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PubMed1998

Team behaviors: working effectively in teams.

The work of building and sustaining teams is often underestimated by middle managers. A manager must have the ability to develop and evolve staff toward a new level of competence, required because of radically upgraded expectations. Managers must be clear about what it means to empower teams, to avoid the trappings of giving "lip service" to authority boundaries, which may exist only on paper. Achieving this clarity means understanding the characteristics of effective teams: a high degree of interdependence, strong sense of organizational empowerment, self-determination, competence, commitment, and genuine concern about the quality of work being performed. An important tool for the manager interested in team development is the creation of a performance model, grounded in the foundational relationship competencies necessary for team success. Performance modeling assists not only in identifying of competency gaps that can be addressed by training but also in determining the workplace barriers to team success.

Decision Making, Organizational↗
PubMed2004

A Model of Feeding Readiness for Preterm Infants.

This paper presents a theoretical model of bottle feeding readiness in preterm infants, which hypothesizes relationships between bottle feeding readiness, experience, and outcomes. The synactive theory of development provided the conceptual foundation for the model. The model, which is currently being tested, is designed to establish bottle feeding readiness criteria that will help nurses decide when to offer a bottle to a preterm infant The model may also provide a useful framework for determining preterm infant readiness for other aspects of care.

Journal Article↗
PubMed2000

The four "P"s of marketing are dead.

For several decades marketing planning in the United States has relied upon the "four Ps" model. Product, price, place, and promotion were considered the foundation of the marketing mix. This model, however, has never been a comfortable fit for health care and, as the new century dawns, we find that a new marketing model--emphasizing the "four Rs"--is emerging. The foundations of the new model are relevance, response, relationships, and results.

Evaluation Studies as Topic↗
PubMed2005

Sexy sons from re-mating do not recoup the direct costs of harmful male interactions in the Drosophila melanogaster laboratory model system.

The empirical foundation for sexual conflict theory is the data from many different taxa demonstrating that females are harmed while interacting with males. However, the interpretation of this keystone evidence has been challenged because females may more than counterbalance the direct costs of interacting with males by the indirect benefits of obtaining higher quality genes for their offspring. A quantification of this trade-off is critical to resolve the controversy and is presented here. A multi-generation fitness assay in the Drosophila melanogaster laboratory model system was used to quantify both the direct costs to females due to interactions with males and indirect benefits via sexy sons. We specifically focus on the interactions that occur between males and nonvirgin females. In the laboratory environment of our base population, females mate soon after eclosion and store sufficient sperm for their entire lifetime, yet males persistently court these nonvirgin females and frequently succeed in re-mating them. Females may benefit from these interactions despite direct costs to their lifetime fecundity if re-mating allows them to trade-up to mates of higher genetic quality and thereby secure indirect benefits for their offspring. We found that direct costs of interactions between males and nonvirgin females substantially exceeded indirect benefits through sexy sons. These data, in combination with past studies of the good genes route of indirect benefits, demonstrate that inter-sexual interactions drive sexually antagonistic co-evolution in this model system.

Animals↗
PubMedDate not supplied

[External quality assessment of clinical services in Europe].

All countries and clinical specialties have some elements of systems for quality improvement, but their aims, configurations, models standards and assessments are often not formally recognised or integrated. External programmes to assess service delivery in Europe include the International Standardisation Organisation (ISO) and Excellence (EFQM - European Foundation Quality Management) models (industry based, management focus), peer review and accreditation (health care based, professional focus) and inspection (regulatory, safety-focused). Patient surveys and disease registers also contribute to assessment and benchmarking best performance. There are legal, cultural, professional and commercial reasons to adopt common core standards but there is little legislative framework to allow formal harmonisation within and between countries and clinical specialties. Examples are given of various approaches to the definition, assessment and improvement of standards for clinical services in Europe in order to encourage specialist associations to develop self-regulations based on the experience of others. Clinical practice and clinical services could be more efficiently and effectively harmonised by the professions than by their respective governments.

Accreditation↗
PubMed2006

Towards an acoustic model-based poroelastic imaging method: I. Theoretical foundation.

