To promote human development and flourishing and the creation of just and sustainable workplaces, HRD professionals need a better understanding of the political and economic forces shaping organizational realities. We need new models, grounded in an updated understanding of the political economy of labor and workforce development. This essay offers a brief critique of the current models and discusses alternative ways of thinking about political and economic mechanisms that can promote human flourishing, equity, and sustainability. We offer suggestions for how HRD researchers and practitioners can use this new lens to develop interventions and advance scholarship.

Background: Racial disparities are frequently reported in emergency department (ED) care. Objectives: To examine racial differences in triage scores of pediatric ED patients. We hypothesized that racial differences existed but could be explained after adjusting for sociodemographic and clinical factors. Methods: We examined all visits to two urban, pediatric EDs between August 2009 and March 2010. Demographic and clinical data were electronically extracted from the medical record. We used logistic regression to analyze racial differences in triage scores, controlling for possible covariates. Results: There were 54,505 ED visits during the study period, with 7216 (13.2%) resulting in hospital admission. White patients accounted for 36.4% of visits, African Americans 28.5%, Hispanics 18.0%, Asians 4.1%, and American Indians 1.8%. After adjusting for potential confounders, African American (adjusted odds ratio [aOR] 1.89, 95% confidence interval [CI] 1.69-2.12), Hispanic (aOR 1.77, 95% CI 1.55-2.02), and American Indian (aOR 2.57, 95% CI 1.80-3.66) patients received lower-acuity triage scores than Whites. In three out of four subgroup analyses based on presenting complaints (breathing difficulty, abdominal pain, fever), African Americans and Hispanics had higher odds of receiving low-acuity triage scores. No racial differences were detected for patients with presenting complaints of laceration/head injury/arm injury. However, among patients admitted to the hospital, African Americans (aOR 1.47, 95% CI 1.13-1.90) and Hispanics (aOR 1.71, CI 1.22-2.39) received lower-acuity triage scores than Whites. Conclusion: After adjusting for available sociodemographic and clinical covariates, African American, Hispanic, and American Indian patients received lower-acuity triage scores than Whites. (C) 2016 Elsevier Inc.

Purpose To highlight teaching hospitals’ efforts to reduce readmissions by describing interventions implemented to improve care transitions for heart failure (HF) patients and the variability in implemented HF-specific and care transition interventions. Method In 2012, the authors surveyed a network of 17 teaching hospitals to capture information about the number, type, stage of implementation, and structure of 4 HF-specific and 21 care transition (predischarge, bridging, and postdischarge) interventions implemented to reduce readmissions among patients with HF. The authors summarized data using descriptive statistics, including the mean number of interventions implemented and the frequency and stage of specific interventions, and descriptive plots of the structure of two common interventions (multidisciplinary rounds and follow-up telephone calls). Results Sixteen hospitals (94%) responded. The number and stage of implementation of the HF-specific and care transition interventions implemented varied across institutions. The mean number of interventions at an advanced stage of implementation (i.e., implemented for ≥ 75% of HF patients on the cardiology service or on all services) was 10.9 (standard deviation = 4.3). Overall, predischarge interventions were more common than bridging or postdischarge interventions. There was variability in the personnel involved in multidisciplinary rounds and in the processes/content of follow-up telephone calls. Conclusions Teaching hospitals have implemented a wide range of interventions aimed at reducing hospital readmissions, but there is substantial variability in the types, stages, and structure of their interventions. This heterogeneity highlights the need for collaborative efforts to improve understanding of intervention effectiveness.

Multiple methods for detecting asthma encounters are used today in public surveillance, quality reporting, and clinical research. Failure to detect asthma encounters can make it difficult to measure the scope and effectiveness of hospital or community-based interventions important in comparative effectiveness research and accountable care. Given the pairing of asthma with certain respiratory conditions, the objective of this study was to develop and test an asthma detection algorithm with specificity and sensitivity using 2 criteria: (1) principal discharge diagnosis and (2) asthma diagnosis code position. A medical record review was conducted (n = 191) as the gold standard for identifying asthma encounters given objective criteria. The study team observed that for certain principal respiratory diagnoses (n = 110), the observed odds ratio that encounters were for asthma when asthma was coded in the second or third code position was not significantly different than when asthma was coded as the principal diagnosis, 0.36 (P = 0.42) and 0.18 (P = 0.14), respectively. In contrast, the observed odds ratio was significantly different when asthma was coded in the fourth or fifth positions (P <.001). This difference remained after adjusting for covariates. Including encounters with asthma in 1 of the 3 first positions increased the detection sensitivity to 0.84 [95% confidence interval (CI): 0.76-0.92] while increasing the false positive rate to 0.19 [95% CI: 0.07-0.31]. Use of the proposed algorithm significantly improved the reporting accuracy [0.83 95% CI: 0.76-0.90] over use of (1) the principal diagnosis alone [0.55 95% CI: 0.46-0.64] or (2) all encounters with asthma 0.66 [95% CI: 0.57-0.75]. Bed days resulting from asthma encounters increased 64% over use of the principal diagnosis alone. Given these findings, an algorithm using certain respiratory principal diagnoses and asthma diagnosis code position can reliably improve asthma encounter detection for population-based health impact measurement.

