The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Rules for mapping a conceptual model onto various data base management systems. Available in 2 volumes.

The design and implementation of data bases involve, firstly, the formulation of a conceptual data model by systematic analysis of the structure and information requirements of the organisation for which the system is being designed; secondly, the logical mapping of this conceptual model onto the data structure of the target data base management system (DBMS); and thirdly, the physical mapping of this structured model into storage structures of the target DBMS. The accuracy of both the logical and physical mapping determine the performance of the resulting systems. This thesis describes research which develops software tools to facilitate the implementation of data bases. A conceptual model describing the information structure of a hospital is derived using the Entity-Relationship (E-R) approach and this model forms the basis for mapping onto the logical model. Rules are derived for automatically mapping the conceptual model onto relational and CODASYL types of data structures. Further algorithms are developed for partly automating the implementation of these models onto INGRES, MIMER and VAX-11 DBMS.

The impact of the language barrier on the management of multinational companies : a case study and survey, based exploration of the impact of the language barrier on the strategies, policies and systems by which multinational companies manage their subsidaries

The thesis begins with a conceptual model of the way that language diversity affects the strategies, organisation and subsidiary control policies of multinational companies. The model is based solely on the researcher'’ personal experience of working in a variety of international management roles, but in Chapter 2 a wide-ranging review of related academic literature finds evidence to support the key ideas. The model is developed as a series of propositions which are tested in a comparative case study, refined and then re-tested in a global survey of multinational subsidiaries. The principal findings of the empirical phases of the thesis endorse the main tenets of the model: - That language difference between parent and subsidiary will impair communication, create mistrust and impede relationship development. - That subsequently the feelings of uncertainty, suspicion and mistrust will influence the decisions taken by the parent company. - They will have heightened sensitivity to language issues and will implement policies to manage language differences. - They will adopt low-risk strategies in host countries where they are concerned about language difference. - They will use organisational and manpower strategies to minimise the consequences and risks of the communications problems with the subsidiary. - As a consequence the level of integration and knowledge flow between parent and subsidiary will be curtailed. - They will adopt styles of control that depend least on their ability to communicate with their subsidiary. Although there is adequate support for all of the above conclusions, on some key points the evidence of the Case Studies and Survey is contradictory. The thesis, therefore, closes with an agenda for further research that would address these inconsistencies.

Collaborative enterprise governance : sustainable management of inter-firm R&D relationships in the German car industry

This research reports on the appropriate governance, i.e. design and management, of inter-firm R&D relationships in order to achieve sustainable competitive success for the whole partnership as well as its individual members. An exploratory study in the German automotive industry using inductive Grounded Theory was conducted. This involved data collection via 28 semi-structured interviews with 16 companies in order to form a set of 35 tentative propositions that have been validated via a questionnaire survey receiving 110 responses from 52 companies. The research has resulted in the consolidation of the validated propositions into a novel concept termed Collaborative Enterprise Governance. The core of the concept is a competence based contingency framework that helps decision makers in selecting the most appropriate governance strategy (i.e. sourcing strategy) for an inter-firm R&D relationship between a buyer and its supplier. Thereby, the concept does not draw on whole company-to-company connectivity. It rather conceptualises an inter-firm relationship to be composed of autonomous cross-functional units of the individual partner companies that contribute value to a particular joint R&D project via the possession of task specific competencies. The novel concept and its elements have been evaluated in a focus group with industrial experts of the German automotive industry and revealed positive effects on the sustainable competitive success of the whole partnership and the individual partner companies. However, it also showed that current practice does not apply the right mechanisms for its implementation and hence guidelines for practitioners and decision makers involved in inter-firm R&D collaboration in the automotive industry are offered on how to facilitate the implementation and usage of the Collaborative Enterprise Governance philosophy.

Human resource management, employee attitudes and business performance in Post Office Ltd

Whilst a consistent link between the adoption of human resource management (HRM) practices by organisations and their performance has been confirmed by numerous studies, there is a need for greater understanding of why such effects occur. Recently, the attention of researchers has shifted towards understanding the so-called ‘black box’ linking HRM and business performance. This study focuses on this area of research by testing processes through which HRM may affect performance, in particular the process of HR implementation, mediation mechanisms, and fit with internal and external boundary conditions. This research was based on a sample of 136 Post Office branches in the UK and investigated the role of HR implementation, employee attitudes and competitive environment. The study revealed that HR implementation, a climate for service, job satisfaction and effective organisational commitment predicted independent measures of economic and service performance in branches. Employee attitudes moderated the relationship between implemented HRM and service performance, and both job satisfaction and commitment were found to mediate relationships between a climate for service and service performance. Finally, relative levels of competition faced by branches moderated the relationship between employee attitudes and sales. The findings demonstrate how the process of HR implementation, interactions with employee attitudes and moderation by external competition all influence the impact of HR systems on service and economic performance outcomes. These results illustrate the need for greater attention to processes of internal and external fit within HRM research in order to develop theory relating to why HR systems affect performance.

