagnostic criteria; and d) suggest appropriate assessment tools including new technologies.
The expert panel (N = 23) included researchers and health care professionals working on brain disorders and apathy, a representative of a regulatory body, and a representative of the pharmaceutical industry. The revised diagnostic criteria for apathy were developed in a two-step process. First, following the standard Delphi methodology, the experts were asked to answer questions via web-survey in two rounds. Second, all the collected information was discussed on the occasion of the 26th European Congress of Psychiatry held in Nice (France).
Apathy was defined as a quantitative reduction of goal-directed activity in comparison to the patient’s previous level of functioning (criterion A). Symptoms must persist for at least four weeks, and affect at least two of the three apathy dimensions (behaviour/cognition; emotion; social interaction; criterion B). Apathy should cause identifiable functional impairments (criterion C), and should not be fully explained by other factors, such as effects of a substance or major changes in the patient’s environment (Criterion D).
Apathy diagnostic criteria 2018.
CRITERION A: A quantitative reduction of goal-directed activity either in behavioral, cognitive, emotional or social dimensions in comparison to the patient’s previous level of functioning in these areas. These changes may be reported by the patient himself/herself or by observation of others.
CRITERION B: The presence of at least 2 of the 3 following dimensions for a period of at least four weeks and present most of the time B1. BEHAVIOUR & COGNITION Loss of, or diminished, goal-directed behaviour or cognitive activity as evidenced by at least one of the following: General level of activity: the patient has a reduced level of activity either at home or work, makes less effort to initiate or accomplish tasks spontaneously, or needs to be prompted to perform them. Persistence of activity: He/she is less persistent in maintaining an activity or conversation, finding solutions to problems or thinking of alternative ways to accomplish them if they become difficult. Making choices: He/she has less interest or takes longer to make choices when different alternatives exist (e.g., selecting TV programs, preparing meals, choosing from a menu, etc.) Interest in external issue: He/she has less interest in or reacts less to news, either good or bad, or has less interest in doing new things Personal wellbeing: He/she is less interested in his/her own health and wellbeing or personal image (general appearance, grooming, clothes, etc.). B2. EMOTION Loss of, or diminished, emotion as evidenced by at least one of the following: Spontaneous emotions: the patient shows less spontaneous (self-generated) emotions regarding their own affairs, or appears less interested in events that should matter to him/her or to people that he/she knows well. Emotional reactions to environment: He/she expresses less emotional reaction in response to positive or negative events in his/her environment that affect him/her or people he/she knows well (e.g., when things go well or bad, responding to jokes, or events on a TV program or a movie, or when disturbed or prompted to do things he/she would prefer not to do). Impact on others: He/she is less concerned about the impact of his/her actions or feelings on the people around him/her. Empathy: He/she shows less empathy to the emotions or feelings of others (e.g., becoming happy or sad when someone is happy or sad, or being moved when others need help). Verbal or physical expressions: He/she shows less verbal or physical reactions that reveal his/her emotional states. B3. SOCIAL INTERACTION Loss of, or diminished engagement in social interaction as evidenced by at least one of the following: Spontaneous social initiative: the patient takes less initiative in spontaneously proposing social or leisure activities to family or others. Environmentally stimulated social interaction: He/she participates less, or is less comfortable or more indifferent to social or leisure activities suggested by people around him/her. Relationship with family members: He/she shows less interest in family members (e.g., to know what is happening to them, to meet them or make arrangements to contact them). Verbal interaction: He/she is less likely to initiate a conversation, or he/she withdraws soon from it Homebound: He /She prefer to stays at home more frequently or longer than usual and shows less interest in getting out to meet people.
CRITERION C These symptoms (A - B) cause clinically significant impairment in personal, social, occupational, or other important areas of functioning.
CRITERION D The symptoms (A - B) are not exclusively explained or due to physical disabilities (e.g. blindness and loss of hearing), to motor disabilities, to a diminished level of consciousness, to the direct physiological effects of a substance (e.g. drug of abuse, medication), or to major changes in the patient’s environment.
The new diagnostic criteria for apathy provide a clinical and scientific framework to increase the validity of apathy as a clinical construct. This should also help to pave the path for apathy in brain disorders to be an interventional target.