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Objectives During obstetric hemorrhage, peripheral vasoconstriction maintains heart rate and blood pressure until compensatory mechanisms are overwhelmed and patients deteriorate rapidly. Real-time perfusion measurements could quantify vasoconstriction, improving early recognition of hemorrhage and facilitating early intervention to reduce morbidity and mortality. The AccuFlow device makes rapid, non-invasive, quantitative measurements of perfusion, but has not been studied for hemorrhage detection or used in surgical settings. This study evaluated feasibility, tolerability, and preliminary efficacy of the AccuFlow for assessment of blood loss at cesarean delivery (CD). Methods In this pilot study, sensors were applied to the wrist, forearm, bicep, and chest wall of 25 patients undergoing scheduled CD. Postoperatively, sensors were removed and patients rated the AccuFlow and the standard anesthesia monitoring equipment on a validated comfort rating scale for wearable computers (CRS). Blood loss was estimated by the surgical team (EBL) and calculated from change in hematocrit, weight, and height (CBL). CRS scores were compared via Wilcoxon signed ranks tests. Coefficients of correlation between sensor readings and CBL, and between EBL and CBL, were compared using Fisher’s R-to-z transformation. Results There were no safety events; no participants requested device removal. CRS ratings of the AccuFlow and the standard monitoring equipment were similar (7.2 vs. 8.8, p=0.25). Change in wrist perfusion from delivery to dressing placement was more strongly correlated with CBL than was EBL (R=−0.48 vs. R=0.087, p=0.03). Conclusions The AccuFlow sensor is well-tolerated and shows promise in detecting intrapartum hemorrhage, though larger studies are needed.

Background The single nucleotide polymorphism (SNP) rs61839660 lies within the IL2RA (CD25) intronic enhancer and has been identified as a causal variant in Crohn’s disease (CD), with a heterozygote frequency of 16.8% in a European population. CD25 is the high-affinity receptor for IL-2, and is constitutively expressed on regulatory T cells (Tregs). Low-dose IL-2 (LD-IL2) is under investigation in IBD, under the premise that it will expand a group of tolerising Tregs. However, finding a therapeutic dose which activates Tregs without activating effector T cells (Teffs) has proved challenging and activation of CD56dim NK cells has been linked to adverse events in trial subjects. We have demonstrated that the rs61839660 risk (T) allele carriers exhibit higher CD4+ T cell CD25 expression, enhanced pSTAT5 activation on stimulation with IL-2, and greater Teff release of pro-inflammatory cytokines. We sought to understand the impact of the risk allele on NK cell immunophenotype and function. Methods We recruited CD patients homozygous major allele (CC), or heterozygous (CT) at the rs61839660 locus. We extracted peripheral blood mononuclear cells and flow-sorted CD56dim (cytotoxic) and CD56bright (regulatory) NK subsets. Cells were stimulated with IL-2, then stained for intracellular pSTAT5. To assess cytotoxicity, NK cells were rested in media either with or without IL-2, before plating with CFSE-labelled K562 target cells. The proportion of K562 cells positive for dead cell marker was assessed for each condition. Results There was no difference in CD phenotype or severity between groups, in terms of age at diagnosis, sex distribution, presence of perianal disease or the proportion requiring surgery. CD25 expression was significantly enhanced on CD56Bright NK cells in CT subjects compared to CC subjects (1b). Enhanced CD25 expression was also seen in CD56Dim NK cells, though this did not reach statistical significance (1a). The concentration of IL-2 required to activate 50% intracellular STAT5 was lower in CT subjects’ CD56Bright NK cells compared to those from CC subjects (21.5IU/ml vs. 132.4IU/ml, p=0.039). The cytotoxicity of CT subjects’ CD56dim NK cells was significantly enhanced following exposure to IL-2, compared to CC subjects (1c). Conclusion Our findings suggest that risk (T) allele carriers have enhanced responsiveness to IL-2 signalling in NK cells, mediated by increased expression of CD25. We hypothesise that these subjects would be at greater risk of adverse events on exposure to LD-IL2, through enhanced CD56Dim NK cytotoxicity. Our results suggest that screening of subjects entering trials of IL-2-based therapy for the rs61839660 risk variant should be considered, as the threshold for adverse events in these subjects may be lower.