The ultrasonic measurement and imaging of tissue elasticity is currently under wide investigation and development as a clinical tool for the assessment of a broad range of diseases, but little account in this field has yet been taken of the fact that soft tissue is porous and contains mobile fluid. The ability to squeeze fluid out of tissue may have implications for conventional elasticity imaging, and may present opportunities for new investigative tools. When a homogeneous, isotropic, fluid-saturated poroelastic material with a linearly elastic solid phase and incompressible solid and fluid constituents is subjected to stress, the behaviour of the induced internal strain field is influenced by three material constants: the Young's modulus (E(s)) and Poisson's ratio (nu(s)) of the solid matrix and the permeability (k) of the solid matrix to the pore fluid. New analytical expressions were derived and used to model the time-dependent behaviour of the strain field inside simulated homogeneous cylindrical samples of such a poroelastic material undergoing sustained unconfined compression. A model-based reconstruction technique was developed to produce images of parameters related to the poroelastic material constants (E(s), nu(s), k) from a comparison of the measured and predicted time-dependent spatially varying radial strain. Tests of the method using simulated noisy strain data showed that it is capable of producing three unique parametric images: an image of the Poisson's ratio of the solid matrix, an image of the axial strain (which was not time-dependent subsequent to the application of the compression) and an image representing the product of the aggregate modulus E(s)(1-nu(s))/(1+nu(s))(1-2nu(s)) of the solid matrix and the permeability of the solid matrix to the pore fluid. The analytical expressions were further used to numerically validate a finite element model and to clarify previous work on poroelastography.

Acoustics↗
PubMed1999

Artificial neural networks applied to the in vitro-in vivo correlation of an extended-release formulation: initial trials and experience.

Artificial neural networks applied to in vitro-in vivo correlations (ANN-IVIVC) have the potential to be a reliable predictive tool that overcomes some of the difficulties associated with classical regression methods, principally, that of providing an a priori specification of the regression equation structure. A number of unique ANN configurations are presented, that have been evaluated for their ability to determine an IVIVC from different formulations of the same product. Configuration variables included a combination of architectural structures, learning algorithms, and input-output association structures. The initial training set consisted of two formulations and included the dissolution from each of the six cells in the dissolution bath as inputs, with associated outputs consisting of 1512 pharmacokinetic time points from nine patients enrolled in a crossover study. A third formulation IVIVC data set was used for predictive validation. Using these data, a total of 29 ANN configurations were evaluated. The ANN structures included the traditional feed forward, recurrent, jump connections, and general regression neural networks, with input-output association types consisting of the direct mapping of the dissolution profiles to the pharmacokinetic observations, mapping the individual dissolution points to the individual observations, and using a "memorative" input-output association. The ANNs were evaluated on the basis of their predictive performance, which was excellent for some of these ANN models. This work provides a basic foundation for ANN-IVIVC modeling and is the basis for continued modeling with other desirable inputs, such as formulation variables and subject demographics.

Computer Simulation↗
PubMed2005

Discrimination and calibration of mortality risk prediction models in interventional cardiology.

OBJECTIVES: Using a local percutaneous coronary intervention (PCI) data repository, we sought to compare the performance of a number of local and well-known mortality models with respect to discrimination and calibration. BACKGROUND: Accurate risk prediction is important for a number of reasons including physician decision support, quality of care assessment, and patient education. Current evidence on the value of applying PCI risk models to individual cases drawn from a different population is controversial. METHODS: Data were collected from January 01, 2002 to September 30, 2004 on 5216 consecutive percutaneous coronary interventions at Brigham and Women's Hospital (Boston, MA). Logistic regression was used to create a local risk model for in-hospital mortality in these procedures, and a number of statistical methods were used to compare the discrimination and calibration of this new and old local risk models, as well as the Northern New England Cooperative Group, New York State (1992 and 1997), University of Michigan consortium, American College of Cardiology-National Cardiovascular Data Registry, and The Cleveland Clinic Foundation risk prediction models. Areas under the ROC (AUC) curves were used to evaluate discrimination, and the Hosmer-Lemeshow (HL) goodness-of-fit test and calibration curves assessed applicability of the models to individual cases. RESULTS: Multivariate risk factors included in the newly constructed local model were: age, prior intervention, diabetes, unstable angina, salvage versus elective procedure, cardiogenic shock, acute myocardial infarction (AMI), and left anterior descending artery intervention. The area under the ROC curve (AUC) was 0.929 (SE=0.017), and the p value for the Hosmer-Lemeshow (HL) goodness-of-fit was 0.473. This indicates good discrimination and calibration. Bootstrap re-sampling indicated AUC stability. Evaluation of the external models showed an AUC range from 0.82 to 0.90 indicating good discrimination across all models, but poor calibration (HL p value < or = 0.0001). CONCLUSIONS: Validation of AUC values across all models suggests that certain risk factors have remained important over the last decade. However, the lack of calibration suggests that small changes in patient populations and data collection methods quickly reduce the accuracy of patient level estimations over time. Possible solutions to this problem involve either recalibration of models using local data or development of new local models.

