Comparative effectiveness of long term drug treatment strategies to prevent asthma exacerbations: network meta-analysis

Objective To determine the comparative effectiveness and safety of current maintenance strategies in preventing exacerbations of asthma. Design Systematic review and network meta-analysis using Bayesian statistics. Data sources Cochrane systematic reviews on chronic asthma, complemented by an updated search when appropriate. Eligibility criteria Trials of adults with asthma randomised to maintenance treatments of at least 24 weeks duration and that reported on asthma exacerbations in full text. Low dose inhaled corticosteroid treatment was the comparator strategy. The primary effectiveness outcome was the rate of severe exacerbations. The secondary outcome was the composite of moderate or severe exacerbations. The rate of withdrawal was analysed as a safety outcome. Results 64 trials with 59 622 patient years of follow-up comparing 15 strategies and placebo were included. For prevention of severe exacerbations, combined inhaled corticosteroids and long acting β agonists as maintenance and reliever treatment and combined inhaled corticosteroids and long acting β agonists in a fixed daily dose performed equally well and were ranked first for effectiveness. The rate ratios compared with low dose inhaled corticosteroids were 0.44 (95% credible interval 0.29 to 0.66) and 0.51 (0.35 to 0.77), respectively. Other combined strategies were not superior to inhaled corticosteroids and all single drug treatments were inferior to single low dose inhaled corticosteroids. Safety was best for conventional best (guideline based) practice and combined maintenance and reliever therapy. Conclusions Strategies with combined inhaled corticosteroids and long acting β agonists are most effective and safe in preventing severe exacerbations of asthma, although some heterogeneity was observed in this network meta-analysis of full text reports.

EU actorness and effectiveness under political pressure at the Copenhagen climate change negotiations

This paper analyses the extent of European Union (EU) actorness and effectiveness at the fifteenth United Nations Framework Convention on Climate Change (UNFCCC) Conference of the Parties (COP) meeting in Copenhagen in December 2009. For over a decade the European Union has been characterised as a leader in international climate policy-making and as an important actor in international climate change negotiations. The COP15 meeting in Copenhagen has overall brought about disappointing outcomes, especially from the perspective of the European Union. This casts doubts on EU leadership and begs the question of what has happened to EU actorness and effectiveness in this field. In terms of actorness we take Jupille and Caporaso (1998) as a point of departure and then specify a more parsimonious actorness framework that consists of cohesion and autonomy. Effectiveness (i.e. goal attainment) is seen as conceptually separate from actorness. Effectiveness is conceptualised as the result of actorness conditioned by the ‘opportunity structure’, i.e. the external context (of other actors, events and ideas) that enables or constrains EU actions. We hold that the EU’s actorness has been only moderate, especially given somewhat limited preference cohesion. In terms of the opportunity structure in Copenhagen we argue that the high degree of politicisation constrained the EU’s ability to negotiate and thus to attain its goals. Another external factor that had a substantial adverse impact on the EU’s effectiveness at the Copenhagen negotiations was the strong involvement of other actors with rather different positions, namely the United States (US) and the BASIC countries (Brazil, South Africa, India, and China).

Impaired Antigen Presentation and Effectiveness of Combined Active/Passive Immunotherapy for Epithelial Tumors

Background: Although immunization with tumor antigens can eliminate many transplantable tumors in animal models, immune effector mechanisms associated with successful immunotherapy of epithelial cancers remain undefined. Methods: Skin from transgenic mice expressing the cervical cancer-associated tumor antigen human papillornavirus type 16 (HPV16) E6 or E7 proteins from a keratin 14 promoter was grafted onto syngeneic, non-transgenic mice. Skin graft rejection was measured after active immunization with HPV16 E7 and adoptive transfer of antigen-specific T cells. Cytokine secretion of lymphocytes from mice receiving skin grafts and immunotherapy was detected by enzyme-linked immunosorbent assay, and HPV16 E7-specific memory CD8(+) T cells were detected by flow cytometry and ELISPOT. Results: Skin grafts containing HPV16 E6- or E7-expressing keratinocytes were not rejected spontaneously or following immunization with E7 protein and adjuvant. Adoptive transfer of E7-specific T-cell receptor transgenic CD8(+) T cells combined with immunization resulted in induction of antigen-specific interferon gamma-secreting CD8(+) T cells and rejection of HPV16 E7-expressing grafts. Specific memory CD8(+) T cells were generated by immunotherapy. However, a further HPV16 E7 graft was rejected from animals with memory T cells only after a second E7 immunization. Conclusions: Antigen-specific CD8(+) T cells can destroy epithelium expressing HPV16 E7 tumor antigen, but presentation of E7 antigen from skin is insufficient to reactivate memory CD8(+) T cells induced by immunotherapy. Thus, effective cancer immunotherapy in humans may need to invoke sufficient effector as well as memory T cells.