Motivation and the gift relationship

This thesis proposes a theory of Motivation to Work, as a particular condition of general motivation, using the Maussian concept of the Gift to explain the operation of Lacanian Desire. Specifically, it argues that de-motivation stems from Gift rejection. However, as the arguments are not paradigmatically commensurable with managerialist theories, it has been necessary to establish the epistemological tradition of which this work is representative, namely, Critical Theory and Post-Structuralism/Post- Modernism. In distinction to the managerialist explanations of motivation, management and work, behaviourist theories of motivation are characterised as more properly a concern with psychological incentives, management in its current socio-historic institutionalised form as a process of social domination and work as a social experience of domination, but also as a forum for social life generally. However, as such a view receives little theoretical or empirical confirmation from managerialist literature, it is argued that it is necessary to broaden the catchment area of relevant writing, and that the literary arts have more insight than orthodox science. This is supported by reference to modern literary theory in terms of the Form/Content distinction. Central to this argument is the ontological concept of Difference and its `political' use in maintaining social domination by privileging certain forms over others. Having established the basis on which to articulate this theory of motivation, the Lacanian concept of Desire is explored, together with its relevance to motivation and management/organisation theory. The theory of the Gift Relationship is then explicated and developed, together with some of its popular sociological conceptualisations, and an argument made for an understanding in terms of its psychological signficance in explaining the operationalisation of Lacanian Desire. This is related to the work situation and to its relevance for organisational management. In conclusion, its utility is considered, as are some potential criticisms of the arguments put forward.

The application of remote sensing to the management of urban wildlife habitats

The project set out with two main aims. The first aim was to determine whether large scale multispectral aerial photography could be used to successfully survey and monitor urban wildlife habitats. The second objective was to investigate whether this data source could be used to predict population numbers of selected species expected to be found in a particular habitat type. Panchromatic, colour and colour infra-red, 1:2500 scale aerial photographs, taken in 1981 and 1984, were used. For the orderly extraction of information from the imagery, an urban wildlife habitat classification was devised. This was based on classifications already in use in urban environments by the Nature Conservancy Council. Pilot tests identified that the colour infra-red imagery provided the most accurate results about urban wildlife habitats in the study area of the Blackbrook Valley, Dudley. Both the 1981 and 1984 colour infra-red photographs were analysed and information was obtained about the type, extent and distribution of habitats. In order to investigate whether large scale aerial photographs could be used to predict likely animal population numbers in urban environments, it was decided to limit the investigation to the possible prediction of bird population numbers in Saltwells Local Nature Reserve. A good deal of research has already been completed into the development of models to predict breeding bird population numbers in woodland habitats. These models were analysed to determine whether they could be used successfully with data extracted from the aerial photographs. The projects concluded that 1:2500 scale colour infra-red photographs can provide very useful and very detailed information about the wildlife habitats in an urban area. Such imagery can also provide habitat area data to be used with population predictive models of woodland breeding birds. Using the aerial photographs, further investigations into the relationship between area of habitat and the breeding of individual bird species were inconclusive and need further research.

Budgeting, budgetary control and management information in the highways departments

The need for an adequate information system for the Highways Departments in the United Kingdom has been recognised by the report of a committee presented to the Minister of Transport in 1970, (The Marshall Report). This research aims to present a comprehensive information system on a sound theoretical basis which should enable the different levels of management to execute their work adequately. The suggested system presented in this research covers the different functions of the Highways Department, and presents a suggested solution for problems which may occur during the planning and controlling of work in the different locations of the Highways Department. The information system consists of:- 1. A coding system covering the cost units, cost centres and cost elements. 2. Cost accounting records for the cost units and cost centres. 3. A budgeting and budgetary control system covering, the different planning methods and procedures which are required for preparing the capital expenditure budget, the improvement and maintenance operation flexible budgets and programme of work, the plant budget, the administration budget, and the purchasing budget. 4. A reporting system which ensures that the different levels of management are receiving relevant and timely information. 5. The flow of documents which covers the relationship between the prime documents, the cost accounting records, budgets, reports and their relation to the different sections and offices within the department. A comprehensive cost units, cost centres, and cost elements codes together with a number of examples demonstrating the results of the survey, and examples of the application and procedures of the suggested information system have been illustrated separately as appendices. The emphasis is on the information required for internal control by management personnel within the County Council.

