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At least 343 records · Page 19Linked to original sources
PubMed2001

Understanding the role of opinion leaders in improving clinical effectiveness.

We present findings from evaluations of two government-funded initiatives exploring the transfer of research evidence into clinical practice--the PACE Programme (Promoting Action on Clinical Effectiveness), and the Welsh Clinical Effectiveness Initiative National Demonstration Projects. We situate the findings within the context of available research evidence from healthcare and other settings on the role of opinion leaders or product champions in innovation and change--evidence which leaves a number of problems and unanswered questions. A major concern is the difficulty of achieving a single replicable description of what opinion leaders are and what they do--subjective understandings of their role differ from one setting to another, and we identify a range of very different types of opinion leadership. What makes someone a credible and influential authority is derived not just from their own personality and skills and the dynamic of their relationship with other individuals, but also from other context-specific factors. We examine the question of expert versus peer opinion leaders, and the potential for these different categories to be more or less influential at different stages in the innovation process. An often neglected area is the impact of opinion leaders who are ambivalent or hostile to an innovation. Finally, we note that the interaction between individual opinion leaders and the collective process of negotiating a change and reorienting professional norms remains poorly understood. This raises a number of methodological concerns which need to be considered in further research in this area.

Evidence-Based Medicine↗
PubMed1999

Using sensitivity analysis for efficient quantification of a belief network.

Sensitivity analysis is a method to investigate the effects of varying a model's parameters on its predictions. It was recently suggested as a suitable means to facilitate quantifying the joint probability distribution of a Bayesian belief network. This article presents practical experience with performing sensitivity analyses on a belief network in the field of medical prognosis and treatment planning. Three network quantifications with different levels of informedness were constructed. Two poorly-informed quantifications were improved by replacing the most influential parameters with the corresponding parameter estimates from the well-informed network quantification; these influential parameters were found by performing one-way sensitivity analyses. Subsequently, the results of the replacements were investigated by comparing network predictions. It was found that it may be sufficient to gather a limited number of highly-informed network parameters to obtain a satisfying network quantification. It is therefore concluded that sensitivity analysis can be used to improve the efficiency of quantifying a belief network.

Algorithms↗
PubMed2000

The relationship between coaching behaviours and sport anxiety in athletes.

Previous research has identified the relationship between athlete sport anxiety and various sport outcomes (e.g., performance and dropout). For the majority of athletes involved in sport, the coach is an influential element of the competitive experience. Two hundred and twenty-eight athletes from 15 sports, completed the Sport Anxiety Scale (SAS) and the Coaching Behavior Scale for Sport (CBS-S). The predictive ability of athletes' perceived frequency of seven coaching behaviours (physical training, mental preparation, goal setting, technical skills, competition strategies, personal rapport and negative personal rapport) on four forms of sport anxiety (total anxiety, somatic anxiety, concentration disruption and worry) was examined. Results indicate that negative personal rapport was a significant predictor of all measured forms of sport anxiety while competition strategies was a significant predictor for total anxiety, concentration disruption, and worry. Other behaviours were not significant. The findings suggest that negative rapport between coach and athlete is an important contributor to athlete anxiety. In addition, behaviours that the coach demonstrates relative to competition can be influential in reducing athlete anxiety.

Adolescent↗
PubMed1999

Use of jackknife influence profiles in bioequivalence evaluations.

Generic drug product-development involves many bioavailability trials in an attempt to establish bioequivalence of the test drug product with an innovator's drug product. A major challenge for decision makers in the generic drug product-development process is to identify a successful test product based on the outcome of individual bioavailability trials, which may be misleading as a result of influential observations. The author identifies the need for a graphical diagnostic technique and then introduces such a technique, the jackknife influence profile, for the systematic scanning of influential observations. This review also describes the possible application of the technique in deriving the required reliable statistic values for bioequivalence assessment.

Journal Article↗
PubMedDate not supplied

Mentoring in the career development of hospital staff nurses: models and strategies.