Effective leadership in salient groups: Revisiting leader-member exchange theory from the perspective of the social identity theory of leadership

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring Work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high- than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not Prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.

Developmental stability and leadership effectiveness

Developmental stability is the degree to which we can withstand environmental or genetic stressors during development. Fluctuating asymmetry (FA), concerns the extent to which the right and left side of the body is asymmetrical and is one way to measure developmental stability. Two studies were carried out that examined both the predictive value of leader FA with leadership behaviors and its role in facilitating group performance. The first study examined the hypothesis that a leader's FA is correlated with scores on the Multifactor Leadership Questionnaire (MLQ). The results revealed individuals with a more asymmetrical morphology scored higher on the transformational, but not transactional, dimensions of leadership behavior. A second study examined the hypothesis that asymmetrical morphology and leadership effectiveness would share a positive relationship. In this study participants who led a business game exercise, revealed a positive relationship between FA and self-reported well-being and task satisfaction. Importantly, there was also a positive correlation between the leader's FA score and group performance. The role that developmental stability may play in leadership effectiveness is discussed in the wider context of evolutionary psychology.

Effective leadership in salient groups:revisiting leader-member exchange theory from the perspective of the social identity theory of leadership

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high-than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.

Team effectiveness: a test of in-put process-output

This research addressed the question: "Which factors predict the effectiveness of healthcare teams?" It was addressed by assessing the psychometric properties of a new measure of team functioning with the use of data collected from 797 team members in 61 healthcare teams. This new measure is the Aston Team Performance Inventory (ATPI) developed by West, Markiewicz and Dawson (2005) and based on the IPO model. The ATPI was pilot tested in order to examine the reliability of this measure in the Jordanian cultural context. A sample of five teams comprising 3-6 members each was randomly selected from the Jordan Red Crescent health centers in Amman. Factors that predict team effectiveness were explored in a Jordanian sample (comprising 1622 members in 277 teams with 255 leaders from healthcare teams in hospitals in Amman) using self-report and Leader Ratings measures adapted from work by West, Borrill et al (2000) to determine team effectiveness and innovation from the leaders' point of view. The results demonstrate the validity and reliability of the measures for use in healthcare settings. Team effort and skills and leader managing had the strongest association with team processes in terms of team objectives, reflexivity, participation, task focus, creativity and innovation. Team inputs in terms of task design, team effort and skills, and organizational support were associated with team effectiveness and innovation whereas team resources were associated only with team innovation. Team objectives had the strongest mediated and direct association with team effectiveness whereas task focus had the strongest mediated and direct association with team innovation. Finally, among leadership variables, leader managing had the strongest association with team effectiveness and innovation. The theoretical and practical implications of this thesis are that: team effectiveness and innovation are influenced by multiple factors that must all be taken into account. The key factors managers need to ensure are in place for effective teams are team effort and skills, organizational support and team objectives. To conclude, the application of these findings to healthcare teams in Jordan will help improve their team effectiveness, and thus the healthcare services that they provide.

When creativity enhances sales effectiveness:the moderating role of leader–member exchange

This study extends research on creativity by exploring the boundary conditions of the creativity-job effectiveness relationship. Building on social exchange theory, we argue that the extent to which employee creativity is related to sales - an objective work effectiveness measure - depends on the quality of leader-member exchange (LMX). We hypothesize that the relationship between creativity and sales is significant and positive when LMX is high, but not when LMX is low. Hierarchical linear modelling analysis provided support for the interaction hypothesis in a sample of 151 sales agents and 26 supervisors drawn from both pharmaceutical and insurance companies. Results showed that sales agents who were more creative generated higher sales only when they had high quality LMX. An ad-hoc qualitative study provided a more detailed understanding of the moderator role played by LMX. Copyright © 2012 John Wiley & Sons, Ltd.