The development and operation of the effective interpersonal relationship skills relevant to career development problems from staff assessment at an industrial research laboratory

This study concerns the application of a model of effective interpersonal relationships to problems arising from staff assessment at I.C.I. Ltd. Corporate Laboratory between 1972 and 1974. In collaboration with academic and industrial supervision, the study commenced with a survey of management and supervisor opinions about the effectiveness of current staff (work) relationships, with particular reference to the problem of recognising and developing creative potential. This survey emphasised a need to improve the relationships between staff in the staff assessment context. A survey of research into creativity emphasised the importance of the interpersonal environment for obtaining creative behaviour in an organisation context. A further survey of theories of how inter­personal behaviour related to personal creativity (therapeutic psychology) provided a model of effective interpersonal behaviour (Carkhuff, 1969) that could be applied to the organisation context of staff assessment. The objective of the project was redefined as a need to improve the conditions of interpersonal behaviour in relation to certain (career development) problems arising from staff assessment practices. In order to demonstrate the application of the model of effective interpersonal behaviour, the research student recorded interviews between himself and members of staff designed to develop and operate the dimensions of the model. Different samples of staff were used to develop the 'facilitative' and the 'action oriented' dimensions of bahaviour, and then for the operation of a helping programme (based on vocational guidance tests). These interactions have been analysed, according to the scales of measurement in the model ana the results are presented in case study form in this thesis. At each stage of the project, results and conclusions were presented to the sponsoring organisation (e.g. industrial supervisor) in order to assess their (subjective) opinion of relevance to the organ­ isation. Finally, recommendations on further actions towards general improvement of the work relationships in the laboratory were presented in a brief report to the sponsor.

Diversity faultlines, shared objectives, and top management team performance

Faultline theory suggests that negative effects of team diversity are better understood by considering the influence of different dimensions of diversity in conjunction, rather than for each dimension separately. We develop and extend the social categorization analysis that lies at the heart of faultline theory to identify a factor that attenuates the negative influence of faultlines: the extent to which the team has shared objectives. The hypothesized moderating role of shared objectives received support in a study of faultlines formed by differences in gender, tenure, and functional background in 42 top management teams. The focus on top management teams has the additional benefit of providing the first test of the relationship between diversity faultlines and objective indicators of organizational performance. We discuss how these findings, and the innovative way in which we operationalized faultlines, extend faultline theory and research as well as offer guidelines to manage diversity faultlines.

The role of line managers in employee career management:an attachment theory perspective

Line managers increasingly play a key role in organizational career development systems, yet few studies have examined the nature of this role or its implications for employee career attitudes and behaviors. In two studies, we used attachment theory to explore this issue. In Study 1, in-depth interviews (N = 20) showed that employees viewed career management as a relational process in which line managers are expected to act as ‘caregiver’ to support individualized career development. Study 2 was a large-scale international survey (N = 891). Participants scoring higher on attachment avoidance in their line manager relationships reported more negative perceptions of career growth opportunities, lower participation in organizational career development activities and higher turnover intentions. Trust in the organization partially mediated the relationship. Theoretical and practical implications for HRM are discussed.

An exploratory study of the role of trust in medication management within mental health services

Objective - To develop understandings of the nature and influence of trust in the safe management of medication within mental health services. Setting - Mental health services in the UK. Method - Qualitative methods were applied through focus groups across three different categories of service user—older adult, adults living in the community and forensic services. An inductive thematic analysis was carried out, using the method of constant comparison derived from grounded theory. Main Outcome - Measure Participants’ views on the key factors influencing trust and the role of trust in safe medication management. Results - The salient factors impacting trust were: the therapeutic relationship; uncertainty and vulnerability; and social control. Users of mental health services may be particularly vulnerable to adverse events and these can damage trust. Conclusion - Safe management of medication is facilitated by trust. However, this trust may be difficult to develop and maintain, exposing service users to adverse events and worsening adherence. Practice and policy should be oriented towards developing trust.

Social network theory and the sales manager role:engineering the right relationship flows

Sales leadership research has typically taken a leader-focused approach, investigating key questions from a top-down perspective. Yet considerable research outside sales has advocated a view of leadership that takes into account the fact that employees look beyond a single designated individual for leadership. In particular, the social networks of leaders have been a popular topic of investigation in the management literature, although coverage in the sales literature remains rare. The present paper conceptualizes the sales leadership role as one in which the leader must manage a network of simultaneous relationships; several types of sales manager relationships, such as the sales-manager-to-top-manager and the sales-manager-to-sales manager relationships, have received limited attention in the sales literature to date. Taking an approach based on social network theory, we develop a conceptualization of the sales manager as a "network engineer," who must manage multiple relationships, and the flows between them. Drawing from this model, we propose a detailed agenda for future sales research. © 2012 PSE National Educational Foundation. All rights reserved.