Structuring the situation: Organizational goals trigger and direct decision-making.

Organizational goals are assigned to individuals, and thus differ from goals that individuals voluntarily adopt. The Carnegie School has a significant research stream on how organizations are affected by goals, with a focus on how disappointing performance disrupts regular organizational behavior and triggers a search for alternative actions. We have a good understanding of the organization-level process of setting aspiration levels, triggering search for alternatives, and making decisions, but the individual-level mechanisms contributing to it are less well known. An assessment of the progress of Carnegie School research so far reveals a list of research questions that should be resolved in order to understand how individual updating of aspiration levels, triggering of search, directing of search, and decision-making help explain organizational responses to goals. The role of construal, or interpretation, in guiding these processes is a central theoretical mechanism that needs further investigation.

Dual Goals, Dual Agency: The Perils of Measurement and Control Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

This commentary to Waitzberg et al draws on the research stream on organizational goals in management to examine the findings they report, point out the correspondence of their findings and interpretation with existing theory, including development beyond it. Their work discusses these considerations very well. It also suggests paths to further theoretical development and proposes how their work demonstrate the potential for further research on multiple goals in hospitals. Such research will be important both for health policy and management and for management theory and practice generally.

Are goals scored just before halftime worth more? An old soccer wisdom statistically tested.

There is an old soccer wisdom that a goal scored just before halftime has greater value than other goals. Many dismiss this old wisdom as just another myth waiting to be busted. To test which is right we have analysed the final score difference through linear regression and outcome (win, draw, loss) through logistic regression. We use games from many leagues, control for the halftime score, comparing games in which a goal was scored after 1 minute remained of regulation time with games in which it was scored before the 44th minute. Our main finding is that the home team scoring just before halftime influence these outcomes to its advantage, compared with scoring earlier with the same halftime score. We conclude that a goal scored just before halftime has greater value than other goals provided it is scored by the home team. In other words; the wisdom may be old, but it's still wise.

Prevention of feeding tube dislodgement with the Wiesbaden rein: a case series.

We describe initial experience with the use of a new fixation method (Wiesbaden rein), which has been developed to prevent dislodgement of feeding tubes in the gastrointestinal tract. The Wiesbaden rein has been used in three patients without complication. In none of the patients was dislodgement or malfunction of the feeding tube observed. Therefore, the use of the Wiesbaden rein might prevent dislodgement of feeding tubes. Clinical trials are required before this new method can be recommended for general use.

Strategic rule breaking: Time wasting to win soccer games.

Rules regulate behavior, but in competitive contexts they also create incentives for rule-breaking because enforcement is imperfect. Sports is a prime example of this, and one that lends itself well to investigation because strategic rule-breaking is often measurable. Professional soccer is a highly competitive team sport with economic rewards for winning given to teams and players. It has a set of rules to ensure fair play, but the enforcement is incomplete, and hence can lead to strategic behavior. Using newly available data, we examine strategic time-wasting, a behavior that help teams win games, or tie games against superior opponents, but is contrary to the objective of game play as entertainment for the spectators. We demonstrate that strategic time-wasting is widespread and is done through delayed restart of the game after goalie capture of the ball, goal kick, throw-in, free kick, corner kick, and substitution. The strategic time-wasting has substantial magnitude, and models of the value per minute predict time-wasting well. Because this time-wasting is a result of incentives created by not stopping the game clock, we predict that a change to rules with stopped game clock when the play is stopped would make game play more time efficient.

Lateral lipid distribution and phase transition in phosphatidylethanolamine/phosphatidylserine vesicles. A cross-linking study.

To determine the nonideal mixing of two lipid components within the membrane, lipid cross-linking experiments were carried out on dipalmitoylphosphatidylethanolamine (DPPE) vesicles and on dipalmitoylphosphatidylethanolamine/dipalmitoylphosphatidylserine (DPPE/DPPS) vesicles. By comparison of the cross-linking reactions on both types of vesicle the mean neighbourhood relations within the binary lipid mixture can be obtained. To elucidate the relationship between cluster formation and phase transition, the temperature dependences of the lipid arrangement within the vesicle membrane and of the lipid order parameter describing the fluidity of the membrane were measured. Cluster size and phase transition correlate: during the phase transition of the lipid species with the lower phase-transition temperature (DPPS) the nonideality of the mixture increases by phase separation. Above the phase transition temperature of the second lipid species (DPPE) the clusters disappear and a slight alternating lipid arrangement is characteristic of the fluid phase.