OBJECTIVES:Accountable care puts pressure on hospitals to manage care episodes. Initial length of stay (ILOS) and readmission risk are important elements of a care episode and measures of care quality. Understanding the association between these two measures can guide hospital efforts in managing care episodes. This study was designed to explore the association between ILOS and readmission risk in a cohort of pediatric asthma patients. MATERIALS AND METHODS:The sample cohort (n = 4965) consisted of all asthma patients discharged from Children's Hospitals and Clinics of Minnesota (CHC MN) from January 2008 through August 2012. Asthma discharges included cases with a principal diagnosis of asthma or certain respiratory cases with asthma listed as a secondary diagnosis. Multiple logistic regression was used to test associations, adjusting for covariates. RESULTS:Adjusting for covariates, we found no significant association between ILOS and readmission (OR: 1.04 [95% CI: 0.98-1.10]). Analyzing ILOS categorically by length of stay, one-day stays did not have a significantly higher readmission risk (OR:1.27 [95% CI: 0.87-1.85]) than two-day stays, which had the lowest observed readmission risk. Risk increased as ILOS exceeded two days but was not significantly different by day. We found no association when comparing the difference in actual versus expected ILOS and readmission risk (shorter than expected OR: 1.13 [95% CI: 0.74-1.71]; longer than expected OR: 0.97 [95% CI: 0.69-1.38]). CONCLUSIONS:Attempts to prolong ILOS would dramatically increase costs with little impact on readmissions. For example, increasing one-day visits to two-day visits would increase hospital patient days 38% (1870 d) in this cohort while decreasing total readmissions by 3.8% [95% CI: 3.6-4.0%]. Understanding the mechanisms that impact readmissions is essential in evaluating cost-effective approaches to improving patient outcomes and lowering the cost of care.

AbstractKnowledge of the timing and sequence of start‐up teams' delegation of business functions in growing entrepreneurial ventures has significant implications for understanding those ventures' need for human resource development (HRD) interventions at different stages of their development. As a first step in exploring the evolution of functional differentiation in growing ventures, we analyze the extent to which 539 new businesses delegate a number of business functions. The start‐up teams retain the marketing and marketing‐related functions (marketing, sales, advertising, pricing and bidding, and new product development) in the majority of all firms with less than $10 million in sales. This group of functions ranks second only to general planning as a function retained. Three major size groups of emerging small businesses with distinctly different levels of functional delegation have been identified. There was no difference in the patterns of delegation of functions between manufacturing and service firms.

Objective: To identify important cognitive and behavioral predictors of sexually transmitted disease (STD) risk behavior among a sexually active adolescent cohort.Design: One-year longitudinal. study of health beliefs, sexual behaviors, and STD acquisition among 549 adolescents, 14 to 21 years of age.Setting: School- and community-based health clinics in a large metropolitan area.Participants: Data from 410 sexually active adolescents completing surveys at baseline and 1-year follow-up.Interventions: None.Main Outcome Measurer Sexually transmitted disease risk behavior-a composite measure of condom use consistency with most recent sexual partner(s), number of vaginal sex partners, and frequency of intercourse with most recent sexual partner(s).Results: For girls (n=335), a model including baseline STD risk behavior, condom use self-efficacy, oral contraceptive use, communication with sexual partners about STD prevention, and alcohol use in connection with sexual activity explained 21.1% of the variance in STD risk behavior at 1-year follow-up. For boys (n=75), the strongest predictors of STD risk behavior at follow-up included baseline STD risk behavior, perceived susceptibility to STD, condom use self-efficacy, negative outcome expectations associated with condom use, and perceived barriers to STD prevention.Conclusions: Efforts targeting reduction in STD risk behavior must begin before the onset of somewhat stable patterns of sexual risk behavior. Among adolescents who are sexually active, interventions should include components that increase condom use self-efficacy, build skills to communicate with sexual partners about STD prevention, and address behaviors associated with STD risk behavior including oral contraceptive use.

