Lost in translation: a multi-level case study of the metamorphosis of meanings and action in public sector organisational innovation

This paper explores the early implementation of an organisational innovation in the UK National Health Service (NHS) - Treatment Centres (TCs) - designed to dramatically reduce waiting lists for elective care. The paper draws on case studies of eight TCs (each at varying stages of their development) and aims to explore how meanings about TCs are created and evolve, and how these meanings impact upon the development of the organisational innovation. Research on organisational meanings needs to take greater account of the fact that modern organisations like the NHS are complex multi-level phenomena, comprising layers of interlacing networks. To understand the pace, direction and impact of organisational innovation and change we need to study the interconnections between meanings across different organisational levels. The data presented in this paper show how the apparently simple, relatively unformed, concept of a TC framed by central government, is translated and transmuted by subsequent layers in the health service administration, and by players in local health economies and, ultimately in the TCs themselves, picking up new rationales, meanings, and significance as it goes. The developmental histories of TCs reveal a range of significant re-workings of macro policy with the result that there is considerable diversity and variation between local TC schemes. The picture is of important disconnections between meanings, that in many ways mirror Weick’s (1976) ‘loosely coupled systems’. The emergent meanings and the direction of micro-level development of TCs appear more strongly determined by interactions within the local TC environment, notably between what we identify as groups of ‘idealists’, ‘pragmatists’, ‘opportunists’ and ‘sceptics’ than by the framing (Goffman 1974) provided by macro and meso organisational levels. While this illustrates the limitations of top down and policy-driven attempts at change, and highlights the crucial importance of the front-line local ‘micro-systems’ (Donaldson & Mohr, 2000) in the overall scheme of implementing organisational innovations, the space or headroom provided by frames at the macro and meso levels can enable local change, albeit at variable speed and with uncertain outcomes

Terror management theory: A theoretical perspective on orgination, maintenance, and research

Research suggests that humans engage in several worldview defense mechanisms to shield against the terror associated with an awareness of mortality (Greenberg, Pyszczynski, & Solomon, 1986). To mitigate anxiety, people strongly adhere to their cultural worldviews that allow them to boost their self-esteem. This self-esteem fosters a sense of immortality because the world is considered a \u27just place that will not harm someone that is living in adherence to cultural guidelines (Rosenblatt, Greenberg, Solomon, Pyszczynski, & Lyon, 1989). This paper provides a theoretical background for Terror Management Theory including its philosophical origination, the primary tenets of the theory, and the experimental methods used to manipulate death awareness

The relationship of religiosity to psychopathy: the predictive ability of religious orientation for stress and depression in college undergraduates

Evidence supports that different levels of religiosity are related to mental health outcomes. This study examines the relationship between religiosity and measures of psychological maladjustment. The current study compared participants\u27 scores on several measures of religiosity with scores on Locus of Control, Depression, Anxiety, Stress, and Obsessive-Compulsive tendencies. Multiple regressions analyses were conducted suggesting that Indiscriminate Proreligiousness, a measure of overall religiosity, was found to be negatively correlated with stress. Highly religious people were found to have more of an intrinsic religious orientation than either extrinsic or quest orientation

Sexual orientation and associated characteristics among north american academic psychiatrists

We mailed questionnaires inquiring about a range of personal and professional attributes to 972 North American psychiatrists at five leading medical schools in the United States and Canada. Of these, 49% (435 psychiatrists) responded. Of the respondents, 90.9% reported being exclusively heterosexual, 3.5% predominantly heterosexual, and 5.6% bisexual/homosexual. Analyses were performed to assess the relationship between sexual orientation and other variables. We found that exclusive heterosexuals were more likely than other psychiatrists to be Jewish (p = .002), to have first‐degree relatives with psychiatric illness (p =.015), and to have conducted research after residency training (p = .034). Exclusively heterosexual psychiatrists were less likely to have used recreational drugs (p = .025), or to prescribe psychotropic medications to none of their patients (p = .017). Sexual orientation was not correlated with a variety of other personal and professional characteristics. The findings suggest that gay men and lesbians are represented within psychiatry at rates comparable to their estimated representation in society. Moreover, the data invite several hypotheses—for example, that medical students may be drawn to psychiatry for specific reasons such as feeling marginalized due to being gay or bisexual

Treatment Orientation and Associated Characteristics of North American Academic Psychiatrists

We present data showing the degree to which a “biological-psychotherapeutic” division persists in American psychiatry, and how psychiatrists' treatment orientation is associated with personal and professional characteristics. Almost two thirds of academic psychiatrists who responded to our survey (N = 435) could be classified as either biological (27%) or psychotherapeutic (37%) in orientation, according to the proportion of their caseload to which they provided psychotherapy (25% vs. ≥75%). There appears to have been an increase over the last 35 years in the proportion of psychiatrists who can be classified as biologically oriented and a decrease in the proportion who can be classified as psychotherapeutically oriented, as well as the emergence of a large class of intermediate or “eclectic” practitioners (36%). Several personal and professional attributes were distributed differentially according to treatment orientation. Psychotherapeutically oriented respondents more frequently reported personal histories of psychiatric disorders than did biologically oriented respondents (64% vs. 39%) as well as greater satisfaction with clinical work (81% vs. 53% “very satisfied”). Differences were also found in age, gender, history of personal psychotherapy, family history of psychiatric disorder, history of marijuana use, degrees of involvement in research, teaching and clinical care of patients, and overall work satisfaction, as well as other characteristics

Diffusion MR Characteristics Following Concurrent Radiochemotherapy Predicts Progression-Free and Overall Survival in Newly Diagnosed Glioblastoma.

