Breast cancer teams:the impact of constitution, new cancer workload and methods of operation on their effectiveness

National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload. Information about team constitution, processes, effectiveness, clinical performance, and members' mental well-being was gathered using appropriate instruments. Two input variables, team workload (P=0.009) and the proportion of breast care nurses (P=0.003), positively predicted overall clinical performance in multivariate analysis using a two-stage regression model. There were significant correlations between individual team inputs, team composition variables, and clinical performance. Some disciplines consistently perceived their team's effectiveness differently from the mean. Teams with shared leadership of their clinical decision-making were most effective. The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians, the NHS, and the general population. This study established that team composition, working methods, and workloads are related to measures of effectiveness, including the quality of clinical care. © 2003 Cancer Research UK.

The professional role of breast cancer nurses in multi-disciplinary breast cancer care teams

Since the 1970s breast cancer services have witnessed considerable changes in the management of patients. One significant change was the introduction of specialist core personnel, including the breast care nurse (BCN). The role of the BCN has been gaining credence rapidly in the British NHS and this service is perhaps the paradigm of care for other services. With the lack of specific evidence of the role of specialist nurses in the breast care team, the current study aims to explore this area by in-depth interviews with core team members, and observations of 16 multi-disciplinary teams in England. The study explores the following themes: Nurses' unique informal management leadership role in ensuring the co-ordination, communication and planning of the team work; nurses' innovatory role in making the bureaucracy respond to patients and their relatives needs; nurses supportive role in the provision of expert advice and guidance to other members of the team; nurses confidence and humour in well-performing teams; and the limitations of the professional role of the breast cancer nurse. This study indicates that there is evidence that the BCN is practicing at an advanced level of practice. However, there is a severe lack of evidence-based description of that advanced practice. Cancer nurses including the BCNs should develop and participate in programmes of research in line with cancer legislation in order to build an evidence base that ultimately supports their unique role. © 2004 Elsevier Ltd. All rights reserved.

Getting the most out of multidisciplinary teams: a multi-sample study of team innovation in health care

Driven by the assumption that multidisciplinarity contributes positively to team outcomes teams are often deliberately staffed such that they comprise multiple disciplines. However, the diversity literature suggests that multidisciplinarity may not always benefit a team. This study departs from the notion of a linear, positive effect of multidisciplinarity and tests its contingency on the quality of team processes. It was assumed that multidisciplinarity only contributes to team outcomes if the quality of team processes is high. This hypothesis was tested in two independent samples of health care workers (N = 66 and N = 95 teams), using team innovation as the outcome variable. Results support the hypothesis for the quality of innovation, rather than the number of innovations introduced by the teams.

A critical assessment of the finite element method for calculating electric and magnetic fields

The present dissertation is concerned with the determination of the magnetic field distribution in ma[.rnetic electron lenses by means of the finite element method. In the differential form of this method a Poisson type equation is solved by numerical methods over a finite boundary. Previous methods of adapting this procedure to the requirements of digital computers have restricted its use to computers of extremely large core size. It is shown that by reformulating the boundary conditions, a considerable reduction in core store can be achieved for a given accuracy of field distribution. The magnetic field distribution of a lens may also be calculated by the integral form of the finite element rnethod. This eliminates boundary problems mentioned but introduces other difficulties. After a careful analysis of both methods it has proved possible to combine the advantages of both in a .new approach to the problem which may be called the 'differential-integral' finite element method. The application of this method to the determination of the magnetic field distribution of some new types of magnetic lenses is described. In the course of the work considerable re-programming of standard programs was necessary in order to reduce the core store requirements to a minimum.

Impact of cholinesterase inhibitors on behavioral and psychological symptoms of Alzheimer's disease:a meta-analysis

Objective: To determine the efficacy of cholinesterase inhibitors (ChEIs) in improving the behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer’s disease (AD). Data sources: We searched MEDLINE, Cochrane Registry, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1966 to 2007. We limited our search to English Language, full text, published articles and human studies. Data extraction: We included randomized, double-blind, placebo-controlled trials evaluating the efficacy of donepezil, rivastigmine, or galantamine in managing BPSD displayed by AD patients. Using the United States Preventive Services Task Force (USPSTF) guidelines, we critically appraised all studies and included only those with an attrition rate of less than 40%, concealed measurement of the outcomes, and intention to treat analysis of the collected data. All data were imputed into pre-defined evidence based tables and were pooled using the Review Manager 4.2.1 software for data synthesis. Results: We found 12 studies that met our inclusion criteria but only nine of them provided sufficient data for the meta-analysis. Among patients with mild to severe AD and in comparison to placebo, ChEIs as a class had a beneficial effects on reducing BPSD with a standard mean difference (SMD) of -0.10 (95% confidence interval [CI]; -0.18, -0.01) and a weighted mean difference (WMD) of -1.38 neuropsychiatry inventory point (95% CI; -2.30, -0.46). In studies with mild AD patients, the WMD was -1.92 (95% CI; -3.18, -0.66); and in studies with severe AD patients, the WMD was -0.06 (95% CI; -2.12, +0.57). Conclusion: Cholinesterase inhibitors lead to a statistical significant reduction in BPSD among patients with AD, yet the clinical relevance of this effect remains unclear.