This study aimed to assess the positive predictive value (PPV) of a 1-hour, 50-g glucose challenge test (GCT) result ≥200 mg/dL for the diagnosis of gestational diabetes mellitus (GDM) on a 3-hour, 100-g glucose tolerance test (GTT). Pregnancies between 2008 and 2016 with a GCT result ≥200 mg/dL were identified retrospectively. GCT and GTT dates and results, demographics, and working due date (EDD) were extracted. Gestational age at testing was calculated from test date and EDD. As some clinicians presumptively diagnose GDM in such cases, if a GTT result was not available, clinic notes were reviewed to determine whether a GTT was ordered. Positive predictive values (PPV) were calculated at GCT cut-offs at and beyond 200 mg/dL. Subgroups were compared including early GCT (16 weeks) versus routine GCT (24-28 weeks), GTT result normal versus GTT diagnostic of GDM, and GTT ordered versus GTT not ordered. Rates of use of medication for glycemic control were assessed among these groups. Of 236 pregnant women with a GCT result ≥200 mg/dL, 115 (48%) GTT was ordered for 115 (49%), whereas 123 (52%) were managed as presumed GDM. Of 100 (87%) who completed the test, 81 (81%) were diagnosed with GDM with a median intertest interval of 14 days. No statistically significant differences were found between groups stratified by GTT result. Use of rates of metformin, glyburide, and insulin were similar between those diagnosed with GDM by GTT and those diagnosed with GDM by GCT alone. A GCT result of ≥200 mg/dL has a PPV of 81% for diagnosis of GDM by GTT in a contemporary U.S. population, with a median intertest interval of 14 days between GCT and GTT. However, those diagnosed by GCT alone were as likely as those diagnosed by GTT to require medication for glycemic control, including insulin, suggesting that requiring a GTT may result in underdiagnosis and delayed treatment of GDM.· A 50-g GCT result of 200 mg/dL or greater has a PPV of 81% for GDM on the 100 g GTT.. · Patients diagnosed with GDM by GCT alone were as likely to require insulin as those diagnosed by GTT.. · 81% of patients diagnosed with GDM on the GTT completed their GTT at least 1 week after the GCT, thus requiring GTT in this population may lead to unnecessary delays in care..

Despite advances in hemorrhage detection and management, postpartum hemorrhage remains the single leading cause of maternal death worldwide. Within the United States, hemorrhage is the leading cause of maternal death on the day of delivery and within the first week after delivery. Blood transfusion after hemorrhage represents a large proportion of severe maternal morbidity during and after delivery. Blood loss during delivery has historically been assessed visually by inspecting soiled pads, linens, and laparotomy sponges. These methods underestimate the volume of blood loss by as much as 40%, becoming increasingly inaccurate as blood loss increases. Young, healthy obstetrical patients compensate for blood loss via peripheral vasoconstriction, maintaining heart rate and blood pressure in a normal range until over 1 L of blood has been lost. A significant decrease in blood pressure along with marked tachycardia (120 bpm) may not be seen until 30% to 40% of blood volume has been lost, or 2.0 to 2.6 L in a healthy term pregnant patient, after which the patient may rapidly decompensate. In resource-poor settings especially, the narrow window between the emergence of significant vital sign abnormalities and clinical decompensation may prove catastrophic. Once hemorrhage is detected, decisions regarding blood product transfusion are routinely made on the basis of inaccurate estimates of blood loss, placing patients at risk of underresuscitation (increasing the risk of hemorrhagic shock and end-organ damage) or overresuscitation (increasing the risk of transfusion reaction, fluid overload, and alloimmunization). We will review novel technologies that have emerged to assist both in the early and accurate detection of postpartum hemorrhage and in decisions regarding blood product transfusion.

