When research setting is important: the influence of subordinate self-esteem on reactions to abusive supervision

In this paper, we argue that the conflicting theoretical views regarding the role that self-esteem plays in the decision to become aggressive can be explained by the particular research methodology used. Specifically, we examine how individuals respond to a perceived abusive supervisor in two settings: (1) using scenarios and (2) in a field study. Results indicate that individuals with high selfesteem are more likely to become aggressive in response to an abusive supervisor in settings where they are asked what they would do (using scenarios). However, in field research settings, where they are asked what they did do, individuals with low self-esteem were more likely to become aggressive in response to an abusive supervisor

Effects of Management Support, Team Member Support, and Job Status on Safety Climate and Employee Attitudes

This study examined the impact of management and team member support on employee attitudes through the mediating effect of safety climate. Five hundred fifty-six physicians and nurses from a large teaching hospital in the eastern United States completed survey items assessing their perceptions of management support, team member support, and safety climate as well as job satisfaction and organizational commitment. Results indicated that while job satisfaction and commitment were directly affected by perceptions of management and team member support, these relationships were also partially mediated by safety climate. In addition, the results suggested that team member support contributed to the prediction of safety climate over and above the effect of management support alone indicating that multiple sources of support may be important in developing positive safety climates. The hypothesized moderating effect of job status was not significant. Implications of the results and suggestions for future research are discussed

Increased hemorrhagic transformation and altered infarct size and localization after experimental stroke in a rat model type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>Interruption of flow through of cerebral blood vessels results in acute ischemic stroke. Subsequent breakdown of the blood brain barrier increases cerebral injury by the development of vasogenic edema and secondary hemorrhage known as hemorrhagic transformation (HT). Diabetes is a risk factor for stroke as well as poor outcome of stroke. The current study tested the hypothesis that diabetes-induced changes in the cerebral vasculature increase the risk of HT and augment ischemic injury.</p> <p>Methods</p> <p>Diabetic Goto-Kakizaki (GK) or control rats underwent 3 hours of middle cerebral artery occlusion and 21 h reperfusion followed by evaluation of infarct size, hemorrhage and neurological outcome.</p> <p>Results</p> <p>Infarct size was significantly smaller in GK rats (10 ± 2 vs 30 ± 4%, p < 0.001). There was significantly more frequent hematoma formation in the ischemic hemisphere in GK rats as opposed to controls. Cerebrovascular tortuosity index was increased in the GK model (1.13 ± 0.01 vs 1.34 ± 0.06, P < 0.001) indicative of changes in vessel architecture.</p> <p>Conclusion</p> <p>These findings provide evidence that there is cerebrovascular remodeling in diabetes. While diabetes-induced remodeling appears to prevent infarct expansion, these changes in blood vessels increase the risk for HT possibly exacerbating neurovascular damage due to cerebral ischemia/reperfusion in diabetes.</p

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda

Abstract Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Matching Commitment to Supervisors and Organizations to In-Role and Extra-Role Performance

There are mixed findings regarding the relations between affective and continuance commitment and job performance. However, past research has largely disregarded the concept of commitment foci and overlooked the importance of matching commitment foci to the target of performance-related behavior. In this study, supervisors rated 189 employees on 2 types of performance hypothesized to be directed more toward supervisors than organizations: in-role performance and courtesy. They also rated 2 types hypothesized to be directed more toward organizations than supervisors: civic virtue and loyal boosterism. After controlling for other forms of commitment, affective commitment to supervisors explained unique variance in in-role performance and courtesy. Affective commitment to organizations did not. After controlling for other forms of commitment, affective commitment to organizations explained unique variance in loyal boosterism. Affective commitment to supervisors did not. Continuance commitment to supervisors and organizations was unrelated to performance. Implications for research and practice are discussed

When Research Setting is Important: The Influence of Subordinate Self-Esteem on Reactions to Abusive Supervision

In this paper, we argue that the conflicting theoretical views regarding the role that self-esteem plays in the decision to become aggressive can be explained by the particular research methodology used. Specifically, we examine how individuals respond to a perceived abusive supervisor in two settings: 1) using scenarios and 2) in a field study. Results indicate that individuals with high self-esteem are more likely to become aggressive in response to an abusive supervisor in settings where they are asked what they would do (using scenarios). However, in field research settings, where they are asked what they did do, individuals with low self-esteem were more likely to become aggressive in response to an abusive supervisor

How cultural values affect the impact of abusive supervision on worker attitudes

Purpose - The purpose of this paper is to analyze the impact of cultural values on the relationship between abusive supervision, or workplace bullying, and worker job attitudes such as job satisfaction, job involvement, negative well-being and perceived organizational support. Design/methodology/approach - The authors used a survey to collect cross-cultural data from workers in the USA and South Korea to test hypotheses regarding how cultural values affect the impact of abusive supervision on employee attitudes. Unlike previous research, the authors measured cultural values directly, rather than using nation as a proxy for culture. Findings - It was found that the effects of abusive supervision on workers' job-related attitudes are moderated by some, but not all, cultural values. In particular, moderating effects were found for Schwartz' achievement and benevolence values, but not for power values. Additionally, evidence was found that some of the measures commonly used in organizational research are not invariant across cultures. Originality/value - Although the incidence of abusive supervision has been well documented in the USA and research on the causes and consequences of abusive supervision has grown steadily, very few studies have examined this topic in a cross-cultural context. This study addresses this important, yet under-researched issue by examining the joint effects of cultural values and abusive supervision on employee attitudes, using a cross-cultural sample of workers. Copyright © 2011 Emerald Group Publishing Limited. All rights reserved.link_to_subscribed_fulltex

Defeating Abusive Supervision: Training Supervisors to Support Subordinates

Although much is known about the antecedents and consequences of abusive supervision, scant attention has been paid to investigating procedures to reduce its frequency. We conducted a quasiexperiment to examine the effects of supervisor support training on subordinate perceptions of abusive supervision and supervisor support. Supervisors (n = 23) in 4 restaurants were trained in 4 supportive supervision strategies (benevolence, sincerity, fairness, and experiential processing) during 4 2-hr sessions over a period of 2 months. We compared perceived supervisor support and abusive supervision before and 9 months after training for 208 employees whose supervisors received support training and 241 employees in 4 similar control restaurants. Compared to employees in the control restaurants, employees whose supervisors received the support training reported higher levels of perceived supervisor support and less abusive supervision. These findings suggest that a relatively brief training program can help managers become more supportive and less abusive. Theoretical and practical implications for effectively managing abusive supervision are discussed