Mentoring in the career development of hospital staff nurses was explored using a qualitative, grounded-theory method in a descriptive study design. Verbatim audiotaped interviews of hospital staff nurses and their nurse managers from four hospitals in the northeast were used. Document analysis of key hospital and nursing organizational policy statements was included. Two models were identified from the study regarding the mentoring of hospital staff nurses, ie, a structural and a process model. Within the structural model, mentoring influentials were noted to be people, events, and environments. Peers and nurse managers proved to be the primary people influential in providing key mentoring strategies. Within the process model, four phases were identified leading to three separate career development outcomes toward which hospital staff nurses strive: the development of career-building relationships, facilitation of career transition points, and positive interaction within the organizational climate.

Female↗
PubMed2006

Motivation for eating behaviour in adolescent girls: the body beautiful.

Body dissatisfaction is commonplace for teenage girls and is associated with dieting and unhealthy weight-control behaviours. The idealisation and pursuit of thinness are seen as the main drivers of body dissatisfaction, with the media prominent in setting thin body ideals. Television and consumer magazine production in the UK are extensive, annually releasing 1x10(6) h programming and >3000 magazine titles. Their engagement by adolescent girls is high, and in surveys girls identify thin and revealing body images as influential to the appeal of thinness and their pursuit of dieting. Experimental studies show a short-term impact of these images on body dissatisfaction, especially in teenagers who are already concerned about body image. Magazine images appear more influential than television viewing. For many adolescents selecting thin-image media is purposive, permitting comparison of themselves with the models or celebrities featured. Indeed, the impact of the media needs to be understood within a social context, as engagement is often a highly-social process. Media influence is uneven because of differences in its content and manner of communication, and individual differences in vulnerability to its content. Greater social responsibility on the part of the media and better media literacy by children would be beneficial. For those working in adolescent nutrition it is a reminder that adolescent food choice and intake are subject to many competing, contradictory and non-health-related determinants.

Adolescent↗
PubMed1999

Sadness in older persons: 13-year follow-up of a community sample in Baltimore, Maryland.

BACKGROUND: Our prior psychometric work suggested that older adults interviewed in 1981 in a community survey were less likely than younger adults to report dysphoria. We hypothesized that this would also be true of older adults interviewed 13 years later. METHODS: This study is a population-based 13-year follow-up survey of community-dwelling adults living in East Baltimore in 1981. Subjects were the continuing participants of the Baltimore Epidemiologic Catchment Area Program. After excluding 269 adults who were 65 years of age and older at initial interview in 1981, 1651 adults remained (347 aged 65 years and older and 1304 who were 30-64 years-old at follow-up). We applied structural equations with a measurement model for dichotomous data (the MIMIC -- multiple indicators, multiple causes -- model) to compare symptoms between adults who were 65 years and older at follow-up with younger adults, in relation to the nine symptom groups comprising the diagnostic criteria for major depression, adjusting for several potentially influential characteristics (namely, gender, self-reported ethnicity, educational attainment, cognitive impairment, marital status and employment). RESULTS: Older adults were less likely to endorse sadness as evidenced by a direct effect coefficient of -0.335 (95% Confidence Interval -0.643, -0.027). After adjusting for several potentially influential characteristics, the direct effect of age was substantially unchanged (-0.298 (95% CI -0.602, 0.006)). CONCLUSIONS: Older adults in 1994, like older adults in 1981, were less likely to endorse sadness than younger persons. This finding suggests, but does not prove, that the observed age difference in reporting depression does not reflect a cohort effect.

Adult↗
PubMed2004

The role of family systems in severe and recurrent psychiatric disorders: a developmental psychopathology view.