A cross-national investigation into the marketing department's influence within the firm:toward initial empirical generalizations

An ongoing strong debate within the marketing discipline concerns the role of marketing within the firm. It has been frequently reported that the marketing function is in a deep decline. Marketing executives and academics alike are interested in the antecedents of this decline and potential performance consequences of this decline. Recent academic research have started investigations on this important topic. Using studies in single countries innovativeness and accountability of the marketing department has been reported as major antecedents of the influence of the marketing department within the organization. Academic research, however, does not provide convincing evidence for a direct link between this influence and business performance. Instead it shows that market orientation is a crucial intervening variable, as marketing department influence is positively related market orientation, which subsequently positively related to business performance. As noted prior research, however, studies firms in single countries. In this article we execute a cross-national study on the antecedents and performance consequences of marketing department influence in order to derive initial empirical generalizations. This study is executed in seven Western-oriented countries, including USA, UK, The Netherlands, Germany, Sweden, Israel and Australia. The study heavily builds on the framework developed in the 2009 Journal of Marketing article of Verhoef and Leeflang. This framework is tested per country and subsequently meta-analytic tests are used to derive initial empirical generalizations. An important empirical generalization is that innovativeness, the customer-connecting capabilities, and accountability of the marketing department are positively related to marketing department influence. Interestingly, a second initial generalization is that creativity of the marketing negative induces less influence. Our results also show a third empirical generalization in that firms having a CEO with a marketing background tend to have more influential marketing departments. Confirming prior research a fourth initial empirical generalization is that MD influence measures and market orientation are positively related. Market orientation is subsequently positively related to business performance. Our most important generalization is, however, that MD influence is positively related to business performance. Hence, beyond striving to become market oriented, firms should also aim to have strong marketing departments. These departments can create a stronger focus on the customer and can also coordinate marketing efforts. In order to become more influential marketing departments should: (1) acquire innovative capabilities, (2) be more connected to customers, (3) invest in accountability, and (4) be careful with be careful being too creative.

A cross-national investigation into the marketing department's influence within the firm

Both marketing academics and practitioners are debating the diminished role of marketing as a separate function within firms. In this study, which expands on previous research on Dutch companies, the authors focus on how the marketing department’s capabilities relate to business performance across countries. The authors collected data in seven Western countries—the Netherlands, Germany, Sweden, United Kingdom, United States, Australia, and Israel. They surveyed top marketing and financial executives, CEOs, and other top employees of profit-based middle-sized and large firms. Their findings show that accountability provides the most consistent predictor of influence, whereas the marketing department’s innovativeness and customer connection show less consistent results. Across the seven countries, the department’s integration with the finance department has a consistent but negative effect on the department’s perceived influence. The influences of marketing departments clearly differ across countries. Perceived influence is substantially higher in the United States and Israel than in other countries, whereas top management respect for the marketing department is substantially higher in Israel than in any other country. The study also found that the marketing department is well represented on the boards of companies in Sweden, Israel, and the United States. In most countries, marketing tends not to be organized as a line function. Some differences among countries emerge in the relationships between the marketing department’s influence and business performance. In Israel, the United States, the United Kingdom, Germany, and Australia, influence relates positively to business performance, whereas in the Netherlands, it has no influence. The results for Sweden suggest a negative influence. The authors conclude that a strong marketing department appears to benefit firms in most of the countries studied. The results imply that the marketing department should have input into boardroom considerations.

Effect of target distance on accommodative amplitude measured using the minus lens technique

Background: The aim was to investigate the effect on the measured amplitude of accommodation and repeatability of using the minus lens technique with the target at distance or near. Methods: Forty-three students (average age: 21.17 ± 1.50 years, 35 female) had their amplitude of accommodation measured with minus lenses on top of their distance correction in a trial frame with the target at far (6.0m) or near (0.4m). The minus lens power was gradually added with steps of 0.25D. Measurements were taken on two occasions at each distance, which were separated by a time interval of at least 24 hours. Results: The measured amplitude at six metres was significantly lower than that with the target at 40cm, by 1.56 ± 1.17D (p < 0.001) and this varied between individuals (r = 0.716, intraclass correlation coefficient = 0.439). With either target distance, repeated measurement was highly correlated (r > 0.9) but the agreement was better at 6.0m (±0.74D) than at 40cm (± 0.92D). Conclusion: The measurements of the amplitude of accommodation with the minus lens technique using targets at far or near are not comparable and the difference between the target distances may provide clinically relevant information. © 2013 Optometrists Association Australia.

