Crafting A Human Resource Strategy To Foster Organizational Agility: A Case Study

A decade ago, the CEO of Albert Einstein Healthcare Network (AEHN), anticipating a tumultuous and largely unpredictable period in its industry, undertook to convert this organization from one that was basically stable and complacent to one that was agile, “nimble, and change-hardy”. This case study briefly addresses AEHN’s approaches to business strategy and organization design, but focuses primarily on the human resource strategy that emerged over time to foster the successful attainment of organizational agility. Although exploratory, the study suggests a number of lessons for those who are, or will be, studying or trying to create and sustain this promising new organizational paradigm

Probabilistic Insurance

Probabilistic insurance is an insurance policy involving a small probability that the consumer will not be reimbursed. Survey data suggest that people dislike probabilistic insurance and demand more than a 20% reduction in the premium to compensate for a 1% default risk. While these preferences are intuitively appealing they are difficult to reconcile with expected utility theory. Under highly plausible assumptions about the utility function, willingness to pay for probabilistic insurance should be very close to willingness to pay for standard insurance less the default risk. However, the reluctance to buy probabilistic insurance is predicted by the weighting function of prospect theory. This finding highlights the potential role of the weighting function to explain insurance

Photometry and Photometric Redshifts of Faint Galaxies in the Hubble Deep Field South NICMOS Field

We present a catalog of photometry and photometric redshifts of 335 faint objects in the HDF-S NICMOS field. The analysis is based on (1) infrared images obtained with the Hubble Space Telescope (HST) using the Near Infrared Camera and Multi-Object Spectrograph (NICMOS) with the F110W, F160W, and F222M filters, (2) an optical image obtained with HST using the Space Telescope Imaging Spectrograph (STIS) with no filter, and (3) optical images obtained with the European Southern Observatory (ESO) Very Large Telescope (VLT) with U, B, V, R, and I filters. The primary utility of the catalog of photometric redshifts is as a survey of faint galaxies detected in the NICMOS F160W and F222M images. The sensitivity of the survey varies significantly with position, reaching a limiting depth of AB(16,000) ~ 28.7 and covering 1.01 arcmin^2 to AB(16,000) = 27 and 1.05 arcmin^2 to AB(16,000) = 26.5. The catalog of photometric redshifts identifies 21 galaxies (or 6% of the total) of redshift z > 5, 8 galaxies (or 2% of the total) of redshift z > 10, and 11 galaxies (or 3% of the total) of best-fit spectral type E/S0, of which 5 galaxies (or 1% of the total) are of redshift z > 1.Comment: 33 pages, 10 figures, accepted for publication in the Astrophysical Journal, August 1, 2000 issu

Improving workflow for adaptive proton therapy with predictive anatomical modelling: A proof of concept

PURPOSE: To demonstrate predictive anatomical modelling for improving the clinical workflow of adaptive intensity-modulated proton therapy (IMPT) for head and neck cancer. METHODS: 10 radiotherapy patients with nasopharyngeal cancer were included in this retrospective study. Each patient had a planning CT, weekly verification CTs during radiotherapy and predicted weekly CTs from our anatomical model. Predicted CTs were used to create predicted adaptive plans in advance with the aim of maintaining clinically acceptable dosimetry. Adaption was triggered when the increase in mean dose (Dmean) to the parotid glands exceeded 3Gy(RBE). We compared the accumulated dose of two adaptive IMPT strategies: 1) Predicted plan adaption: One adaptive plan per patient was optimised on a predicted CT triggered by replan criteria. 2) Standard replan: One adaptive plan was created reactively in response to the triggering weekly CT. RESULTS: Statistical analysis demonstrates that the accumulated dose differences between two adaptive strategies are not significant (p>0.05) for CTVs and OARs. We observed no meaningful differences in D95 between the accumulated dose and the planned dose for the CTVs, with mean differences to the high-risk CTV of -1.20%, -1.23% and -1.25% for no adaption, standard and predicted plan adaption, respectively. The accumulated parotid Dmean using predicted plan adaption is within 3Gy(RBE) of the planned dose and 0.31Gy(RBE) lower than the standard replan approach on average. CONCLUSION: Prediction-based replanning could potentially enable adaptive therapy to be delivered without treatment gaps or sub-optimal fractions, as can occur during a standard replanning strategy, though the benefit of using predicted plan adaption over the standard replan was not shown to be statistically significant with respect to accumulated dose in this study. Nonetheless, a predictive replan approach can offer advantages in improving clinical workflow efficiency

