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PubMedDate not supplied

[Variables related to job satisfaction. Cross-sectional study using the European Foundation for Quality Management [EFQM] model].

OBJECTIVES: To identify the influence of the dimensions of people items and sociodemographic characteristics included in the EFQM model on high satisfaction of healthcare workers in a district hospital. METHODS: We performed a cross-sectional study in November 2003. The questionnaire used was the personal satisfaction survey of the Basque Country (Spain). The outcome measure was a high degree of satisfaction (75th percentile or higher). Independent variables were sociodemographic and organizational characteristics. The association among variables was assessed using odds ratios (OR) and their 95% confidence interval (CI). Adjustment for confounders was performed by unconditional logistic regression. RESULTS: On a scale from 0 to 10, the mean general satisfaction score was 5.95 (standard deviation, 2). Twenty-five percent of workers gave their general satisfaction with the organizational climate a score of 8 or more points. The most positively considered features were the environmental policy, hierarchical relations, promotion, and professional development. The most negatively viewed items were salary, knowledge and identification of objectives, and training. The variables most closely related to outcome were a favorable perception of training (adjusted OR = 5.04; 95% CI, 2.16-11.77) and recognition of the work performed (adjusted OR = 4.68; 95% CI, 2.20-10.08). Sociodemographic factors had less influence on satisfaction. CONCLUSIONS: Almost half of the staff surveyed in our hospital were satisfied or highly satisfied with the organizational climate. Satisfaction was strongly associated with positive evaluation of organizational characteristics.

Adult↗
PubMed2004

Support and psychotherapy.

In recent years the psychiatric and psychoanalytical literature has expressed increasing interest in supportive therapy, which has long been considered rather disparagingly as a "lesser form" of psychotherapy. At the same time there has been much reflection on the significance and role of support in various therapeutic settings, outside the formal psychotherapeutic context. A review of updated literature shows, on the one hand, a general appreciation of the idea of support, as an acknowledged component of any therapeutic action. On the other, in the area of psychoanalytic-oriented therapies, there is still debate on the status of supportive psychotherapy, and particularly on the relations between supportive and explorative variants. The eclecticism of supportive therapy and the lack of consensus on its theoretical bases are reviewed in an attempt to develop theoretical/clinical models as the foundation for supportive measures. These potential models would greatly facilitate the transmission and technical application of supportive measures in clinical work. Further research is needed to define the theoretical underpinnings of supportive therapy, establish its origins, the pattern it should take in different therapeutic settings, its potential and limits.

Humans↗
PubMed1976

Toward a utility theory foundation for health status index models.

The axioms of utility theory are restated in terms of health outcomes, and some additional assumptions, consistent with the assumptions implicit in health status index models, are adduced to develop a consistent theory of the utility of health states. On the basis of the axioms and specific assumptions, techniques for measuring the health utility functions of individuals are described, and it is shown how these axioms and assumptions may be used to determine the utility to the individual of health programs that will affect him in various ways.

Health↗
PubMed1991

Comparison of four behavioral theories. A literature review.

A major concern among occupational health nurses is the efficacy of their health education and health promotion programs. The success of programs may be improved when they are built on a sound and appropriate theoretical foundation. Four models that present a logical and reasonable approach to behavioral change include the Health Belief Model, the Theory of Self Efficacy, the Theory of Reasoned Action, and the Multiattribute Utility Model. Behavioral models provide a framework for the development of interventions and strategies which will facilitate behavioral change.

Attitude to Health↗
PubMed2002

King's theory as foundation for an advance directive decision-making model.

This article discusses the utilization of King's conceptual system, transaction process model, and theory of goal attainment as foundations for an advance directive decision-making model. Research has shown nurses may be educationally unprepared, experience conflicts between beliefs and actions, or resist the responsibility to address advance directives and end-of-life issues. Nurses, especially nurse practitioners providing primary care, are in positions to facilitate the process. By understanding and incorporating this model into practice, both the nurse and the client may achieve mutual goal attainment resulting in both increased client autonomy and Patient Self-Determination Act compliance.

Advance Directive Adherence↗
PubMed1989

Facilitating research utilization: a model for nurse managers.

Nursing research utilization has been studied and models have been developed by many nursing groups. However, the important role of the nurse administrator or manager in promoting utilization of research has been neglected. This pilot study used a nursing diagnosis--alterations in comfort (pain)--to identify common and expected variables in selected studies. Findings from this research together with the literature on research utilization models provided the foundation for the development of a preliminary model for nurse managers. The authors discuss this process and make recommendations for implementation.

Clinical Nursing Research↗
PubMed1996

Variances of additive and dominance genetic effects for ovulation and twinning rates in a population selected for twinning.

