Preparing Leaders in Public Health for Success in a Flatter, More Distributed and Collaborative World

In a world that is rapidly changing, what are the challenges for which leaders in public health in the future need to be prepared, what are the qualities and skills they will need for success, and where will they get the training they require? Addressing each of these questions in succession, this article contends that success in a flatter, more distributed and collaborative world will require a new generation of leaders in public health with new mindsets, an appetite for innovation and interdisciplinary collaboration and a strong dose of political savvy. Faculty, curricula and com­petencies in academic centers play an important role in this equation

Giant Planet Occurrence in the Stellar Mass-Metallicity Plane

Correlations between stellar properties and the occurrence rate of exoplanets can be used to inform the target selection of future planet search efforts and provide valuable clues about the planet formation process. We analyze a sample of 1194 stars drawn from the California Planet Survey targets to determine the empirical functional form describing the likelihood of a star harboring a giant planet as a function of its mass and metallicity. Our stellar sample ranges from M dwarfs with masses as low as 0.2 Msun to intermediate-mass subgiants with masses as high as 1.9 Msun. In agreement with previous studies, our sample exhibits a planet-metallicity correlation at all stellar masses; the fraction of stars that harbor giant planets scales as f \propto 10^{1.2 [Fe/H]}. We can rule out a flat metallicity relationship among our evolved stars (at 98% confidence), which argues that the high metallicities of stars with planets are not likely due to convective envelope "pollution." Our data also rule out a constant planet occurrence rate for [Fe/H]< 0, indicating that giant planets continue to become rarer at sub-Solar metallicities. We also find that planet occurrence increases with stellar mass (f \propto Mstar), characterized by a rise from 3.5% around M dwarfs (0.5 Msun) to 14% around A stars (2 Msun), at Solar metallicity. We argue that the correlation between stellar properties and giant planet occurrence is strong supporting evidence of the core accretion model of planet formation.Comment: Fixed minor typos, modified the last paragraph of Section

Industry Evolution Through Consolidation: Implications for Addiction Treatment.

Drawing on experiences in other industries, this article argues that the business of addiction treatment is likely to be transformed by the advent of a period of consolidation, in which a number of small independent programs will be acquired by larger, better capitalized, and managerially more sophisticated enterprises. Consolidation will be driven by opportunities to leverage new technologies, to exploit new regulatory initiatives, and to introduce economies of scale and scope into an industry that is currently highly fragmented. The process is likely to result in segmentation of the market, with the coexistence of large, generalist, highly standardized firms and a number of small highly specialized firms. When an industry consolidates, the types and quality of services provided can improve through the adoption of best practices and through increased competition among larger providers. If these larger providers are publicly traded, however, efforts to improve will inevitably be influenced by pressures to maintain or increase quarter-to-quarter earnings and share prices, leaving open the long-term impact on service quality

Cultural Variations and the Morphology of Innovation

The relationship between culture and innovation has intrigued researchers for generations. After much research and experimentation, what we know about the relationship is that innovation both shapes and is shaped by culture, and that both culture and innovation can be conceptualized as operating at multiple levels - national, regional, and organizational. We also know that in the management literature, culture has most commonly been conceptualized as an organizational variable - a constellation of norms and values, unique in some respects to every organization, that can, through its influence on behavior of organizational members, either encourage and facilitate innovation or be an obstacle to it

Linking enzyme sequence to function using conserved property difference locator to identify and annotate positions likely to control specific functionality

BACKGROUND: Families of homologous enzymes evolved from common progenitors. The availability of multiple sequences representing each activity presents an opportunity for extracting information specifying the functionality of individual homologs. We present a straightforward method for the identification of residues likely to determine class specific functionality in which multiple sequence alignments are converted to an annotated graphical form by the Conserved Property Difference Locator (CPDL) program. RESULTS: Three test cases, each comprised of two groups of funtionally-distinct homologs, are presented. Of the test cases, one is a membrane and two are soluble enzyme families. The desaturase/hydroxylase data was used to design and test the CPDL algorithm because a comparative sequence approach had been successfully applied to manipulate the specificity of these enzymes. The other two cases, ATP/GTP cyclases, and MurD/MurE synthases were chosen because they are well characterized structurally and biochemically. For the desaturase/hydroxylase enzymes, the ATP/GTP cyclases and the MurD/MurE synthases, groups of 8 (of ~400), 4 (of ~150) and 10 (of >400) residues, respectively, of interest were identified that contain empirically defined specificity determining positions. CONCLUSION: CPDL consistently identifies positions near enzyme active sites that include those predicted from structural and/or biochemical studies to be important for specificity and/or function. This suggests that CPDL will have broad utility for the identification of potential class determining residues based on multiple sequence analysis of groups of homologous proteins. Because the method is sequence, rather than structure, based it is equally well suited for designing structure-function experiments to investigate membrane and soluble proteins

Managing Customization in Health Care: A Framework Derived from the Services Sector Literature

Organizations that provide health services are increasingly in need of systems and approaches that will enable them to be more responsive to the needs and wishes of their clients. Two recent trends, namely, patient-centered care (PCC) and personalized medicine, are first steps in the customization of care. PCC shifts the focus away from the disease to the patient. Personalized medicine, which relies heavily on genetics, promises significant improvements in the quality of healthcare through the development of tailored and targeted drugs. We need to understand how these two trends can be related to customization in healthcare delivery and, because customization often entails extra costs, to define new business models. This article analyze how customization of the care process can be developed and managed in healthcare. Drawing on relevant literature from various services sectors, we have developed a framework for the implementation of customization by the hospital managers and caregivers involved in care pathways

Conclusions: The Global Diffusion of Casemix

The previous chapters have presented summaries of the adoption of patient classification systems (PCS) in fifteen countries around the globe, starting with the US in 1983 and continuing through to Germany in 2005. The purpose of this final chapter is to stand back from the details of each country\u27s experience with patient classification systems and analyze patterns of convergence and divergence in these experiences. The chapters describe some similarities, but also a great deal of variation in the definition, goals, and purposes of PCS from one country to the next as well as in the processes by which these systems were adopted. These differences lead us to ask the following questions: Why do some nations use PCS extensively, including, for example, as a payment method for health care providers, while others rely relatively little on these systems? What accounts for variation in the difficulty and duration of adoption and implementation of PCS across nations? What accounts for variation in the timing of adoption?Why have some nations just begun to use PCS, while others have used them for more than twenty years? Addressing these and related questions is important because the adoption and implementation of these systems remains incomplete both within and across nations. There may well be key lessons to be learned from examining adoption patterns, and these lessons can inform decision makers who are both current and potential users of this technology

The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study.

UnlabelledABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States.MethodsIn-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics.ResultsWe found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice.ConclusionsThe findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes

Antiretroviral Therapy-Associated Acute Motor and Sensory Axonal Neuropathy

Guillain-Barré syndrome (GBS) has been reported in HIV-infected patients in association with the immune reconstitution syndrome whose symptoms can be mimicked by highly active antiretroviral therapy (HAART)-mediated mitochondrial toxicity. We report a case of a 17-year-old, HIV-infected patient on HAART with a normal CD4 count and undetectable viral load, presenting with acute lower extremity weakness associated with lactatemia. Electromyography/nerve conduction studies revealed absent sensory potentials and decreased compound muscle action potentials, consistent with a diagnosis of acute motor and sensory axonal neuropathy. Lactatemia resolved following cessation of HAART; however, neurological deficits minimally improved over several months in spite of immune modulatory therapy. This case highlights the potential association between HAART, mitochondrial toxicity and acute axonal neuropathies in HIV-infected patients, distinct from the immune reconstitution syndrome