Leadership is a process where leaders enact certain behaviors to influence followers. Yet, each follower may view the leader’s enactment differently, owing to differences in disposition and context. Here we examine leadership as a property attributed by followers to their leader, influenced by both the leader and followers’ personal attributes and the situation in which leaders and followers interact. Guiding this study, we asked: how do followers’ affect (negative and positive traits), motivation (regulatory focus), and cognitions (identity) and their congruence with their leader’s corresponding attributes influence their ratings of transformational leadership? Participants operated in extreme situations where their lives were often at risk because of exposure to combat. Results based on a sample of 1587 US Army soldiers operating in 262 units show that when there is a higher congruence between leaders’ and followers’ positive affect, promotion focus, relational identity, and collective identity, follower ratings of transformational leadership are higher, whereas a higher level of incongruence between followers’ and leaders’ positive and negative affect predicted lower ratings of transformational leadership. These findings differed based on the soldiers’ time spent in deployment and the level of combat exposure they experienced. The authors disclosed receipt of the following financial support for the research, authorship, and/ or publication of this article. The authors received financial and logistical support for this research from the US Army Center for the Army Profession and Ethic. The third author's research contribution was supported by the grant “Advancing Leadership Research” (W911NF-18-2-0049) US Army Research Institute for the Behavioral and Social Sciences (ARI).

Zebra mussels (Dreissena polymorpha) have exacerbated the decline of native freshwater mussels (order Unionida) in North America since their arrival in the 1980s. Options for controlling invasive mussels, particularly in unionid mussel habitats, are limited. Previously, carbon dioxide (CO2) showed selective toxicity for zebra mussels, relative to unionids, when applied in cool water (12 °C). We first determined 96‐h lethal concentrations of CO2 at 5 and 20 °C to zebra mussels and responses of juvenile plain pocketbook (Lampsilis cardium). Next, we compared the time to lethality for zebra mussels at 5, 12, and 20 °C during exposure to partial pressure of CO2 (PCO2) values of 110 to 120 atm (1 atm = 101.325 kPa) and responses of juvenile plain pocketbook and fragile papershell (Leptodea fragilis). We found efficacious CO2 treatment regimens at each temperature that were minimally lethal to unionids. At 5 °C, plain pocketbook survived 96‐h exposure to the highest PCO2 treatment (139 atm). At 20 °C, the 96‐h lethal concentration to 10% of animals (LC10) for plain pocketbook (173 atm PCO2, 95% CI 147–198 atm) was higher than the LC99 for zebra mussels (118 atm PCO2, 95% CI 109–127 atm). Lethal time to 99% mortality (LT99) of zebra mussels in 110 to 120 atm PCO2 ranged from 100 h at 20 °C to 300 h at 5 °C. Mean survival of both plain pocketbook and fragile papershell juveniles exceeded 85% in LT99 CO2 treatments at all temperatures. Short‐term infusion of 100 to 200 atm PCO2 at a range of water temperatures could reduce biofouling by zebra mussels with limited adverse effects on unionid mussels. Environ Toxicol Chem 2020;39:1546–1557. Published 2020. This article is a U.S. Government work and is in the public domain in the USA. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

We offer a comprehensive review of the theoretical underpinnings and existing empirical evidence in the implicit leadership and implicit followership theories domain. After briefly touching on the historical roots of information-processing approaches to leadership and leader categorization theory, we focus on current contextualized and dynamic perspectives. We specifically present neural network approaches and adaptive resonance processes that guide leadership perceptions. We further address measurement issues, emerging areas of study such as implicit leadership theories, and identity and cross-cultural issues. We offer specific avenues for future research in the form of a systematic list of unanswered research questions and further outline leadership development implications.

With current concerns around global climate change, new hydrofluorocarbons with low Global Warming Potential (GWP) are being evaluated as alternative refrigerants. These alternative refrigerants, however, may be mildly flammable (as defined by the A2L safety group classification) and pose safety concerns for the heating, ventilation, air conditioning, and refrigeration (HVACR) industry. Consequently, careful assessments of different flammability characteristics and risks for these refrigerants are essential for their safe use in actual applications. In this study, deflagration propagation measurements for different mildly flammable refrigerants, including difluoromethane (R-32) and 2,3,3,3-tetrafluoropropene (R-1234yf), were undertaken in different geometries including a 9.1-m long conduit test rig and a closed cubical 12.5 m 3 volume. Different tests were conducted for full volume deflagrations as well as with and without obstructions. Turbulent deflagration speeds for well-mixed, refrigerant-air mixtures have been shown to be orders of magnitude larger than their corresponding laminar flame speed values that are used in classifying flammable refrigerants in safety standards. Testing has also quantified the resulting severity as measured by the event overpressure which was shown to worsen with increased congestion or confinement as a consequence of increased induced turbulence. This work illustrates the importance for severity evaluations for actual large-scale or congested geometries of concern in practical applications. Even for mildly flammable refrigerants characterized by laminar flame speeds

