Empirical study of an team-based incentive model in the Day Surgical Department at Huddinge University Hospital

The study shows that a team-based incentive model changed personnel attitude and behaviour and increased the productivity in the Day Surgical Department at Huddinge University Hospital. The aims by introducing a team-based incentive model were to increase the productivity, to recruit personnel, to strengthen the team feeling and to commit the staff to work on continuous improvement. A bonus wage system based on production, financial and patient satisfaction in a balanced scorecard was implemented in October 2000. The results shown in the study cover the first year. Quantitative data on production, personnel administration and financial was collected. A questionnaire on patient satisfaction was given to patients. Qualitative data was collected by focused interviews with all personnel in the department and with key persons outside the department. The productivity measured as the surgical procedures/surgical-room hours increased by 7 per cent and the surgical hours/surgical-room hours also increased by 7 per cent. Net income was positive. Financial measured as total costs/surgical hour decreased despite of increased salaries and bonus. The patient satisfaction index was rated high. More employees were recruited than finished their employment. The qualitative analysis demonstrates that the employees had changed attitude with increased responsibility and teamwork resulting in an increased productivity. The reward system achieved a broad acceptance within as well as outside the department. Knowledge about the financial goals and the incentive model and information about related matters are fields for improvement. The results of increased productivity and the net recruitment of personnel in the study is encouraging. However, the results have to be evaluated over a longer period of time. The future development of the model may include rewards when achieving goals in the work on continuous improvement.Health care; management control; compensation systems; incentive; incentive model; productivity

Overt Cleft Palate Phenotype and TBX1 Genotype Correlations in Velo-cardio-facial/DiGeorge/22q11.2 Deletion Syndrome Patients

Velo-cardio-facial syndrome/DiGeorge syndrome, also known as 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome, with an estimated incidence of 1/2,000 – 1/4,000 live births. Approximately 9–11% of patients with this disorder have an overt cleft palate (CP), but the genetic factors responsible for CP in the 22q11DS subset are unknown. The TBX1 gene, a member of the T-box transcription factor gene family, lies within the 22q11.2 region that is hemizygous in patients with 22q11DS. Inactivation of one allele of Tbx1 in the mouse does not result in CP, but inactivation of both alleles does. Based on these data, we hypothesized that DNA variants in the remaining allele of TBX1 may confer risk to CP in patients with 22q11DS. To test the hypothesis, we evaluated TBX1 exon sequencing (n = 360) and genotyping data (n = 737) with respect to presence (n = 54) or absence (n = 683) of CP in patients with 22q11DS. Two upstream SNPs (rs4819835 and rs5748410) showed individual evidence for association but they were not significant after correction for multiple testing. Associations were not identified between DNA variants and haplotypes in 22q11DS patients with CP. Overall, this study indicates that common DNA variants in TBX1 may be nominally causative for CP in patients with 22q11DS. This raises the possibility that genes elsewhere on the remaining allele of 22q11.2 or in the genome could be relevant

Neurodevelopmental and Epilepsy Phenotypes in Individuals With Missense Variants in the Voltage-Sensing and Pore Domains of KCNH5

Background and Objectives KCNH5 encodes the voltage-gated potassium channel EAG2/Kv10.2. We aimed to delineate the neurodevelopmental and epilepsy phenotypic spectrum associated with de novo KCNH5 variants.Methods We screened 893 individuals with developmental and epileptic encephalopathies for KCNH5 variants using targeted or exome sequencing. Additional individuals with KCNH5 variants were identified through an international collaboration. Clinical history, EEG, and imaging data were analyzed; seizure types and epilepsy syndromes were classified. We included 3 previously published individuals including additional phenotypic details.Results We report a cohort of 17 patients, including 9 with a recurrent de novo missense variant p.Arg327His, 4 with a recurrent missense variant p.Arg333His, and 4 additional novel missense variants. All variants were located in or near the functionally critical voltage-sensing or pore domains, absent in the general population, and classified as pathogenic or likely pathogenic using the American College of Medical Genetics and Genomics criteria. All individuals presented with epilepsy with a median seizure onset at 6 months. They had a wide range of seizure types, including focal and generalized seizures. Cognitive outcomes ranged from normal intellect to profound impairment. Individuals with the recurrent p.Arg333His variant had a self-limited drug-responsive focal or generalized epilepsy and normal intellect, whereas the recurrent p.Arg327His variant was associated with infantile-onset DEE. Two individuals with variants in the pore domain were more severely affected, with a neonatal-onset movement disorder, early-infantile DEE, profound disability, and childhood death.Discussion We describe a cohort of 17 individuals with pathogenic or likely pathogenic missense variants in the voltage-sensing and pore domains of Kv10.2, including 14 previously unreported individuals. We present evidence for a putative emerging genotype-phenotype correlation with a spectrum of epilepsy and cognitive outcomes. Overall, we expand the role of EAG proteins in human disease and establish KCNH5 as implicated in a spectrum of neurodevelopmental disorders and epilepsy.</p

Model averaging for the parameters linking sniffing and over-marking responses of badgers for a) the complete dataset (<i>n</i> = 351).

