Midlevel clouds are observed globally and impact the general circulation through their influence on the radiation budget and their precipitation production. However, because midlevel clouds occur less frequently than high and low clouds they are relatively understudied. Satellite observations from the MODIS, CALIPSO, and CloudSat instruments onboard the A-Train are combined to study midlevel cloud characteristics in the Tropical Western Pacific (TWP) between January 2007 and December 2010. Characteristic cloud and microphysical properties including cloud top height (CTH), geometric thickness, optical depth, effective radius, and liquid or ice water path (LWP or IWP), and environmental properties, including temperature and specific humidity profiles, are determined for precipitating and non-precipitating midlevel clouds. In the study region, approximately 14% of all cloudy scenes are classified as midlevel clouds (4 km < CTH < 8 km). These are concentrated in areas of deeper convection associated with the Pacific warm pool, ITCZ, and SPCZ. Non-precipitating clouds dominate the region, accounting for approximately 70% of all single and two-layer midlevel clouds scenes. Midlevel clouds occur most frequently in three different scenarios: high over midlevel clouds (~65%), single-layer (~25%), and midlevel over mid- or low-level clouds (~10%). Environmental moisture appears to play a larger role than temperature in determining midlevel cloud distributions due to large variations in moisture between the different cloud scenarios. In all scenes, a trimodal distribution in CTH frequency is found within the midlevel. Two of these peaks have been identified in previous studies; however a third midlevel mode is recognized here. CTHs occur most frequently in peaks between 5-6 km, 6-6.25 km, and 6.5-7.5 km. Although the past studies have only noted two midlevel peaks, this third mode is a robust feature in this dataset. Two types of clouds dominate these peaks: non-precipitating altostratus or altocumulus-like clouds less than 1 km thick and geometrically thick precipitating cumulus congestus clouds. Environmental temperature stable layers and dry maxima are found at each one of these peak frequency heights. Again, moisture seems to play a more dominant role in determining the height of the midlevel clouds due to larger variances between the moisture gradients associated with each peak. Microphysical properties (optical depth, effective radius, and LWP or IWP) are characterized for single-layer clouds. Approximately 30% of all single-layer midlevel clouds are precipitating and these clouds tend to occur on the edges of the deep tropics. In general, precipitating clouds have greater optical depths, effective radii, and water path. This research implies that some past studies at single point locations can be representative of the broader tropics, whereas others are not.

Some midlevel managers in the China's luxury hotel industry lack leadership strategies for engaging employees to reduce employee turnover. Employee turnover rates in China's hotel industry have reached the 30% mark, affecting hotels' bottom lines. This high employee turnover rate is impacting the hotels' performance, and negatively affecting the industry's profitability. The purpose of this qualitative multiple case study was to explore employee engagement strategies luxury hotel industry midlevel managers apply to reduce turnover. The conceptual framework for this study was the three levels of leadership model created by Scouller. The participants in this study were 5 midlevel department managers from 3 luxury hotels in China, who demonstrated strong employee engagement leadership strategies to reduce turnover. Data were collected using semistructured interviews as the primary source, and companies' related websites and internal documents about training and talent development. After analysis of the data through qualitative content analysis, 4 themes emerged, including corporate culture-related strategies, talent development-related strategies, leadership-related strategies, and mentorship- and coaching-related strategies. The results of this study may contribute to positive social change by improving leadership competencies to strengthen economic output, increase job opportunities, and improve and sustain employment benefiting employees, families, and communities.

The ability to improve employee engagement in small businesses is critical, not only to workers but also to midlevel managers who want to retain productive employees in the workplace. Supervisors who lack efficient managerial practices also risk decreases in productivity, profitability, and sustainability. The conceptual framework for this qualitative, exploratory single-case study was Kahn's theory of personal engagement and disengagement. The population consisted of 2 midlevel managers from a single, small, franchise company in metropolitan Alabama, both of whom used engagement practices, and managed at least 5 subordinates in the company. Data collected, analyzed, and triangulated were from semistructured interviews, direct observations, and a review of company documents. Coded interview responses aligned with the research question, conceptual framework, and emergent themes resulted in identifying successful engagement strategies that midlevel leaders to use. Two critical themes that emerged were management and communication. Supportive management behaviors and leader-member exchange yielded positive employee engagement and increased job performance and productivity. These results could be used to help midlevel managers develop strategies that improve employee enagagement and job performance. Social change implications included leaders developing new strategies that encourage positive relationships among top-level and midlevel leaders, lower level employees, and customers.

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The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.