The study of leadership emergence has increased substantially over the past few decades. However, due to a lack of integrative theory, we believe limited advancement has been made regarding the full process of leadership emergence. To address this concern, first, we conceptualize the leadership emergence process from a complexity perspective and define emergence as a dynamic, interactive process grounded in three principles of emergent phenomena. Second, we review how previous research has modeled leadership emergence by focusing on the content areas of the lower-level elements, the mechanisms that facilitate their emergence, and the dynamism of the process once it has emerged. Third, based on the findings from the review, we introduce a process-oriented framework of leadership emergence. Fourth, we offer propositions to guide developing and testing emergent leadership processes, and we conclude with recommendations for future leadership process research. Our hope is that by realigning the study of leadership emergence with complexity and multilevel theory, we can reorient this area to focusing more on the process mechanisms within emergence, connecting back to research progress made over 60 years ago.

The concept of boundaryless careers characterizes emerging career patterns that are less dependent on traditional organizational career management. Based on an evidence-based review of literature on the relationship between career boundarylessness and career success published from 1994 to 2018, we found that boundaryless careers have mixed effects on the various indictors of career success, and these effects depend on the operationalization of career boundarylessness, the motives (voluntary vs. involuntary), career competencies, adaptive capabilities and career resources held by individuals, as well as the structural constraints and institutional support for boundary-crossing behaviors. In addition, career success was also found to predict subsequent career mobility. Based on these findings, we develop an integrative model to understand the complicated and dynamic relationship between boundaryless careers and career success. This review serves as an important step to integrate theories and research on boundaryless careers and career success, and more interdisciplinary work should be done in the future to examine this question.

Congress first enacted the generation-skipping transfer (GST) tax in 1976 to protect the estate and gift tax base and to ensure that extraordinary fortunes would bear their fair share of the transfer tax burden. Nearly a half-century into the life of the GST tax, those goals remain unrealized. In recent decades, high-net-worth individuals have succeeded in shifting hundreds of billions of dollars to “dynasty trusts” that—under current law—are poised to escape federal wealth transfer taxation indefinitely. The rise of dynasty trusts reduces the revenue-raising potential of the estate and gift taxes and allows a privileged class to exert vast economic and political power based solely on an accident of birth. This white paper presents a legislative reform agenda designed to reinvigorate the GST tax, stem the rise of dynasty trusts, and bring hundreds of billions of dollars back within the federal transfer tax base. We highlight three flaws in current law that account for the GST tax’s failure: (1) very high exemption amounts; (2) loopholes that allow high-net-worth taxpayers to stuff GST-exempt trusts with assets worth many multiples of the exemption amount; and (3) the lack of any durational limit on dynasty trusts in states that have abolished the rule against perpetuities. Our three-part reform agenda addresses each of these flaws. First, we propose a reduction in the GST exemption from the current level ($11.7 million) to the 2009 level ($3.5 million). A $3.5 million GST exemption still would be higher, in inflation-adjusted terms, than the exemption amount advocated by the Reagan administration. Second, we propose a set of common-sense loophole closers that would prevent high-net-worth taxpayers from stuffing GST-exempt trusts with assets worth far more than the exemption amount. Third, we propose to limit the maximum duration of a trust’s GST exemption to two generations, with an exception that would allow tax-free distributions to beneficiaries who were alive at the time of the trust’s inception. Our plan would shore up the estate and gift tax base and stem the rise of dynasty trusts while allowing more than 99 percent of American families to pass wealth across multiple generations tax-free.