Angioplasty, Balloon, Coronary↗
PubMed2006

21st century neontology and the comparative development of the vertebrate skull.

Classic neontology (comparative embryology and anatomy), through the application of the concept of homology, has demonstrated that the development of the gnathostome (jawed vertebrate) skull is characterized both by a fidelity to the gnathostome bauplan and the exquisite elaboration of final structural design. Just as homology is an old concept amended for modern purposes, so are many of the questions regarding the development of the skull. With due deference to Geoffroy-St. Hilaire, Cuvier, Owen, Lankester et al., we are still asking: How are bauplan fidelity and elaboration of design maintained, coordinated, and modified to generate the amazing diversity seen in cranial morphologies? What establishes and maintains pattern in the skull? Are there universal developmental mechanisms underlying gnathostome autapomorphic structural traits? Can we detect and identify the etiologies of heterotopic (change in the topology of a developmental event), heterochronic (change in the timing of a developmental event), and heterofacient (change in the active capacetence, or the elaboration of capacity, of a developmental event) changes in craniofacial development within and between taxa? To address whether jaws are all made in a like manner (and if not, then how not), one needs a starting point for the sake of comparison. To this end, we present here a "hinge and caps" model that places the articulation, and subsequently the polarity and modularity, of the upper and lower jaws in the context of cranial neural crest competence to respond to positionally located epithelial signals. This model expands on an evolving model of polarity within the mandibular arch and seeks to explain a developmental patterning system that apparently keeps gnathostome jaws in functional registration yet tractable to potential changes in functional demands over time. It relies upon a system for the establishment of positional information where pattern and placement of the "hinge" is driven by factors common to the junction of the maxillary and mandibular branches of the first arch and of the "caps" by the signals emanating from the distal-most first arch midline and the lamboidal junction (where the maxillary branch meets the frontonasal processes). In this particular model, the functional registration of jaws is achieved by the integration of "hinge" and "caps" signaling, with the "caps" sharing at some critical level a developmental history that potentiates their own coordination. We examine the evidential foundation for this model in mice, examine the robustness with which it can be applied to other taxa, and examine potential proximate sources of the signaling centers. Lastly, as developmental biologists have long held that the anterior-most mesendoderm (anterior archenteron roof or prechordal plate) is in some way integral to the normal formation of the head, including the cranial skeletal midlines, we review evidence that the seminal patterning influences on the early anterior ectoderm extend well beyond the neural plate and are just as important to establishing pattern within the cephalic ectoderm, in particular for the "caps" that will yield medial signaling centers known to coordinate jaw development.

Animals↗
PubMed2001

Three mouse models of muscular dystrophy: the natural history of strength and fatigue in dystrophin-, dystrophin/utrophin-, and laminin alpha2-deficient mice.

To optimize and evaluate treatments for muscular dystrophy, it is important to know the natural history of the disease in the absence of therapeutic intervention. Here we characterized disease progression of three mutant mouse strains of muscular dystrophy: mdx mice, which lack dystrophin; mdx:utrn-/- mice, which also lack utrophin; and dy/dy mice, which are deficient in laminin alpha2. Normal mice show a marked increase in forelimb strength over the first 10 weeks of life and little fatigue (<5%) over five consecutive strength trials. Mdx and mdx:utrn-/- mice demonstrate less strength then normal mice and approximately 40% fatigue at each age. Mdx mice become obese but mdx:utrn-/- mice do not. Dy/dy mice remain small and are much weaker than mdx and mdx:utrn-/- mice at all ages even when normalized to weight; however, they show only minimal fatigue (10%). This work demonstrates a distinct pattern of disease progression in each model and provides a foundation for assessing strategies for improving strength in each model.

Aging↗
PubMed2006

The health promotion model as assessed by ageing workers.

AIMS: This study describes qualitatively ageing workers and their health promotion. It also describes quantitatively the importance of individual, workplace and occupational health promoting factors, the impact of health promotion and the contributions of the other co-partners promoting the health of ageing workers. These form the foundation for a model of health promotion. BACKGROUND: Very little is known about the health promotion factors exclusively focused at ageing workers. METHODS: A pretested questionnaire with structured and some open-ended questions were devised to form the basis of qualitative data and sent to 150 ageing workers, of whom 93 (62%) returned it. Qualitative data were analysed by content analysis. Statistical analyses were performed using frequencies and means. RESULTS: Over 90% of respondents stated that health habits, individual arrangements at the workplace, a good workplace spirit, health checks, counselling and access to nursing care were important factors for health promotion. Better health (99%), work satisfaction (95%) and motivation of employees (96%) were the factors impacting on health promotion. Ageing workers stated that health and safety organization (94%) and rehabilitation institutes (93%) were the most important co-partners. CONCLUSIONS: This study confirms extremely high importance of different health promotion factors, their impact and some co-partners. Health problems, early retirement and work absenteeism are rather common in ageing workers. If we are to avoid these problems, it is important to support their work ability effectively and systematically to allow these workers to stay employed until the normal retirement age. Relevance to clinical practice. It is necessary, that management appreciate the benefits of ageing workers; they have to take a positive attitude toward these workers and participate more effectively in their health promotion. Occupational health professionals play a key role in training workers and management to undertake the required measures.