Raising a Small Flock of Sheep in Ohio

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Home Monitoring to Detect Progression of Interstitial Lung Disease:A Prospective Cohort Study

In this prospective observational cohort study, 20 IPF and non-IPF patients, as diagnosed by a multidisciplinary team were recruited from the University College London Hospital (UCLH) between August 2021 and January 2022 using 2018 ATS criteria. Patients who met the criteria for ILD other than IPF, including those with sarcoidosis, and hypersensitivity pneumonitis, were grouped together as non-IPF. They were monitored over 26 weeks using the RADAR-Base mHealth platform. Data collection tools included: questionnaires, a Garmin wearable device, finger pulse oximeter and a NuvoAir smart-spirometer.7 In addition, participants underwent lung function testing in a hospital setting as part of their usual hospital visits. Patients were divided into two groups: progressed and stable. Progression was defined as a ≥5% decline in forced vital capacity (FVC) at6 months by hospital-based spirometry and/or death

Standardized treatment planning methodology for passively scattered proton craniospinal irradiation

Background: As the number of proton therapy centers increases, so does the need for studies which compare proton treatments between institutions and with photon therapy. However, results of such studies are highly dependent on target volume definition and treatment planning techniques. Thus, standardized methods of treatment planning are needed, particularly for proton treatment planning, in which special consideration is paid to the depth and sharp distal fall-off of the proton distribution. This study presents and evaluates a standardized method of proton treatment planning for craniospinal irradiation (CSI).Methods: We applied our institution\u27s planning methodology for proton CSI, at the time of the study, to an anatomically diverse population of 18 pediatric patients. We evaluated our dosimetric results for the population as a whole and for the two subgroups having two different age-specific target volumes using the minimum, maximum, and mean dose values in 10 organs (i.e., the spinal cord, brain, eyes, lenses, esophagus, lungs, kidneys, thyroid, heart, and liver). We also report isodose distributions and dose-volume histograms (DVH) for 2 representative patients. Additionally we report population-averaged DVHs for various organs.Results: The planning methodology here describes various techniques used to achieve normal tissue sparing. In particular, we found pronounced dose reductions in three radiosensitive organs (i.e., eyes, esophagus, and thyroid) which were identified for optimization. Mean doses to the thyroid, eyes, and esophagus were 0.2%, 69% and 0.2%, respectively, of the prescribed dose. In four organs not specifically identified for optimization (i.e., lungs, liver, kidneys, and heart) we found that organs lateral to the treatment field (lungs and kidneys) received relatively low mean doses (less than 8% of the prescribed dose), whereas the heart and liver, organs distal to the treatment field, received less than 1% of the prescribed dose.Conclusions: This study described and evaluated a standardized method for proton treatment planning for CSI. Overall, the standardized planning methodology yielded consistently high quality treatment plans and perhaps most importantly, it did so for an anatomically diverse patient population. © 2013 Giebeler et al.; licensee BioMed Central Ltd

BOLD Coupling between Lesioned and Healthy Brain Is Associated with Glioma Patients’ Recovery