Three transfer tax minimization mechanisms—zeroed-out grantor retained annuity trusts (GRATs), intentionally defective grantor trusts (IDGTs), and family-controlled entities with steep valuation discounts—significantly shrink the federal estate and gift tax base. This white paper explains how Congress can close all three loopholes. We estimate that these actions—along with complementary base-protecting and base-expanding proposals—would raise more than $65 billion over the fiscal year 2022 to fiscal year 2031 window (and possibly much more than $65 billion). They also would enhance the progressivity of the federal tax system and bolster the long-term revenue-raising capacity of the estate and gift taxes. To summarize key conclusions: — Congress should repeal section 2702(b)(1), the provision that enables high-net-worth individuals to achieve extraordinary transfer tax savings via GRATs; — Congress should harmonize the income tax and transfer tax treatment of IDGTs, preferably by treating these trusts as nongrantor trusts for income tax purposes; — Congress should limit lack-of-marketability discounts and eliminate lack-of-control discounts with respect to transfers of interests in family-controlled entities; and — Congress should supplement these three reforms with additional base-protecting and base-broadening measures: shifting to a tax-inclusive base for gift taxes; limiting the gift tax annual exclusion for transfers in trust; and expanding the requirement of consistency in value for transfer and income tax purposes. All of these steps remain relevant—and in some respects, even more urgent—if Congress enacts the Biden-Harris administration’s capital income tax reform proposal, which would limit the tax-free step-up in basis at death to the first $1 million of unrealized gains ($2 million per couple). Unless Congress secures the estate and gift tax base, high-net-worth taxpayers will respond to stepped-up basis reform by exploiting transfer-tax loopholes even more aggressively. For this reason, estate and gift tax loophole closers and stepped-up basis reform should be considered complements, not substitutes.

BACKGROUND Following the destruction of pharmaceutical production facilities in Puerto Rico by Hurricane Maria in September 2017, a shortage of small-volume bags of sterile intravenous fluid for infusion led to a decreased ability to administer intravenous azithromycin and ampicillin efficiently for use in the treatment of patients with preterm premature rupture of membranes. OBJECTIVE This study aimed to assess pregnancy latency after preterm premature rupture of membranes following treatment with oral-only antibiotics compared with treatment with intravenous antibiotics followed by oral antibiotics. STUDY DESIGN This is a retrospective historic control study comparing women with preterm premature rupture of membranes who were initiated on a 7-day oral-only regimen of azithromycin and amoxicillin (modified regimen) during a 12-month period beginning December 2017 (during which time there was a shortage of small-volume bags of intravenous fluid) to women with preterm premature rupture of membranes who were initiated on a 2-day regimen of intravenous ampicillin and azithromycin followed by 5 days of oral amoxicillin and azithromycin (standard regimen) from December 2016 to December 2018. Women were included in the study if they were diagnosed with preterm premature rupture of membranes at

Background Immune checkpoint inhibitors (CPI) have revolutionised cancer treatment, with previously untreatable disease now amenable to potential cure. Combination regimens of anti-CTLA4 and anti-PD-1 show enhanced efficacy but are prone to off target immune-mediated tissue injury, particularly at the barrier surfaces. CPI-induced colitis is a common a serious complication. Methods To probe the impact of immune checkpoints on intestinal homeostasis mice were challenged with combination anti-CTLA4 and anti-PD-1 immunotherapy, manipulation of the intestinal microbiota and antibody blockade/depletion studies. Colonic immune responses were profiled using RNA-sequencing, including high-resolution single cell analyses, and flow cytometry. Results CPI colitis was dependent on the composition of the intestinal microbiota and was characterized by remodelling of mucosal lymphocytes with induction of polyfunctional lymphocyte responses characterized by expression of interferon-g (IFNg), other pro-inflammatory cytokines/chemokines (Il22, Il17a Ccl3, Ccl4 and Ccl9) and cytotoxicity molecules (Gzmb, Gzma, Prf1, Nkg7). In comparison with mucosal lymphocytes in the steady state, polyfunctional lymphocytes from both CD4+ and CD8+ lineages upregulated costimulatory molecules and checkpoint molecules in CPI-colitis, indicating that these cells are usually very tightly regulated. CPI-colitis was attenuated following depletion of effector lymphocytes or following blockade of the IL23/IFNg axis. Conclusion This study provides new mechanistic insights into CPI-colitis, identifying polyfunctional, cytotoxic lymphocytes as key mediators of disease. Therapeutic targeting of their effector response or regulatory networks, including the IL23/IFNg axis holds the key to preventing and reversing CPI-colitis.