Absenteeism↗
PubMed1993

A graph theory model of the semantic structure of attitudes.

The semantic structure underlying the attitudes of pretreatment and posttreatment drug addicts was modeled using a network analysis of free word associations. Measures of graph theoretic properties were used to assess structural differences in the associative networks of the two populations. These measures modeled the information processes of associative networks proposed in the spreading activation theory of semantic processing. As expected based on graph theory, the structure of the associative networks of posttreatment subjects was more dense, less constrained, and more hierarchically organized by the self concept. In a test of the network model, the subjects' evaluations of concepts in the associative network were found to be a function of their evaluations of semantically similar concepts. Although preliminary and limited, the results suggest that graph theory may provide a broad mathematical foundation for diverse models of cognitive systems.

Attitude↗
PubMed2002

A model for constitutive lutropin receptor activation based on molecular simulation and engineered mutations in transmembrane helices 6 and 7.

Many naturally occurring and engineered mutations lead to constitutive activation of the G protein-coupled lutropin receptor (LHR), some of which also result in reduced ligand responsiveness. To elucidate the nature of interhelical interactions in this heptahelical receptor and changes thereof accompanying activation, we have utilized site-directed mutagenesis on transmembrane helices 6 and 7 of rat LHR to prepare and characterize a number of single, double, and triple mutants. The potent constitutively activating mutants, D556(6.44)H and D556(6.44)Q, were combined with weaker activating mutants, N593(7.45)R and N597(7.49)Q, and the loss-of-responsiveness mutant, N593(7.45)A. The engineered mutants have also been simulated using a new receptor model based on the crystal structure of rhodopsin. The results suggest that constitutive LHR activation by mutations at Asp-556(6.44) is triggered by the breakage or weakening of the interaction found in the wild type receptor between Asp-556(6.44) and Asn-593(7.45). Whereas this perturbation is unique to the activating mutations at Asp-556(6.44), common features to all of the most active LHR mutants are the breakage of the charge-reinforced H-bonding interaction between Arg-442(3.50) and Asp-542(6.30) and the increase in solvent accessibility of the cytosolic extensions of helices 3 and 6, which probably participate in the receptor-G protein interface. Asn-593(7.45) and Asn-597(7.49) also seem to be necessary for the high constitutive activities of D556(6.44)H and D556(6.44)Q and for full ligand responsiveness. The new theoretical model provides a foundation for further experimental work on the molecular mechanism(s) of receptor activation.

Amino Acid Substitution↗
PubMed2002

Lysine scanning mutagenesis delineates structural model of the nicotinic receptor ligand binding domain.

Nicotinic acetylcholine receptors (AChR) and their relatives mediate rapid chemical transmission throughout the nervous system, yet their atomic structures remain elusive. Here we use lysine scanning mutagenesis to determine the orientation of residue side chains toward core hydrophobic or surface hydrophilic environments and use this information to build a structural model of the ligand binding region of the AChR from adult human muscle. The resulting side-chain orientations allow assignment of residue equivalence between AChR subunits and an acetylcholine binding protein solved by x-ray crystallography, providing the foundation for homology modeling. The resulting structural model of the AChR provides a picture of the ACh binding site and predicts novel pairs of residues that stabilize subunit interfaces. The overall results suggest that lysine scanning can provide the basis for structural modeling of other members of the AChR superfamily as well as of other proteins with repeating structures delimiting a hydrophobic core.

Amino Acid Sequence↗
PubMed2003

A biologic model for assessment of osseous strain patterns and plating systems in the human maxilla.