This article belongs to the Special Issue Perioperative Imaging and Mapping Methods in Glioma Patients.[Simple Summary] Glioma, a type of brain tumour, affects not only the function of immediately adjacent brain tissue but also that in more distant areas, potentially impacting cognitive function after its surgical removal. Here, 17 patients with glioma had brain scans and tests of cognitive function during treatment and recovery. We investigated the effects of glioma on the brain, and what happens during recovery, using the brain’s “global signal” detected with magnetic resonance imaging (MRI). We found that the signal from gliomas was synchronised with the global signal in all patients and that this synchronisation was associated with the recovery of cognition after surgery. Specifically, patients with a greater reduction in glioma–global signal synchronisation following surgery were more likely to have a larger number of newly acquired cognitive difficulties. Together, these results suggest that the interaction between gliomas and the brain can predict how patients recover their cognitive abilities, which is important for their quality of life.[Abstract] Predicting functional outcomes after surgery and early adjuvant treatment is difficult due to the complex, extended, interlocking brain networks that underpin cognition. The aim of this study was to test glioma functional interactions with the rest of the brain, thereby identifying the risk factors of cognitive recovery or deterioration. Seventeen patients with diffuse non-enhancing glioma (aged 22–56 years) were longitudinally MRI scanned and cognitively assessed before and after surgery and during a 12-month recovery period (55 MRI scans in total after exclusions). We initially found, and then replicated in an independent dataset, that the spatial correlation pattern between regional and global BOLD signals (also known as global signal topography) was associated with tumour occurrence. We then estimated the coupling between the BOLD signal from within the tumour and the signal extracted from different brain tissues. We observed that the normative global signal topography is reorganised in glioma patients during the recovery period. Moreover, we found that the BOLD signal within the tumour and lesioned brain was coupled with the global signal and that this coupling was associated with cognitive recovery. Nevertheless, patients did not show any apparent disruption of functional connectivity within canonical functional networks. Understanding how tumour infiltration and coupling are related to patients’ recovery represents a major step forward in prognostic development.This research was supported by the Guarantors of Brain, Cancer Research UK Cambridge Centre, The Brain Tumour Charity and the EMERGIA Junta de Andalucia program. Y.E. is funded by a Royal Society Dorothy Hodgkin Research Fellowship (DHF130100). JMG is funded by the Ministerio de Ciencia e Innovación (España)/FEDER under the RTI2018-098913-B100 project, by the Consejería de Economía, Innovación, Ciencia y Empleo (Junta de Andalucía) and FEDER under CV20-45250, A-TIC-080-UGR18, B-TIC-586-UGR20 and P20-00525 projects. MA was funded by a Cambridge Trust—Yousef Jameel Scholarship. This research was also supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014). SJP (NIHR Career Development Fellowship, CDF-2018-11-ST2-003) is funded by the National Institute for Health Research (NIHR) for this research project

Photorhabdus adhesion modification protein (Pam) binds extracellular polysaccharide and alters bacterial attachment.

Journal ArticleResearch Support, Non-U.S. Gov'tBACKGROUND: Photorhabdus are Gram-negative nematode-symbiotic and insect-pathogenic bacteria. The species Photorhabdus asymbiotica is able to infect humans as well as insects. We investigated the secreted proteome of a clinical isolate of P. asymbiotica at different temperatures in order to identify proteins relevant to the infection of the two different hosts. RESULTS: A comparison of the proteins secreted by a clinical isolate of P. asymbiotica at simulated insect (28 degrees C) and human (37 degrees C) temperatures led to the identification of a small and highly abundant protein, designated Pam, that is only secreted at the lower temperature. The pam gene is present in all Photorhabdus strains tested and shows a high level of conservation across the whole genus, suggesting it is both ancestral to the genus and probably important to the biology of the bacterium. The Pam protein shows limited sequence similarity to the 13.6 kDa component of a binary toxin of Bacillus thuringiensis. Nevertheless, injection or feeding of heterologously produced Pam showed no insecticidal activity to either Galleria mellonella or Manduca sexta larvae. In bacterial colonies, Pam is associated with an extracellular polysaccharide (EPS)-like matrix, and modifies the ability of wild-type cells to attach to an artificial surface. Interestingly, Surface Plasmon Resonance (SPR) binding studies revealed that the Pam protein itself has adhesive properties. Although Pam is produced throughout insect infection, genetic knockout does not affect either insect virulence or the ability of P. luminescens to form a symbiotic association with its host nematode, Heterorhabditis bacteriophora. CONCLUSIONS: We studied a highly abundant protein, Pam, which is secreted in a temperature-dependent manner in P. asymbiotica. Our findings indicate that Pam plays an important role in enhancing surface attachment in insect blood. Its association with exopolysaccharide suggests it may exert its effect through mediation of EPS properties. Despite its abundance and conservation in the genus, we find no evidence for a role of Pam in either virulence or symbiosis.BBSRCWellcome TrustEMBEK