Background A subset of mucosal CD4+ T-cells expressing the NK cell receptor NKG2D (encoded by the KLRK1 gene) are enriched in patients with Crohn’s Disease (CD). In pre-clinical models of colitis, NKG2D expression was confined to a subset of colonic CD4+ T-cells that hyper-expressed interferon gamma. However, the functional role of these cells in mediating intestinal inflammation is unknown. Little is known about the transcriptional regulation of this population or the key signalling networks that they engage. Methods Pre-clinical models of CD, adoptive transfer experiments and in vitro culture systems were used to investigate the phenotype and pathogenicity of NKG2D using Klrk1-/- and WT mice. Signalling networks and interactions between NKG2D, key transcription factors and relevant cytokines were investigated by probing published single-cell RNA seq data (Martin et al. Cell 2019). Pathway members of potential interactions were collected from the literature, and the OmniPath database and we applied a heat propagation model. Results NKG2D-expressing T-cells were potently pathogenic when adoptively transferred to Rag1- mice, mediating more severe disease than Klrk1-/- CD4+ T-cells. Notably, Klrk-/- T-cells were still able to induce colitis, indicating that NKG2D-independent pathogenic pathways also exist. Chromatin immunoprecipitation demonstrated that T-bet bound at the transcriptional start site of the Klrk1 locus in WT Th1 cells, but not Tbx21-/- Th1 T-cells. There were significantly fewer NKG2D expressing CD4+ T-cells from Tbx21-/- mice, and forced expression of T-bet in Tbx21-/-Ifng-/- double knockout CD4+ T-cells induced Klrk1 mRNA expression, consistent with T-bet being a transcriptional activator of the Klrk1 gene. The NKG2D model network reached FOS, NFKB and JUN transcription factors depending on the presence of the NKG2D. The model distinguished two comparable pathway activation - one with active PRKCA in T-cells including CD8+ T-cells and one with less active PRKCA mostly in macrophages. Comparing the inflamed and uninflamed conditions, highly activated T-cells, and a population of Th17+ TRM cells had an active KLRK pathway only in inflamed Crohn disease. Conclusion NKG2D expressing colonic CD4+ T-cells are potent cytokine producing cells and are more colitigenic than their NKG2D-negative counterparts. Network-based heat propagation showed that specific populations of colonic memory T cells are active only in the inflamed condition, meanwhile, the model identified two types of cells that had active KLRK1 pathway: one which was PRKCA dependent activity and one which had non-PRKCA dependent activity. We also identify T-bet as an important transcriptional regulator of NKG2D expression.

Computational fluid dynamics (CFD) simulations, verified against test data, were undertaken to quantify ventilation dilution requirements needed for mitigating flammability risks during leaks of mi...

Previous research on determinants of marital and reproductive timing focused on factors prominent in evolutionary theories. We focused on complementary factors prominent in research on attitudes, social cognition, and personality. Attitude construal and situated inference theories hold that priming can increase the accessibility of specific concepts, and that valence of the primed concepts can affect subsequent judgments. In two studies, one with college students and the other with a larger, more diverse sample, women, but not men, wanted to get married sooner if they had than had not recently seen images of smiling babies. Primed women also listed a greater number of and more positive children-related thoughts about marriage. These results suggest that subtle contextual cues can alter accessibility of relevant concepts, affect attitudes even on important issues, and work differently for different individuals. The results also suggest closer links between evolutionary, social cognitive, and personality theories.

Although leadership and followership processes are flexible and fluid, our theoretical and empirical knowledge of the short-term dynamics in individuals’ leadership and followership identities are ...

Applied research, such as leadership, should inform practice. However, there have been calls for researchers to do more bridge the gap between theory and practice. This session bring together a gro...