Family systems theory has been highly influential in the study of recurrent psychiatric disorders. This review examines two interrelated domains: research on expressed emotion (EE) attitudes among relatives (criticism, hostility, or emotionally overinvolvement) and relapses of schizophrenia or bipolar disorder, and randomized trials of family intervention in these populations. The literature is discussed in terms of contemporary systems theory and concepts from developmental psychopathology research. Several conclusions are drawn: (a) levels of EE are correlated with caregivers' attributions regarding the controllability of patients' behaviors; (b) EE attitudes are associated with bidirectional, mutually influential cycles of interaction between relatives and patients; and (c) family psychoeducational therapy, when combined with pharmacotherapy, is associated with lower rates of relapse in schizophrenia and bipolar illness. Underlying disturbances in family systems may emerge in response to illness symptoms in a family member, but also have recursive effects on the developmental course of the illness once manifest. The nature and stability of these recursive effects will depend on dynamic processes in the patient, the relative, and their relationship. Future research should elucidate mediating and moderating variables in the pathways from EE to patients' outcomes, and the conditions under which family treatments bring about favorable outcomes of psychiatric disorder.

Adult↗
PubMed1998

Antacid (A02A) and antiulcer (A02B) drug prescription patterns: predicting factors, dosage and treatment duration.

BACKGROUND: A study is made of the pharmaco-epidemiology of antacid (ATC class A02A) and antiulcer (A02B) drug prescriptions during the year 1992. METHODS: Prescription data were extracted from 1941 case histories of patients over 15 years old from four health care centers in the Valencian Community (Spain). Dosage and treatment duration were evaluated, along with the way in which morbidity, self-evaluated health, the demographic pattern and life-style characteristics influence drug prescription. RESULTS: The proportion of drug prescriptions increased with age in both sexes (p < 0.01). Drug use depended mainly on chronic diseases. In prescribing antacids, the most influential diagnosis was gastritis (ICD 534, OR: 157), followed by duodenal ulcer (ICD 532, OR: 152) and gastric ulcer (ICD 531, OR: 122), other gastrointestinal disorders (ICD 66, OR: 54) and undefined diagnoses (OR: 15). In the prescription of antiulcer drugs, the most influential diagnoses were gastric and duodenal ulcer (OR: 380 and 342, respectively), and a significant relation was observed with the diagnosis of osteomuscular diseases (OR: 6). Lifestyle and demographic pattern were of marginal importance. The estimated duration of treatment was 85 days. No significant differences were observed in either treatment duration or administered doses of almagate, ranitidine and omeprazole with respect to sex, age or diagnosis. CONCLUSIONS: Prolonged treatment is common for acid suppression. The widespread use of peptic ulcer drugs is mostly due to excessive prescription for non-ulcer dyspepsia. At the same time, many patients consume these drugs on a long-term basis in the absence of a clear diagnosis. This observation supports the need for appropriate diagnostic and prescription protocols to secure increased economical savings and management results.

Adolescent↗
PubMed1997

Mortality risk perceptions: a Bayesian reassessment.

"This study uses data on perceived and actual mortality risks to test several alternative Bayesian models of the factors influencing risk beliefs. The analysis...indicates that while the hazard rate for the individual age group is an influential factor, the overall population death rate and the discounted expected number of life years lost due to the cause of death are also influential in affecting risk perceptions.... The predictive power of a linear perception model increases with the level of the risk and is least accurate for very small risks."

Behavior↗
PubMed1999

Prediction of pharmacokinetic parameters and the assessment of their variability in bioequivalence studies by artificial neural networks.

PURPOSE: The methodology of predicting the pharmacokinetic parameters (AUC, cmax, tmax) and the assessment of their variability in bioequivalence studies has been developed with the use of artificial neural networks. METHODS: The data sets included results of 3 distinct bioequivalence studies of oral verapamil products, involving a total of 98 subjects and 312 drug applications. The modeling process involved building feedforward/backpropagation neural networks. Models for pharmacokinetic parameter prediction were also used for the assessment of their variability and for detecting the most influential variables for selected pharmacokinetic parameters. Variables of input neurons based on logistic parameters of the bioequivalence study, clinical-biochemical parameters, and the physical examination of individuals. RESULTS: The average absolute prediction errors of the neural networks for AUC, cmax, and tmax prediction were: 30.54%, 39.56% and 30.74%, respectively. A sensitivity analysis demonstrated that for verapamil the three most influential variables assigned to input neurons were: total protein concentration, aspartate aminotransferase (AST) levels, and heart-rate for AUC, AST levels, total proteins and alanine aminotransferase (ALT) levels, for cmax, and the presence of food, blood pressure, and body-frame for tmax. CONCLUSIONS: The developed methodology could supply inclusion or exclusion criteria for subjects to be included in bioequivalence studies.