Leader-member exchange and upward influence: Interrelationships and successful consequences

The relationship between leader-member exchange (LMX) and upward influence was investigated in a field sample of 134 employees in four organizations. These variables were related to three outcome variables comprising an employee's job success: (a) current annual salary, (b) overall job satisfaction, and (c) overall reputational effectiveness. Measures used were the LMX7, revised Influence Tactics Questionnaire, overall job satisfaction, and reputational effectiveness questionnaires. A negative relationship was found between coalitions and upward appeal with quality of LMX. Support was also found for the relationship between quality of LMX and overall job satisfaction. Partial support was found for the relationship between upward influence and success variables. Finally, partial support was found for the addition of quality of LMX above and beyond the control variables and influence tactics in explaining an employee's job success. Avenues for future research are discussed. ^

Adaptation in knowledge-based teams: An examination of team composition, leader sensegiving, and cognitive, behavioral, and motivational mechanisms

Organizations are increasingly relying on teams to do the work that has traditionally been done by individuals. At the same time, the environments in which these organizations and teams operate have been becoming progressively more complex and uncertain. These trends raise important questions about the factors that enable teams to adapt. In response to these questions, the current study sought to identify the cognitive, behavioral, and motivational processes and emergent states that promote a team's adaptation to unforeseen changes and novel events, and the team compositional characteristics and leadership processes that enabled these processes and emergent states. Two hundred twenty two undergraduate students from a large Southeastern University composed 74 3-person teams, and participated in a computerized decision-making simulation where each team formed the governing body (i.e., Mayor's cabinet) for two separate simulated cities, and made strategic decisions about city operations. Participants were randomly assigned to one of three roles, distributing expertise and creating mutual interdependence. External team leader sensegiving was manipulated through video recorded communications from an external team leader. Results indicate that team cognitive ability, achievement striving, and psychological collectivism, as well as external team leader sensegiving, were all related to the similarity and quality of team members' strategy-focused mental models (cognitive emergent states), and to the amount of information sharing among members (behavioral process). In turn, teams with more similar and higher quality mental models, and who shared greater levels of information, were found to have a greater ability to react and adapt to environmental changes, and to have greater levels of decision-making effectiveness. Results indicate a pattern of relationships consistent with hypotheses, and have important implications for organizations and knowledge-based teams charged with management responsibilities. Organizations should staff teams with the compositional characteristics that enable the development of similar and high quality mental models, and that promote information sharing among teammates. Similarly, organizations which train and develop leaders to engage in sensegiving behaviors enable team adaptability and promote enhanced decision-making effectiveness when faced with unforeseen changes and novel situations.

Error Recovery Performance: The Impact of Leader Behavioral Integrity and Job Satisfaction

This article introduces the concept of error recovery performance, followed by the development and validation of an instrument to measure it. The first objective of this article is to broaden the current concept of service recovery to be relevant to the back-of-house operations. The second objective is to examine the influence of leader behavioral integrity (BI) on error recovery performance. Moreover, the study examines the mediating effect of job satisfaction between BI and error recovery performance. Finally, the study links error management performance with work-unit effectiveness. Data for Study 1 were collected from 369 hotel employees in Turkey. The same relationships were tested again in Study 2 to validate the findings of Study 1 with a different sample. Data for Study 2 were collected from 33 departmental managers from the same hotels. Linear regression analysis was used to test the direct effects. The mediating effects were tested using the mediation test suggested by Preacher and Hayes. In addition, in Study 2, general managers of the hotels were asked to rate the effectiveness of each manager and their respective department. Results from Study 1 indicate that BI drives error recovery performance, and this impact is mediated by employee job satisfaction. Results of Study 2 confirm this model and finds further that managers’ self-rated error recovery performance was associated with their general managers’ assessment of their deliverables and of their department’s overall performance.

An Investigation of the Impact of an Aspiring Principals Preparation Program on Principal Leadership Effectiveness

School districts need to “build the bench” to ensure that their schools will have effective principals when vacancies arise (Johnson-Taylor & Martin, 2007). Assistant principals represent a potential pool of new school leaders who are prepared to move confidently into the principalship (Oliver, 2005). Although a critical leader in schools, the assistant principal position is underutilized and under-researched (Oleszewski, Shoho, & Barnett, 2012). This lack of focus on assistant principals is concerning because they are part of the school leadership team and often advance to the position of school principal. The purpose of this study was to examine the impact of Bay City Public Schools’ (a pseudonym) Aspiring Principals Preparation Program (AP3; also a pseudonym) on assistant principals’ learning-centered leadership behaviors, as assessed by the Vanderbilt Assessment of Leadership in Education (Val-Ed) survey. The study compared the Val-Ed scores of assistant principals who had participated in one of three cohorts of AP3 training to the scores of assistant principals who did not participate. The results indicated that participation in the AP3 had no significant impact on respondents’ learning-centered leadership behaviors, as assessed on the VAL-ED instrument. This study may be useful as the district seeks to validate the effectiveness of AP3 and identify potential refinements and program modifications.