Estimates of variances due to additive and dominance genetic effects and permanent and temporary environmental effects were obtained for ovulation and twinning rates from a composite population selected for twinning rate. Measures of ovulation rate after 11 mo of age on 2,317 heifers with a total of 19,209 measures were used. Twinning measures were on 1,522 first-parity cows, 1,311 later-parity cows with a total of 3,571 measures, and 1,704 all-parity cows with 5,100 measures. Models included fixed effects of year-season-age at calving for twinning, and year-season of birth, age in months, and calendar month of measurement for ovulation rate. Four analyses were performed for each sample: combinations of models with and without dominance effects and with and without covariates for fractions of inheritance from the seven foundation groups. Variance components as fractions of phenotypic variance for analysis of all ovulation rate measures were .076, .000, and .045 for additive, dominance, and permanent environmental effects with no foundation groups in the model and .069, .000, and .050 with foundation groups in the model. For sums of eight measures, the estimates were .287 and .000 for relative variances of additive and dominance effects with groups in the model and .316 and .000 with groups ignored. For twinning rate for first parity, estimates were .126 and .209 for relative variances of additive and dominance effects; for later parities, estimates were .045 and .035 for models including foundation group effects. The results suggest lack of dominance effects in expression of ovulation rate and the possibility of dominance effects for embryo and(or) fetal survival or conception rate because twinning rate is a function of ovulation, conception, and embryo and(or) fetal survival rates.

Aging↗
PubMed2000

Sperm competition games: a comparison of loaded raffle models and their biological implications.

Our main aim is to compare the additive model, due to Mesterton-Gibbons, and the multiplicative model, due to Parker, of sperm allocation under sperm competition, when other influences are treated in the same way. We first review these (and other) models and their foundations, leading to a generalization of the multiplicative model. Sperm is assumed to cost energy, and this constraint is incorporated differently in the two models. These give the same results in the random-roles situation when the males occupy roles (of first and second to mate) randomly: the number of sperm ejaculated in the favoured role is greater than that in the disfavoured role by an amount that depends on the effect of sperm limitation (i.e. the probability that there is insufficient sperm to ensure full fertility). If the latter is negligible, or the fertilization raffle fair, this difference is zero, as Parker found originally. In the constant roles situation (where males of a particular type always occupy the same role) the predictions differ: the additive model has the same predictions as in the random roles case, but the multiplicative model predicts that males of the type occupying the favoured role ejaculate less than males of the type occupying the disfavoured role, in accord with Parker's original conclusion. The fitnesses of the two types of male can be calculated in the multiplicative model: the fitness of the favoured male is usually higher, even if he has to expend more energy in "finding" a female, e.g. through fighting, etc. These conclusions relate to inter-male behaviour (i.e. of different male types), as distinct from intra-male behaviour (i.e. of a given male when in different roles). We analyse situations in which one male type has some probability of acting in its less usual role: calculations with varying amounts of sperm limitation are presented. It is found that the presence of a male of a different type has an effect on intra-male ejaculate behaviour, which also depends critically on the role usually occupied. We conclude that the multiplicative model is the more accurate model and provides more information. Some experimental data on sperm numbers are used to find the effects of sperm limitation. For species which conform to the loaded raffle model, sperm limitation typically has small or negligible effects: in this case, we argue that empiricists should look for equal ejaculates in the two roles when studying random role situations; when roles are occupied non-randomly average sperm expenditure should be greater by male types typically occupying the disfavoured role, but within a male type, expenditure should be greater in the role it typically occupies.

Animals↗
PubMed2005

A biophysical model of the mitochondrial respiratory system and oxidative phosphorylation.

A computational model for the mitochondrial respiratory chain that appropriately balances mass, charge, and free energy transduction is introduced and analyzed based on a previously published set of data measured on isolated cardiac mitochondria. The basic components included in the model are the reactions at complexes I, III, and IV of the electron transport system, ATP synthesis at F1F0 ATPase, substrate transporters including adenine nucleotide translocase and the phosphate-hydrogen co-transporter, and cation fluxes across the inner membrane including fluxes through the K+/H+ antiporter and passive H+ and K+ permeation. Estimation of 16 adjustable parameter values is based on fitting model simulations to nine independent data curves. The identified model is further validated by comparison to additional datasets measured from mitochondria isolated from rat heart and liver and observed at low oxygen concentration. To obtain reasonable fits to the available data, it is necessary to incorporate inorganic-phosphate-dependent activation of the dehydrogenase activity and the electron transport system. Specifically, it is shown that a model incorporating phosphate-dependent activation of complex III is able to reasonably reproduce the observed data. The resulting validated and verified model provides a foundation for building larger and more complex systems models and investigating complex physiological and pathophysiological interactions in cardiac energetics.