<p>Asterisks (*) denote interaction terms</p><p>When just data from observations with identifiable responders were included in the models (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0132432#pone.0132432.s002" target="_blank">S2 Table</a>), familiarity was the most influential parameter, whereas sample location became relatively un-important. The responder’s reproductive status had a strong effect on sniff-duration, with the responder’s age being of intermediate importance (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0132432#pone.0132432.t004" target="_blank">Table 4</a>). Indeed, the most supported model predictive of sniff-duration included only familiarity, and the responder’s reproductive status (<i>w</i> = 0.097). The model that excluded individual characteristics again had little biological significance (Δ_i = 4.37, <i>w</i> = 0.011).</p><p>The Relative Influence of each parameter (based on Akaike weights) is presented along with model-averaged estimated values of their coefficients (<i>θ</i>), and 95% confidence intervals (CI).</p

Will Trespassers Be Prosecuted or Assessed According to Their Merits? A Consilient Interpretation of Territoriality in a Group-Living Carnivore, the European Badger (<i>Meles meles)</i>

<div><p>Socio-spatial interactions of Carnivores have traditionally been described using the vocabulary of territoriality and aggression, with scent marks interpreted as ‘scent fences’. Here, we investigate the role of olfactory signals in assumed territorial marking of group-living solitary foragers using European badgers <i>Meles meles</i> as a model. We presented anal gland secretions (<i>n</i> = 351) from known individuals to identifiable recipients (<i>n</i> = 187), to assess response-variation according to familiarity (own-group, neighbours, strangers) and spatial context (in-context: at a shared border; out-of-context: at an unshared border/ the main sett). Sniffing and over-marking (with subcaudal gland secretion) responses were strongest to anal gland secretions from strangers, intermediate to neighbouring-group and weakest to own-group members. Secretions from both, strangers and neighbours, were sniffed for longer than were own-group samples, although neighbour-secretion presented out-of-context evoked no greater interest than in-context. On an individual level, responses were further moderated by the relevance of individual-specific donor information encoded in the secretion, as it related to the physiological state of the responder. There was a trend bordering on significance for males to sniff for longer than did females, but without sex-related differences in the frequency of subcaudal over-marking responses, and males over-marked oestrous female secretions more than non-oestrous females. There were no age-class related differences in sniff-duration or in over-marking. Evaluating these results in the context of the Familiarity hypothesis, the Threat-level hypothesis, and the Individual advertisement hypothesis evidences that interpretations of territorial scent-marks depicting rigid and potentially agonistic discrimination between own- and foreign-group conspecifics are overly simplistic. We use our findings to advance conceptual understanding of badger socio-spatial ecology, and the general context of territoriality and group-range dynamics.</p></div

Model averaging for the parameters linking sniffing and over-marking responses of badgers for the restricted dataset (<i>n</i> = 187) including responder characteristics within the linear model.

<p>The Relative Influence of each parameter (based on Akaike weights) is presented along with model-averaged estimated values of their coefficients (<i>θ</i>), and 95% confidence intervals (CI). Asterisks (*) denote interaction terms.</p

Individual-level variation in responses to AGS from donors of different familiarity levels.

<p>Individual level (±SD) (a) duration of sniffing responses; and (b) number of subcaudal-marking responses per potential response to AGS from own–group (<i>n</i> = 20 trials), neighbours (<i>n</i> = 35) and strangers (<i>n</i> = 30) presented at either the responder’s sett, or a border (shared or unshared) between the responder and the scent donor.</p

Clinical application of a scale to assess genomic healthcare empowerment (GEmS): Process and illustrative case examples

The Genome Empowerment Scale (GEmS), developed as a research tool, assesses perspectives of parents of children with undiagnosed disorders about to undergo exome or genome sequencing related to the process of empowerment. We defined genomic healthcare empowerment as follows: perceived ability to understand and seek new information related to the genomic sequencing, manage emotions related to the diagnostic process and outcomes, and utilize genomic sequencing information to the betterment of the individual/child and family. The GEmS consists of four scales, two are primarily emotion-focused (Meaning of a Diagnosis, and Emotional Management of the Process) and two are action-oriented (Seeking Information and Support, and Implications and Planning). The purpose of this research was to provide a strategy for interpreting results from the GEmS and present illustrative cases. These illustrations should serve to facilitate use of the GEmS in the clinical and research arena, particularly with respect to guiding genetic counseling processes for parents of children with undiagnosed conditions

Subcaudal over-marking (i.e., marking on top of the introduced AGS), and proximity-marking (i.e., within 50cm) in response to different levels of familiarity (own group, neighbour, stranger), spatial-context (sett, shared border, unshared border) and sex of donor (<i>n</i> = 141).

<p>Subcaudal over-marking (i.e., marking on top of the introduced AGS), and proximity-marking (i.e., within 50cm) in response to different levels of familiarity (own group, neighbour, stranger), spatial-context (sett, shared border, unshared border) and sex of donor (<i>n</i> = 141).</p