The standard of care for newly diagnosed glioblastoma (GBM) is surgery, then radiotherapy (RT) with concurrent temozolomide (TMZ), followed by adjuvant TMZ. We hypothesized patients with low diffusivity measured using apparent diffusion coefficient (ADC) histogram analysis evaluated after RT+TMZ, prior to adjuvant TMZ, would have a significantly shorter progression-free (PFS) and overall survival (OS). To test this hypothesis we evaluated 120 patients with newly diagnosed GBM receiving RT+TMZ followed by adjuvant TMZ. MRI was performed after completion of RT+TMZ, prior to initiation of adjuvant TMZ. A double Gaussian mixed model was used to describe the ADC histograms within the enhancing tumor, where ADCL and ADCH were defined as the mean ADC value of the lower and higher Gaussian distribution, respectively. An ADCL value of 1.0 um2/ms and ADCH value of 1.6 um2/ms were used to stratify patients into high and low risk categories. Results suggest patients with low ADCL had significantly shorter PFS (Cox Hazard Ratio = 0.12, P = 0.0006). OS was significantly shorter with low ADCL tumors, showing a median OS of 407 vs. 644 days (Cox Hazard Ratio = 0.31, P = 0.047). ADCH was not predictive of PFS or OS when accounting for age and ADCL. In summary, newly diagnosed glioblastoma patients with low ADCL after completion of RT+TMZ are likely to progress and die earlier than patients with higher ADCL. Results suggest ADC histogram analysis may be useful for patient risk stratification following completion of RT+TMZ

Supervillin (p205): A Novel Membrane-associated, F-Actin–binding Protein in the Villin/Gelsolin Superfamily

Actin-binding membrane proteins are involved in both adhesive interactions and motile processes. We report here the purification and initial characterization of p205, a 205-kD protein from bovine neutrophil plasma membranes that binds to the sides of actin filaments in blot overlays. p205 is a tightly bound peripheral membrane protein that cosediments with endogenous actin in sucrose gradients and immunoprecipitates. Amino acid sequences were obtained from SDS-PAGE–purified p205 and used to generate antipeptide antibodies, immunolocalization data, and cDNA sequence information. The intracellular localization of p205 in MDBK cells is a function of cell density and adherence state. In subconfluent cells, p205 is found in punctate spots along the plasma membrane and in the cytoplasm and nucleus; in adherent cells, p205 concentrates with E-cadherin at sites of lateral cell–cell contact. Upon EGTA-mediated cell dissociation, p205 is internalized with E-cadherin and F-actin as a component of adherens junctions “rings.” At later times, p205 is observed in cytoplasmic punctae. The high abundance of p205 in neutrophils and suspension-grown HeLa cells, which lack adherens junctions, further suggests that this protein may play multiple roles during cell growth, adhesion, and motility. Molecular cloning of p205 cDNA reveals a bipartite structure. The COOH terminus exhibits a striking similarity to villin and gelsolin, particularly in regions known to bind F-actin. The NH2 terminus is novel, but contains four potential nuclear targeting signals. Because p205 is now the largest known member of the villin/gelsolin superfamily, we propose the name, “supervillin.” We suggest that supervillin may be involved in actin filament assembly at adherens junctions and that it may play additional roles in other cellular compartments

The Clustering of AGN in the Sloan Digital Sky Survey

We present the two--point correlation function (2PCF) of narrow-line active galactic nuclei (AGN) selected within the First Data Release of the Sloan Digital Sky Survey. Using a sample of 13605 AGN in the redshift range 0.055 < z < 0.2, we find that the AGN auto--correlation function is consistent with the observed galaxy auto--correlation function on scales 0.2h^{-1}Mpc to >100h^{-1}Mpc. The AGN hosts trace an intermediate population of galaxies and are not detected in either the bluest (youngest) disk--dominated galaxies or many of the reddest (oldest) galaxies. We show that the AGN 2PCF is dependent on the luminosity of the narrow [OIII] emission line (L_{[OIII]}), with low L_{[OIII]} AGN having a higher clustering amplitude than high L_{[OIII]} AGN. This is consistent with lower activity AGN residing in more massive galaxies than higher activity AGN, and L_{[OIII]} providing a good indicator of the fueling rate. Using a model relating halo mass to black hole mass in cosmological simulations, we show that AGN hosted by ~ 10^{12} M_{odot} dark matter halos have a 2PCF that matches that of the observed sample. This mass scale implies a mean black hole mass for the sample of M_{BH} ~ 10^8 M_{odot}.Comment: 5 pages, 4 figures. Accepted for publication in ApJ