Adenosine Triphosphate↗
PubMed2004

[Critical analysis of the immunological self/non-self model and of its implicit metaphysical foundations].

An examination of the concepts used in immunology prompts us to wonder about the origins and the legitimacy of the notions of self and non-self, which constitute the core of the dominant theoretical model in this science. All theoretical reflection concerning immunology must aim at determining a criterion of immunogenicity, that is, an operational definition of the conditions in which an immune reaction occurs or does not occur. By criticizing both conceptually and experimentally the self/non-self vocabulary, we can demonstrate the inaccuracy and even the inadequacy of the dichotomy of self/non-self. Accordingly, the self/non-self model must be reexamined, or even rejected. On the basis of this critique, we can suggest an alternative theoretical hypothesis for immunology, based on the notion of continuity. The 'continuity hypothesis' developed here attempts to give a criterion of immunogenicity that avoids the reproaches leveled at the self model.

Animals↗
PubMed1999

The cost-effectiveness of isotretinoin in the treatment of acne. Part 1. A meta-analysis of effectiveness literature.

OBJECTIVES: This paper reports the results of a meta-analysis of isotretinoin treatment in moderate to severe acne. It forms part of a comprehensive investigation into the cost-effective treatment of acne in South Africa and as such establishes the clinical foundation for an economic model of acne management. This foundation includes an evaluation of the daily dosages, treatment durations, success rates, clinical effectiveness and relapse rates reported in published trials since 1981. METHODOLOGY: A predetermined protocol for the study established the scope, appropriate inclusion and exclusion criteria for peer-reviewed data, and the statistical rigour that would be applied to the selected data. Following an extensive literature search, data reflecting the effectiveness of isotretinoin were extracted, statistically assessed, described and reported. The combinability of the data was confirmed using analyses of variance and chi-square tests, as applicable. RESULTS: Isotretinoin consistently proved to be a highly effective agent in the treatment of moderate to severe acne vulgaris. The response rate determined by the meta-analysis indicated a clinical cure in 84.22% to 86.71% of patients treated. From the data considered, the average treatment duration was calculated to be 17.9 weeks (4 months). The relapse rate was low (21.45%) and dose-dependent. Optimal results were achieved by treating patients with a daily dose of 1 mg/kg and treating to a target cumulative dose of 120 mg/kg over the treatment duration. CONCLUSION: The results of this meta-analysis support the continued use of isotretinoin in the treatment of acne. The results are important in the field of pharmaceutical benefit management where they will assist in the optimal management of this health condition. The results will be used to develop a pharmaco-economic model to evaluate the various treatment regimens used for acne in South Africa.

Acne Vulgaris↗
PubMed1978

Structure-strength relations in mammalian tendon.

The stress-strain relations in mammalian tendon are analyzed in terms of the structure and mechanics of its constituents. The model considers the tensile and bending strength of the collagen fibers, the tensile strength of the elastin fibers, and the interaction between the matrix and the collagen fibers. The stress-strain relations are solved through variational considerations by assuming that the fibermaxtrix interactions can be modeled as beam on elastic foundation. The tissue thus modeled is a hyperelastic material. It is further shown that on the basis of the model, the dominant parameters to the tendon's behavior can be evaluated from simple tensile tests.

Animals↗
PubMed2006

Development of a physiologically based pharmacokinetic model for deltamethrin in the adult male Sprague-Dawley rat.

Deltamethrin (DLT) is a type II pyrethroid insecticide widely used in agriculture and public health. DLT is a potent neurotoxin that is primarily cleared from the body by metabolism. To better understand the dosimetry of DLT in the central nervous system, a physiologically based pharmacokinetic (PBPK) model for DLT was constructed for the adult, male Sprague-Dawley rat that employed both flow-limited (brain, gastrointestinal [GI] tract, liver, and rapidly perfused tissues) and diffusion-limited (fat, blood/plasma, and slowly perfused tissues) rate equations. The blood was divided into plasma and erythrocytes. Cytochrome P450-mediated metabolism was accounted for in the liver and carboxylesterase (CaE)-mediated metabolism in plasma and liver. Serial blood, brain, and fat samples were taken for DLT analysis for up to 48 h after adult rats received 2 or 10 mg DLT/kg po. Hepatic biotransformation accounted for approximately 78% of these administered doses. Plasma CaEs accounted for biotransformation of approximately 8% of each dosage. Refined PBPK model forecasts compared favorably to the 2- and 10-mg/kg po blood, plasma, brain, and fat DLT profiles, as well as profiles subsequently obtained from adult rats given 1 mg/kg iv. DLT kinetic profiles extracted from published reports of oral and iv experiments were also used for verification of the model's simulations. There was generally good agreement in most instances between predicted and the limited amount of empirical data. It became clear from our modeling efforts that there is considerably more to be learned about processes that govern GI absorption and exsorption, transport, binding, brain uptake and egress, fat deposition, and systemic elimination of DLT and other pyrethroids. The current model can serve as a foundation for construction of models for other pyrethroids and can be improved as more definitive information on DLT kinetic processes becomes available.