Addressing the controversial debate about narcissism and its impact on organizations, this article pursues three main purposes: First, we aimed to assess the factorial structure of the Pathological Narcissism Inventory (PNI) in an applied organizational context. In the overall sample of 926 German-speaking managers (Studies 1-3), we found a bifactor model differentiating a general narcissism factor from narcissistic grandiosity and vulnerability to be advantageous over a traditional second-order factor model. Second, we sought to establish the relationships between narcissism and leaders’ drive to aggress against followers (i.e., abusive supervision intent). Above and beyond the general narcissism factor, narcissistic vulnerability consistently predicted leaders’ abusive supervision intent, while narcissistic grandiosity did not. This result also held with an additional measure of grandiose narcissism, the Narcissistic Personality Inventory (NPI) in Study 2. Third, we intended to provide initial insights into the underlying mechanisms linking leaders’ narcissistic vulnerability to their abusive supervision intent. An experimental design in Study 3 identified one reason why narcissistic vulnerability drives leaders to aggress against their followers: they were prone to respond to failure with internal attributions and shame. In sum, this research is the first to point out leaders’ narcissistic vulnerability as a risk-factor for organizations. It advances the current understanding of its conceptual nature and practical implications.

Resilience Strength Training (RST) is a peer specialist program that incorporates a military squad model of group trust and bonding to address problems specific to moral injury (typically involving collapse of meaning or faith, loss of trust, self-isolation, and the failure of relationships). The training program was offered to 97 male and female veterans (ages 24–73) at two Volunteers of America (VOA) affiliates. The veterans completed measures related to moral injury prior to RST training, immediately upon completion, and 6 months after the training. RST significantly improved their reported post-traumatic growth, perceived meaning in life, propensity to trust, dispositional optimism, positive attitudes toward themselves, personal self-esteem, and sleep quality, while decreasing their dependence on both alcohol and sleep medications. These improvements were more pronounced immediately after RST but remained significant on most measures 6 months after training had ended. The results are interpreted as supportive of RST as a vehicle for addressing moral injury in veterans through development of self-calming strategies, communication skills, and self-esteem, as well as development of a peer-supported community with shared experiences.

We investigated the status of leadership theory integration by reviewing 14 years of published research (2000 through 2013) in 10 top journals (864 articles). The authors of these articles examined 49 leadership approaches/theories, and in 293 articles, 3 or more of these leadership approaches were included in their investigations. Focusing on these articles that reflected relatively extensive integration, we applied an inductive approach and used graphic network analysis as a guide for drawing conclusions about the status of leadership theory integration. All 293 articles included in the analysis identified 1 focal theory that was integrated with 2 or more supporting leadership theories. The 6 leadership approaches most often appearing as the focal theory were transformational leadership, charismatic leadership, strategic leadership, leadership and diversity, participative/shared leadership, and the trait approach to leadership. On the basis of inductive reflections on our analysis, we make two key observations. First, the 49 focal leadership theories qualify as middle-range theories that are ripe for integration. Second, drawing from social network theory, we introduce the term “ theoretical neighborhood” to describe the focal theoretical networks. Our graphical inductive analyses reveal potential connections among neighboring middle-range leadership theories that merit investigation and, hence, identify promising future directions for achieving greater theoretical integration. We provide an online supplement with 10 additional leadership theory graphs and analyses: leadership in teams and decision groups, ethical leadership, leader and follower cognitions, leadership emergence, leadership development, emotions and leadership, implicit leadership, leader-member exchange, authentic leadership, and identity and identification process theories of leadership.

Computational fluid dynamics simulations were undertaken to quantify ventilation dilution requirements needed for mitigating flammability risks during leaks of flammable refrigerants from large chillers inside machine rooms. Machine rooms ranging in size from 376 to 2256 m3 were modeled using computational fluid dynamics to simulate major leaks from a 2640 kW (750TR) chiller. As is required by existing safety standards, a refrigerant sensor was incorporated to trigger and activate an alarm or emergency level ventilation system to dilute the room with fresh air. A range of refrigerant leak rates and different alarm-triggered ventilation rates were evaluated to understand dilution requirements to prevent significant flammable mass accumulation. To verify the computational fluid dynamics findings, verification testing was also conducted in a 574 m3 machine room setup using carbon dioxide as a surrogate refrigerant. When matching volumetric leak rates, computational fluid dynamics results were comparable with...