Transfer of technologies from the universities to the private sector is increcrsingly regarded as playing a significant role in new business starts, growth of existing businesses, and new job creation. Further, there are numerous models describing the process of technology transfer. Some of the existing models represent this process as a linear progression of steps: from idea generation and technology development at the university, to patenting the technology and then establishing a university-private firm link through a formal search process. The process culminates in patent rights transfer. Other models describe technology transfer in terms of networking arrangements and emphasize not so much formal search as the role of long-term relationships between the two parties. Still other studies indicate that it is possible to combine the two approaches-formal search and informal networking arrangements-to ensure successful transfer.Business firms involved in transfer also may be classified into several groups. Transfer could occur between the University and an established firm, between the university and a recently created new venture, or transfer could result in the creation of a new company. Technology, for example, could be transferred to a large company that uses the transferred technology as a basis for just one of many product lines, or to a small fir ln that makes the transferred technology a cornerstone of its product strategy.Are there any differences among the transfer processes used when large or small firms are involved, or when technology is transferred to an existing company or results in the creation of a new firm? To address these questions, rue mapped the technology transfer processes of 23 different technologies developed at the University of Minnesota from 1983 to 1993.More than half of the technologies studied went to large companies and were used either to upgrade existing products or to extend existing product lines. In eight cases technologies were transferred to small firms. In three cases technologies were transferred to venture capital firms or intermediaries and had not been commercialized at the time the study was completed. In the rest of the cases new firms were created by the inventors/university scientists themselves and served as vehicles for marketing their inventions. None of the firms of the latter group have grown beyond a part-time employment opportunity for the inventors, and only one firm provided evidence that additional hiring would be, necessary in the near future.Only four cases involved transfers of technologies that have been del eloped and patented by the university to firms that did not have any relationships, with the university prior to the transfer. In these four cases the firms used some form of search strategy to find a needed technology. However, there is no evidence that any of the firms had a well-developed formal search procedure. On the overwhelming majority of cases some form of relationship existed between the university (or individual inventors) and the private firm prior to the transfer. These relationships ranged from long-term friendships and/or cooperation to such less involved forms as interaction at research seminars and university-sponsored events. Further, in four cases, the technologies rt ere initially developed by private companies, whereas the university's role was to assist in refinement or testing of the technology.The research yielded a number of additional findings that deserve further investigation and discussion. Specifically, the study did not provide any evidence that the successfully completed technology transfers made any substantial contribution to either new business creation or the generation of new jobs. This finding suggests that scholars and policy makers should proceed with caution before accepting a notion that new or high technology firms will have any direct Economic impact.The study findings hold specific implications for entrepreneurial behavior and public policy. The ''formal search and shopping'' for a technology model suggests that both business and academic/government laboratories publicize, respectively, their requirements and offerings, and that opportunities for creative brokerage ought to exist. We found that in the majority of cases technology was transferred not through formal search, but through some prior relationships among individuals. This observation suggests that the ability to build extended networks of relationships not only within the business world but also with the university community is an important skill that owners and managers of the technology-based businesses need to possess. Entrepreneurs seeking to start businesses based on new technologies may need to reevaluate how much of their limited rime to allocate to build and maintain networks and cooperative relationships, and how much time to shop for new technologies through formal channels. Further, public policy and the efforts of die university transfer agencies intended to facilitate transfer may need to shift their emphasis from facilitating ''shopping'' by organizing and/or paying for ''publicity'' (which is currently the major emphasis) to providing assistance in network building and relationship marketing efforts. (C) 1997 Elsevier Science Inc.

The relationship between product-market strategies and the growth of new firms is incompletely understood. The lack of understanding reflects the absence of a conceptual framework that would explain why certain product-market strategies achieve specified goals more effectively than do others. Prior research links product and market strategy to business growth, but does not clearly separate product line choices from market choices, and provides little guidance with respect to the sequence in which product and market changes should be made. Richard Cardozo, Karen McLaughlin, Brian Harmon, Paul Reynolds, and Brenda Miller propose a “wave” model of product-market choice, which yields hypotheses they evaluate with data from a subsample of 120 firms drawn from a representative sample of new businesses. Results yield preliminary guidelines for product-market strategy for managers of fledgling businesses.

OBJECTIVE:To assess risk behaviors, health problems, worries and concerns, and resiliency-promoting factors among American Indian-Alaska Native adolescents.DESIGN:Survey.SETTING:Nonurban schools from eight Indian Health Service areas.PARTICIPANTS:A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths.MAIN OUTCOME MEASURES:revised version of the Adolescent Health Survey, a comprehensive, anonymous, self-report questionnaire with 162 items addressing 10 dimensions of health.RESULTS:Poor physical health was reported by 2% of the study sample and was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies. Injury risk behaviors included never wearing seatbelts (44%), drinking and driving (37.9% of driving 10th through 12th graders), and riding with a driver who had been drinking (21.8%). Physical and sexual abuse prevalence was 10% and 13%, respectively, with 23.9% of females reporting physical abuse and 21.6% of females reporting sexual abuse by the 12th grade. Almost 6% of the entire sample endorsed signs of severe emotional distress. Eleven percent of the teens surveyed knew someone who had killed himself or herself, and 17% had attempted suicide themselves. Sixty-five percent of males and 56.8% of females reported having had intercourse by the 12th grade. Weekly or more frequent alcohol use rose from 8.2% of seventh graders to 14.1% by the 12th grade; for males, the survey noted an increase in regular alcohol use of 3% to 5% a year to 27.3% by the 12th grade. For each variable measured, rates are much higher for American Indian adolescents than those for rural white Minnesota youth, except for age at first intercourse and alcohol use.CONCLUSIONS:American Indian-Alaska Native adolescents reported high rates of health-compromising behaviors and risk factors related to unintentional injury, substance use, poor self-assessed health status, emotional distress, and suicide. Interventions must be culturally sensitive, acknowledge the heterogeneity of Indian populations, be grounded in cultural traditions that promote health, and be developed with full participation of the involved communities.