Adipose Tissue↗
PubMed1997

Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries.

Because clinical databases vary in structure, access methods and vocabulary used to represent data, the Arden Syntax does not define a standard model for querying databases. Consequently, database queries are encoded in ad hoc ways and enclosed in "curly braces" in Medical Logic Modules (MLMs). However, the nonstandard representation of queries impairs sharing of MLMs, an impediment that has come to be known as the "curly braces problem." As a first step in solving this problem, we evaluated the proposed HL7 Reference Information Model (RIM) as a foundation for a standard query model for the Arden Syntax. Specifically, we analyzed the MLM knowledge base at the Columbia-Presbyterian Medical Center and compared the queries in these MLMs to the RIM. We studied 488 queries in 104 MLMs, identifying 674 total query data elements. Laboratory tests accounted for 45.8% of these elements, while demographic and ADT data accounted for 37.6%. Pharmacy orders accounted for 10.5%, medical problems for 4.3% and MLM output messages for 1.6%. We found that the RIM encompasses all but those data elements signifying MLM output (1.6% of the total). We conclude that the majority of queries in the CPMC knowledge base access a relatively small set of data elements and that the RIM encompasses these elements. We propose extensions of this analysis to continue construction of an Arden query model capable of solving the "curly braces problem."

Artificial Intelligence↗
PubMed1998

Linking service climate and customer perceptions of service quality: test of a causal model.

A set of foundation issues that support employee work and service quality is conceptualized as a necessary but not sufficient cause of a climate for service, which in turn is proposed to be reflected in customer experiences. Climate for service rests on the foundation issues, but in addition it requires policies and practices that focus attention directly on service quality. Data were collected at multiple points in time from employees and customers of 134 branches of a bank and analyzed via structural equation modeling. Results indicated that the model in which the foundation issues yielded a climate for service, and climate for service in turn led to customer perceptions of service quality, fit the data well. However, subsequent cross-lagged analyses revealed the presence of a reciprocal effect for climate and customer perceptions. Implications of these results for theory and research are offered.

Commerce↗
PubMed2005

Completed three-dimensional model of human coagulation factor va. Molecular dynamics simulations and structural analyses.

Factor Va is the critical cofactor for prothrombinase assembly required for timely and efficient prothrombin activation. In the absence of a complete crystal structure for the cofactor, Pellequer et al. [(2000) Thromb. Haemostasis 84, 849-857] proposed an incomplete homology model of factor Va (it lacks 46 amino acids from the carboxyl terminus of the heavy chain), which is a static model in a vacuum. A recently published X-ray structure of activated protein C (APC) inactivated bovine factor Va(i) (without the A2 domain) suggests a completely new arrangement of the C1 and C2 domains as compared with the previously published structure of the recombinant C1 and C2 domains. Our aims were (a) to exchange the C1 and C2 domains of the homology model with the modified bovine C1 and C2 domains using the X-ray structure as a template, (b) to determine by computation the three-dimensional model for the carboxyl-terminal peptide of the factor Va heavy chain (Ser(664)-Arg(709)) and incorporate it into the incomplete model, (c) to obtain a complete model of the cofactor folded in solution that might account for its physiological functions and interactions with other components of prothrombinase, and (d) to use the model in order to understand the mechanism of factor Va inactivation by APC. In the first step a sequence alignment of the human and bovine C1 and C2 domains was performed followed by amino acid changes in the three-dimensional structure where the sequences were not identical. The new model of the C1 and C2 domains was then attached to the homology model. The analysis of the MD simulation data revealed that several domains of the cofactor were significantly displaced during simulation. Using our completed model of human factor Va, we are also demonstrating for the first time that cleavage of membrane-bound normal factor Va as well as membrane-bound factor V(LEIDEN) by APC at Arg(306) is required for the dissociation of the A2 domain from the rest of the molecule. Thus, differences in the inactivation rates of the two cofactor molecules are due to differences in the rate of cleavage at Arg(306). The data demonstrate that our model represents the foundation for the establishment of a complete prothrombinase complex model, which might be successful in describing accurately the ternary protein-protein interaction and thus accounts for experimental observations.

Amino Acid Substitution↗