Michael D. Cohen

A Garbage Can Model of Organizational Choice

Organized anarchies are organizations characterized by problematic preferences, unclear technology, and fluid participation. Recent studies of universities, a familiar form of organized anarchy, suggest that such organizations can be viewed for some purposes as collections of choices looking for problems, issues and feelings looking for decision situations in which they might be aired, solutions looking for issues to which they might be an answer, and decision makers looking for work. These ideas are translated into an explicit computer simulation model of a garbage can decision process. The general implications of such a model are described in terms of five major measures on the process. Possible applications of the model to more narrow predictions are illustrated by an examination of the models predictions with respect to the effect of adversity on university decision making.

Leadership and ambiguity : the American college president

Examines the American college presidency, discusses goals, budgets, policy decisions, and tenure, and recommends ways to improve university administration.

Intelligent information-sharing systems

The Information Lens system is a prototype intelligent information-sharing system that is designed to include not only good user interfaces for supporting the problem-solving activity of individuals, but also good organizational interfaces for supporting the problem-solving activities of groups.

Evolution of cooperation without reciprocity

A long-standing problem in biological and social sciences is to understand the conditions required for the emergence and maintenance of cooperation in evolving populations. For many situations, kin selection is an adequate explanation, although kin-recognition may still be a problem. Explanations of cooperation between non-kin include continuing interactions that provide a shadow of the future (that is, the expectation of an ongoing relationship) that can sustain reciprocity, possibly supported by mechanisms to bias interactions such as embedding the agents in a two-dimensional space or other context-preserving networks. Another explanation, indirect reciprocity, applies when benevolence to one agent increases the chance of receiving help from others. Here we use computer simulations to show that cooperation can arise when agents donate to others who are sufficiently similar to themselves in some arbitrary characteristic. Such a characteristic, or ‘tag’, can be a marking, display, or other observable trait. Tag-based donation can lead to the emergence of cooperation among agents who have only rudimentary ability to detect environmental signals and, unlike models of direct or indirect reciprocity, no memory of past encounters is required.

Aligning simulation models: A case study and results

This paper develops the concepts and methods of a process we will call “alignment of computational models” or “docking” for short. Alignment is needed to determine whether two models can produce the same results, which in turn is the basis for critical experiments and for tests of whether one model can subsume another. We illustrate our concepts and methods using as a target a model of cultural transmission built by Axelrod. For comparison we use the Sugarscape model developed by Epstein and Axtell.The two models differ in many ways and, to date, have been employed with quite different aims. The Axelrod model has been used principally for intensive experimentation with parameter variation, and includes only one mechanism. In contrast, the Sugarscape model has been used primarily to generate rich “artificial histories”, scenarios that display stylized facts of interest, such as cultural differentiation driven by many different mechansims including resource availability, migration, trade, and combat.The Sugarscape model was modified so as to reproduce the results of the Axelrod cultural model. Among the questions we address are: what does it mean for two models to be equivalent, how can different standards of equivalence be statistically evaluated, and how do subtle differences in model design affect the results? After attaining a “docking” of the two models, the richer set of mechanisms of the Sugarscape model is used to provide two experiments in sensitivity analysis for the cultural rule of Axelrods model.Our generally positive experience in this enterprise has suggested that it could be beneficial if alignment and equivalence testing were more widely practiced among computational modelers.

The published literature on handoffs in hospitals: deficiencies identified in an extensive review

Background In hospitals, handoffs are episodes in which control of, or responsibility for, a patient passes from one health professional to another, and in which important information about the patient is also exchanged. In view of the growing interest in improving handoff processes, and the need for guidance in arriving at standardised handoff procedures in response to regulatory requirements, an extensive review of the research on handoffs was conducted. Methods The authors have collected all research treatments of hospital handoffs involving medical personnel published in English through July 2008. Results A review of this literature yields four significant conclusions: (1) the definition of the handoff concept in the literature is poorly delimited; (2) the meaning of ‘to standardise’ has not been developed with adequate clarity; (3) the literature shows that handoffs perform important functions beyond patient safety, but the trade-offs of these functions against safety considerations are not analysed; (4) studies so far do not fully establish that attempts at handoff standardisation have produced marked gains in measured patient outcomes. Conclusion The existing literature on patient handoffs does not yet adequately support either definitive research conclusions on best handoff practices or the standardisation of handoffs that has been mandated by some regulators.

Inadvertent ketamine overdose in children: Clinical manifestations and outcome

STUDY OBJECTIVE We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. METHODS We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the Institute for Safe Medication Practices. The clinical manifestations, outcome, and reported cause for each case are described. RESULTS We identified 9 cases of inadvertent ketamine overdose in children treated in the ED. Patients received either 5(n=3), 10(n=5), or 100(n=1) times the intended dose, either by the intramuscular (n=5) or intravenous (n=4) route. All 9 experienced prolonged sedation (3 to 24 hours). Four experienced brief respiratory depression shortly after administration, and assisted ventilation was performed in 2. Two children without respiratory difficulty or hypoxemia were intubated by their physicians as a precaution. In 5 children, the dosing error was not discovered until late in the sedation, often when the child was not waking at the expected time. No adverse outcomes were noted, and all children were normal neurologically on discharge and longer-term follow-up if available. CONCLUSION No adverse outcomes were noted in 9 healthy children treated in the ED who inadvertently received 5 to 100 times the intended dose of ketamine. Toxicity manifested as prolonged sedation in all 9 and brief respiratory depression in 4. The margin of safety in ketamine overdose may be wide, although less common and more serious outcomes cannot be excluded by this small, self-reported sample.

Social closeness increases salivary progesterone in humans

We examined whether interpersonal closeness increases salivary progesterone. One hundred and sixty female college students (80 dyads) were randomly assigned to participate in either a closeness task with a partner versus a neutral task with a partner. Those exposed to the closeness induction had higher levels of progesterone relative to those exposed to the neutral task. Across conditions, progesterone increase one week later predicted the willingness to sacrifice for the partner. These results are discussed in terms of the links between social contact, stress, and health.

A handoff is not a telegram: an understanding of the patient is co-constructed

Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient.

The Unappreciated Challenges of Between-Unit Handoffs: Negotiating and Coordinating Across Boundaries

Although interest in studying and improving handoffs has grown considerably in recent years, a general tendency to treat handoff as a single type of activity has resulted in overlooking important variation and in understudying one consequential type: between-unit handoffs. Using the admission handoff between emergency departments and inpatient services as an example, this conceptual article identifies 2 distinguishing structural features of between-unit transitions and demonstrate how these features create negotiation and coordination challenges that are further complicated by several contextual factors. Between-unit handoffs are distinguished from within-unit handoffs because the former are triggered by patient conditions as opposed to shift schedules and entail working across organizational boundaries rather than within them. Consequently, between-unit handoffs are challenged by several contextual factors, including interprofessional differences, unequal distributions of power among units, frequent lack of established relationships among the involved parties, infrequent face-to-face communication, a lack of awareness of the other units state, and the fact that responsibility and control of patients are transferred separately. Implications for improvement are discussed.