Administration, Oral↗
PubMed2003

Sib-pairs in multifactorial disorders: the sib-similarity problem.

Common disorders are, by definition, the major cause of ill health and death. Most can be modified by avoiding or shielding an environment, as in sunburn and coeliac disease, by replacing some deficient substance, as in diabetes or myxoedema, or by empirical methods of evident effect as in schizophrenia and depressive illness. As expected, all show an increased incidence in relatives and the identification of the more influential loci involved may define unexpected links in the metabolic map: these may be amenable to therapy, or, in autoimmune disorders and asthma, define precipitating factors by sequencing the receptor involved. The major investment in trawling the genotype for influential loci has been by affected sib-pairs with parents (ASPs). Over a hundred major studies have been published with very limited success. No substantial study of normal sib-pairs has been undertaken, making this family of surveys one of the largest undertaken in the absence of controls. Possible reasons for this limited success and the many suggestive false positives are considered.

False Positive Reactions↗
PubMed2001

Mother-infant responsiveness: timing, mutual regulation, and interactional context.

Mutual regulation during the naturalistic interaction of 150 mothers and their 4-month-old infants was investigated from a dynamic systems perspective. Microanalyses of a wide range of behaviors and analysis of contingencies indicated that a 3-s time period best captured contingencies. Both mothers and infants communicated primarily through vocal signals and responses, although maternal touches and infant looks also elicited responses. Although more expressive mothers did not have infants who behaved similarly, levels of contingent responsiveness between partners were significantly associated and occurred within distinct behavioral channels, suggesting coregulated interactional processes in which contingently responsive mothers shape their infants' communications toward mutual similarity. Mothers were more influential than infants over object play, whereas infants were more influential than mothers over expressive behavior. Interactional context consistently influenced contingent responsiveness; there was less mutual responsiveness when the infant was exploring, being held, or looking.

Adolescent↗
PubMed2002

Differentiating stages of smoking intensity among adolescents: stage-specific psychological and social influences.

Researchers' understanding of the impact of sociocultural and psychological factors on the various stages of adolescent smoking uptake is limited. Using national data, the authors examined transitions across smoking stages among adolescents (N = 20,747) as a function of interpersonal, familial, and peer domains. Peer smoking was particularly influential on differentiating regular smoking, whereas alcohol use was most influential on earlier smoking. Although significant, depression and delinquency were attenuated in the context of other variables. Higher school grade was more likely to differentiate regular smoking from earlier smoking stages, whereas African American ethnicity and connectedness to school and family were protective of smoking initiation. Results lend support for an interactional approach to adolescent smoking, with implications for stage-matched prevention and intervention applications.

Adolescent↗
PubMed1975

Rate of participation and expertise as factors influencing leader choice.

Seventy-two female subjects were placed in four-person problem-solving groups. A confederate in each group was identified as either expert or inexpert, made expert or inexpert contributions, and either talked a lot or relatively little. The problem was made high or low in ambiguity. It was hypothesized that, as previous studies have shown, a high rate of participation would influence choice of the confederate as leader in the inexpert condition but that talkativeness would not be influential in the expert condition. The results supported the hypothesis. The characteristics of the confederate were somewhat less influential when the problem was low in ambiguity. The results were discussed in terms of what talkativeness may signify to other group members. When talkativeness is not resisted by the group it is tentative evidence that the talker is perceived as an appropriate, qualified, and legitimate leader.

