Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19.Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 µg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 µg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (antispike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing.Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group).Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose

They Don't Think Like We Do: Factors Influencing Employees' Interpretations of Organizational Mission

160 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2004.Organizational mission is the purpose, strategy, values, and behavioral standards of an organization that may or may not be articulated in a formal statement. The influence of mission on employees who are not strategic managers has been largely neglected. Organizational members develop their own interpretations of mission that are critical to their ability to function effectively in organizations. These interpretations influence what employees perceive as appropriate behavior, and eventually impact overall organizational functioning. This study begins to assess the relationship between mission and organizational members by focusing on four issues. First, it explores whether employees develop multiple interpretations of their organization's mission and if there is variability in these interpretations. Second, it investigates whether there is a relationship between an organization's formal mission statement and employees' interpretations of their organization's mission. Third, it tests hypotheses predicting which employees will be more likely to develop interpretations of mission that overlap with the organization's mission statement. Fourth, this study examines the relative influence of theoretical mechanisms on the likelihood of employees having similar interpretations of their organization's mission. Theories grounded in informal mechanisms (e.g., communication with one another), formal organizational factors (e.g., functional work group), and demographic factors (e.g., gender) were tested in three types of organizations (a bureaucracy, a platform organization, and a virtual organization). Semantic network analysis was used to facilitate this investigation. Results suggest employees develop multiple and variable interpretations of their organization's mission, there is an association between formal mission statements and employees' interpretations of mission, and employees who are high in the organizational hierarchy are more likely to have interpretations of the organization's mission that overlap with the mission statement. Further, employees in the bureaucracy who communicated with each other, who were in the same functional work group, and who were spatially proximate to one another were more likely to have similar interpretations of their organization's mission. In the platform organization, employees who were spatially proximate to one another were more likely to have similar interpretations of their organization's mission. Limitations of the study are recognized and avenues for future research are developed.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Free-riding in multi-party alliances: The role of perceived alliance effectiveness and peers' collaboration in a research consortium

International audienceMulti-party alliances rely on partners' willingness to commit and pool their efforts in joint endeavors. However, partners face the dilemma of how much to commit to the alliance. We shed light on this issue by analyzing the relationship between partners' free-riding-defined as their effort-withholding-and their perceptions of alliance effectiveness and peers' collaboration. Specifically, we posit a U-shaped relationship between partners' subjective evaluations of alliance effectiveness and their free-riding. We also hypothesize a negative relation between partners' perceptions of the collaboration of peer organizations and their free-riding. Results from a mixed-method study-combining regression analysis of primary data on a major inter-organizational research consortium and evidence from two experimental designs-support our hypotheses, bearing implications for the multi-party alliances literature. Managerial summary: Free-riding is a major concern in multi-party alliances such as large research consortia, since the performance of these governance forms hinges on the joint contribution of multiple partners that often operate according to different logics (e.g., universities, firms, and government agencies). We show that, in such alliances, partners' perceptions have relevant implications for their willingness to contribute to the consortium's shared goals. Specifically, we find that partners free-ride more-that is, contribute less-when they perceive the effectiveness of the overall alliance to be either very low or very high. Partners also gauge their commitment to the alliance on the perception of the effort of their peers-that is, other organizations similar to them. These findings provide managers of multi-party alliances with additional levers to motivate partners to contribute fairly to such joint endeavor

When Richer is Poorer: Understanding the Influence of Channel Richness and Presence on the Introduction of a Mission Statement

Developing and implementing mission statements continues to be a widely used managerial strategy. This study tests a model incorporating the immersion and transportation dimensions of presence and media richness for evaluating the effectiveness of two commonly used strategies (paper versus video) for introducing a mission statement to members of an organization. Outcomes include participants\u27 recall of the statement, involvement with the statement, and perceived importance of the statement. Results suggest: (a) channel richness does not directly impact the three outcomes, (b) the richer video channel resulted in less presence, and (c) greater presence positively impacted all three outcomes. The implications of these results are discussed for both future presence research and organizational practitioners

When Richer is Poorer: Understanding the Influence of Channel Richness and Presence on the Introduction of a Mission Statement

Developing and implementing mission statements continues to be a widely used managerial strategy. This study tests a model incorporating the immersion and transportation dimensions of presence and media richness for evaluating the effectiveness of two commonly used strategies (paper versus video) for introducing a mission statement to members of an organization. Outcomes include participants\u27 recall of the statement, involvement with the statement, and perceived importance of the statement. Results suggest: (a) channel richness does not directly impact the three outcomes, (b) the richer video channel resulted in less presence, and (c) greater presence positively impacted all three outcomes. The implications of these results are discussed for both future presence research and organizational practitioners

From Microactions to Macrostructure and Back:A Structurational Approach to the Evolution of Organizational Networks

Structuration theory (ST) and network analysis are promising approaches for studying the emergence of communication networks. We offer a model that integrates the conceptual richness of structuration with the precision of relevant concepts and mechanisms offered from communication network research. We leverage methodological advancements (i.e., stochastic actor-oriented models) to test hypotheses deduced from ST using longitudinal communication network data collected over a two-year period. Results indicate that while structural rules external to a social network play a significant role, internal structural rules that emerge from the aggregate of individual actions during previous time periods also predict current structures, and that the reification influence of the latter is greater than that of the external factors