Induced vertical disparity effects on local and global stereopsis

Purpose: Although significant amounts of vertical misalignment could have a noticeable effect on visual performance, there is no conclusive evidence about the effect of very small amount of vertical disparity on stereopsis and binocular vision. Hence, the aim of this study was to investigate the effects of induced vertical disparity on local and global stereopsis at near. Materials and Methods: Ninety participants wearing best-corrected refraction had local and global stereopsis tested with 0.5 and 1.0 prism diopter (Δ) vertical prism in front of their dominant and non-dominant eye in turn. This was compared to local and global stereopsis in the same subjects without vertical prism. Data were analyzed in SPSS.17 software using the independent samples T and the repeated measures ANOVA tests. Results: Induced vertical disparity decreases local and global stereopsis. This reduction is greater when vertical disparity is induced in front of the non-dominant eye and affects global more than local stereopsis. Repeated measures ANOVA showed differences in the mean stereopsis between the different measured states for local and global values. Local stereopsis thresholds were reduced by 10s of arc or less on average with 1.0Δ of induced vertical prism in front of either eye. However, global stereopsis thresholds were reduced by over 100s of arc by the same 1.0Δ of induced vertical prism. Conclusion: Induced vertical disparity affects global stereopsis thresholds by an order of magnitude (or a factor of 10) more than local stereopsis. Hence, using a test that measures global stereopsis such as the TNO is more sensitive to vertical misalignment than a test such as the Stereofly that measures local stereopsis. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.

Generalized mean field approximation for parallel dynamics of the Ising model

The dynamics of the non-equilibrium Ising model with parallel updates is investigated using a generalized mean field approximation that incorporates multiple two-site correlations at any two time steps, which can be obtained recursively. The proposed method shows significant improvement in predicting local system properties compared to other mean field approximation techniques, particularly in systems with symmetric interactions. Results are also evaluated against those obtained from Monte Carlo simulations. The method is also employed to obtain parameter values for the kinetic inverse Ising modeling problem, where couplings and local field values of a fully connected spin system are inferred from data. © 2014 IOP Publishing Ltd and SISSA Medialab srl.

Message-passing algorithms for optimal utilization of cognitive radio networks

Cognitive Radio has been proposed as a key technology to significantly improve spectrum usage in wireless networks by enabling unlicensed users to access unused resource. We present new algorithms that are needed for the implementation of opportunistic scheduling policies that maximize the throughput utilization of resources by secondary users, under maximum interference constraints imposed by existing primary users. Our approach is based on the Belief Propagation (BP) algorithm, which is advantageous due to its simplicity and potential for distributed implementation. We examine convergence properties and evaluate the performance of the proposed BP algorithms via simulations and demonstrate that the results compare favorably with a benchmark greedy strategy. © 2013 IEEE.

Stereoacuity as an indicator of prism adaptation

Purpose: The purpose of this study was to determine whether stereoacuity can be used as an indicator of prism adaptation. In particular, we wanted to know whether the time required for stereoacuity to return to the initial level after viewing through a prism can be used to determine the degree of adaptation. Materials and Methods: Eighteen subjects participated in this study. Stereoacuity and dissociated phoria were determined using the TNO stereotest and the Maddox rod, respectively. Prism vergences were measured using a prism bar. For each participant, prism power equivalent to the blur point of base-in (BI) and base-out (BO) fusional vergence at 40 cm was divided and placed in front of both eyes. At 0, 3, 6, 9 and 12 min after prism introduction, the stereoacuity was measured, and at 0 and 12 min, the heterophoria was measured. Results: The repeated measures ANOVA showed a significant difference between the mean stereoacuity for BI and BO prisms at the different measurement times (p < 0.05). For BO prism, the initial value was different between 0 and 3 min after the prism introduction, whereas for BI prism, a difference in stereoacuity was found between the pre-prism value and the value at 0, 3 and 6 min. The size of the heterophoria with BO and BI prisms was different from 0 to 12 min (p < 0.05). Conclusion: The time required for stereoacuity to return to baseline level was more than 3 min for BO, and more than 6 min for BI prism. In addition, the time required to return to baseline values was not similar for the stereoacuity and heterophoria. The recovery of stereoacuity is slower when adapting to divergence, as when looking from near to far. This implies that stereopsis responds faster to near targets than to distant one, and may precede complete phoria adaptation. © 2014 Informa Healthcare USA, Inc. All rights reserved: reproduction in whole or part not permitted.

Defining an OWL ontology that could be used to integrate mental-health risk information within a decision support system

In the field of mental health risk assessment, there is no standardisation between the data used in different systems. As a first step towards the possible interchange of data between assessment tools, an ontology has been constructed for a particular one, GRiST (Galatean Risk Screening Tool). We briefly introduce GRiST and its data structures, then describe the ontology and the benefits that have already been realised from the construction process. For example, the ontology has been used to check the consistency of the various trees used in the model. We then consider potential uses in integration of data from other sources. © 2009 IEEE.