Aptitude↗
PubMedDate not supplied

Theodore X. Barber (1927-2005).

Presents an obituary for Theodore Xenophon Barber (1927-2005), one of the most prolific and influential researchers in the field of hypnosis. At the time of his death he was an active scholar in his private research enterprise, the Interdisciplinary Science Research Institute. A brief biography of Barber is followed by an overview of his published work, his theories and other influential accomplishments. Although hypnosis was the main focus of Barber's research, his interests and research encompassed other topics, including the phenomenon of investigator bias, psychical phenomena, and even comparative psychology.

History, 20th Century↗
PubMed2003

A longitudinal analysis of organizational fairness: an examination of reactions to tenure and promotion decisions.

Most organizational justice research takes a cross-sectional approach to examining the relationship between perceived fairness and individuals' attitudes. This study examines the effect of procedural and distributive justice over time. It is suggested that individuals acquire more information and experience with procedures and outcomes over time. These changes in information and experience affect the influence of procedural and distributive justice on organizational attitudes. Faculty perceptions of tenure and promotion decisions were assessed 3 times (preallocation, short-term postallocation, long-term postallocation) over a 2-year period. Results generally supported the hypotheses. Procedural justice was most influential prior to and soon after outcome decisions were made. Distributive justice was most influential 1 year later.

Adult↗
PubMed1992

Anti-DNA antibodies form immune deposits at distinct glomerular and vascular sites.

To investigate the capacity of lupus autoAb to produce glomerular immune deposits (ID) and nephritis, 24 murine monoclonal (m) anti-DNA antibodies (Ab), derived from either MRL-lpr/lpr, SNF1 or NZB lupus-prone mice and selected based on properties shared with nephritogenic Ig, were administered i.p. (as hybridomas) and i.v. (as purified Ig) to normal mice; at least four mice/mAb were evaluated. Three general patterns of immune deposit formation (IDF) were observed: extracellular ID within glomeruli (+/- blood vessels, N = 8); intranuclear ID (N = 5); or minimal or no ID (N = 11). The four MRL m anti-DNA Ab that produced significant extracellular ID demonstrated different disease profiles including: (a) mesangial and subendothelial ID with anti-basement membrane staining, associated with proliferative glomerulonephritis, PMN infiltration, and proteinuria; (b) diffuse fine granular mesangial and extraglomerular vascular ID, associated with proliferative glomerulonephritis and proteinuria; (c) dense intramembranous ID and intraluminal ID, associated with capillary wall thickening, mesangial interposition and expansion, aneurysmal dilatation and intraluminal occlusion of glomerular capillary loops, and heavy proteinuria; and (d) mesangial and extraglomerular vascular ID, associated with mild segmental mesangial expansion, without proteinuria. These MRL mAb were derived from four different mice, and they had variable pIs and isotypes. They all cross reacted with multiple autoantigens (autoAg), however, their autoAg binding profiles were distinguishable. Among the SNF1 derived mAb, four produced histologically and clinically indistinguishable disease characterized by diffuse mesangial and capillary wall ID, associated with cellular proliferation/infiltration and proteinuria. Three of the four mAb were derived from the same mouse and were clonally related; they were: IgG2b with SWR allotype, relatively cationic, highly cross reactive with similar Ag binding patterns, idiotypically related and encoded by identical VH and nearly identical VL sequences. We conclude that both the capacity of lupus autoAb to form ID and the location of IDF are dependent on properties unique to individual Ig. The results also indicate that the Ag binding region of the autoAb is influential in this process, and they suggest that multiple Ab-Ag interactions contribute to IDF in individuals with lupus nephritis. Furthermore, these observations raise the possibility that the pathologic and clinical abnormalities resulting from these interactions are influenced by the location of IDF, and that the dominant interaction, in a given individual, may be highly influential in the phenotypic expression of nephritis.

Animals↗