PURPOSE: This study was conducted to examine a biomechanical model and to help answer fundamental questions that relate to rigid plate fixation in the maxilla. Specifically, we sought to elucidate the principal strain patterns generated in the maxilla secondary to masticatory forces as well as the amount of permanent deformational changes incurred due to these loading forces. MATERIALS AND METHODS: Cadaveric heads with the mandible removed were defleshed and placed in a 2-part testing rig to hold and position the skull for testing in a standard material testing system. Rosette strain gages were attached at predefined points on the skull, and an Instron machine was used to load the skull through the loading port on the tray. A Le Fort I osteotomy was then performed on the skull, and a Walter Lorenz Ultra-Micro plating system was applied by a surgeon to reconnect the upper jaw. A 2-mm gap was left at the line of the osteotomy, and a transducer was attached to measure closure of the gap. Again the skull was loaded with the Instron (Canton, MA) machine. RESULTS: The results indicate a linear relationship exists with both maximum (tensile) and minimum (compressive) strain patterns relative to incremental load placement on the intact maxilla. The strain patterns after the Le Fort I osteotomy and plating were different and less linear. The differential variable reluctance transducer data showed a low rate of closure or transient increase in the gap at low loads (0 to 15 kilopond [kp] range) and a steeper slope of closure during high loads (15 to 60 kp range). It is also evident that axial loading forces cause permanent deformation and failure of osseous plating systems predominantly through bending. CONCLUSIONS: This model provides a foundation of knowledge regarding biomechanical strains in the maxilla subjected to static compressive loads in the force range of mastication. In addition, it serves as a comparative reference to assess rigidity of various craniofacial plating systems and to validate proposed standardized synthetic models. With the advent of increasingly precise surgery and new plating systems, this model can be used to help guide placement and design of plating systems; thereby allowing for ideal stabilization and optimizing surgical outcome.

Aged↗
PubMed1995

Hearing loss and cochlear abnormalities in the congenital hypothyroid (hyt/hyt) mouse.

The congenital hypothyroid (hyt/hyt) mouse has been described as having a homozygous recessive mutation of a single locus on chromosome 12 which results in significant endocrine hypofunction and retarded growth. Although a distinct correlation between inherited hypothyroidism and hearing loss in humans exists, there has been no previous evaluation of the auditory system in these mutant mice. We determined hearing thresholds by auditory-evoked brainstem response testing and noted a 40-45 dB elevation in the hyt/hyt mouse compared to littermate heterozygote (hyt/+) animals and normal progenitor controls BALB/cByJ (+/+). Conventional light microscopy was used to examine the general anatomy of the cochlea in these animals, and the surface structure of the organ of Corti was further evaluated with scanning electron microscopy. Heterozygote and normal control mice had no significant abnormalities of the cochlea, however the hyt/hyt mice displayed consistent morphologic abnormalities of the stereocilia on both inner and outer hair cell systems. The surrounding and supporting cells were identified in the cochleas of the hypothyroid mouse and control animals and showed no significant histologic abnormalities. The auditory, histologic, and ultrastructural characterization of this model provides a foundation for evaluating the effects of true inherited hypothyroidism on auditory pathway development.

Animals↗
PubMed2005

Theoretical approach to microwave-radiation-induced zero-resistance states in 2D electron systems.

We present a theoretical model in which the existence of radiation-induced zero-resistance states is analyzed. An exact solution for the harmonic oscillator wave function in the presence of radiation, and a perturbation treatment for elastic scattering due to randomly distributed charged impurities, form the foundations of our model. Following this model most experimental results are reproduced, including the formation of resistivity oscillations, their dependence on the intensity and frequency of the radiation, temperature effects, and the locations of the resistivity minima. The existence of zero-resistance states is thus explained in terms of the interplay of the electron microwave-driven orbit dynamics and the Pauli exclusion principle.

Journal Article↗
PubMed2000

Attachment and the regulation of the right brain.

It has been three decades since John Bowlby first presented an over-arching model of early human development in his groundbreaking volume, Attachment. In the present paper I refer back to Bowlby's original charting of the attachment landscape in order to suggest that current research and clinical models need to return to the integration of the psychological and biological underpinnings of the theory. Towards that end, recent contributions from neuroscience are offered to support Bowlby's assertions that attachment is instinctive behavior with a biological function, that emotional processes lie at the foundation of a model of instinctive behavior, and that a biological control system in the brain regulates affectively driven instinctive behavior. This control system can now be identified as the orbitofrontal system and its cortical and subcortical connections. This 'senior executive of the emotional brain' acts as a regulatory system, and is expanded in the right hemisphere, which is dominant in human infancy and centrally involved in inhibitory control. Attachment theory is essentially a regulatory theory, and attachment can be defined as the interactive regulation of biological synchronicity between organisms. This model suggests that future directions of attachment research should focus upon the early-forming psychoneurobiological mechanisms that mediate both adaptive and maladaptive regulatory processes. Such studies will have direct applications to the creation of more effective preventive and treatment methodologies.

Affect↗