[Non-tropical pyomyositis in Germany]. / Nichttropische Pyomyositis in Deutschland.

Haematogenous primary pyomyositis predominantly caused by staphylococcus aureus is a well-known entity in tropical regions. It is sporadicly observed in non-tropical areas. Lack of clinical familiarity not seldom contributes to delayed recognition of pyomyositis in the suppurative or complicated state. Initially, healing usually can be achieved by antibiotic treatment adjusted by antibiotic treatment adjusted to pyogenic staphylococci. Late stages require concomitant surgical or transcutaneous drainages of pus. In addition, treatment for osteomyelitis or bacterial carditis as typical complications may be necessary. The review of pyomyositis is illustrated by three case-reports from Germany.

[Pulmonary mass suspected as malignant tumour. Thoracic wall abscess and fistula after pulmonary segmental resection]. / Malignomsuspekte pulmonale Raumforderung. Thoraxwandabszess und Fistelbildung nach chirurgischer Resektion.

A 31-year-old patient presented with chronic cough and thoracic pain. A pulmonary mass was seen on chest x-ray, and pulmonary segmental resection was done. Histopathologically, a pulmonary abscess cavity due to actinomycosis was found. Three months later, recurrence of actinomycosis at the thoracic wall was observed. Antibiotic therapy with penicillin was administered. Five months later, with the patient receiving continued antibiotic therapy, a thoracic wall abscess and fistula was diagnosed. Four weeks after abscess drainage and repeat intravenous antibiotic therapy, the patient was symptom-free and had remained symptom-free at 10 months of follow-up.

Endoscopic treatment of the "sump syndrome" after choledochoduodenostomy: a new technique using an amplatzer septal occluder.

A 58-year-old male patient had been suffering for 35 years from recurrent cholangitis, biliary sludge and infection-induced stone formation after open cholecystectomy because of empyema of the gallbladder and severe acute and delayed postoperative complications. The pathophysiological origin of this chronic "sump syndrome" was a choledochoduodenostomy which had been performed prophylactically at the time of the initial operation. The patient agreed to an experimental treatment option with use of an Amplatzer atrial-septal defect (ASD) occluder for closure of the symptomatic choledochoduodenal fistula. The double-disc occluder was introduced through a 9 French diameter and 90 cm long sheath side to side with a duodenoscope. Under endoscopic and fluoroscopic guidance the distal disc was opened in the common bile duct, then retracted against the fistula's orifice. Subsequently, the proximal disc was unfolded in the duodenum, while the 9 mm waist between the two discs filled and shut the fistula. No side effects or complications were detected. The day after the procedure, endoscopic evaluation demonstrated the correct position of the occluder and closure of the fistula. Over a period of 12 months, repeated assessments did not reveal any major problems. The patient felt a significant subjective improvement. The use of a self-expanding occluder system for closure of a choledochoduoenotomy complicated by chronic and symptomatic duodenocholedochal reflux might therefore represent an enrichment of the equipment of interventional endoscopists.

Secondary sclerosing cholangitis after long-term treatment in an intensive care unit: clinical presentation, endoscopic findings, treatment, and follow-up.

BACKGROUND AND STUDY AIMS: We present ten patients who developed secondary sclerosing cholangitis following long-term treatment in an intensive care unit (ICU) between 1999 and 2004. PATIENTS AND METHODS: Ten consecutive patients who had no evidence suggestive of pre-existing hepatobiliary disease were admitted to an ICU because of trauma (n = 5), intracerebral hemorrhage (n = 3), or nonabdominal postsurgical complications (n = 2). All the patients had required treatment with long-term ventilation, catecholamines, total parenteral nutrition, and several antimicrobial agents. RESULTS: Cholestasis was first noted within 11 days after the initial insult. Endoscopic retrograde cholangiopancreatography (ERCP), performed after a median follow-up of 69 days, revealed multifocal stricturing and beading of the intrahepatic bile ducts, and attenuation of the peripheral branches. In all the patients, the bile ducts were partially filled by black-pigmented thrombotic material. All the patients underwent endotherapy, which comprised sphincterotomy and removal of the occluding material, in an attempt to improve biliary drainage; the treatment had to be repeated in seven of the ten patients. After a median follow-up period of 21 months, despite transient clinical improvement following endotherapy, complete recovery has not been achieved in any of the patients and so far one patient has had to undergo orthotopic liver transplantation as a result of end-stage liver disease. CONCLUSIONS: The development of secondary sclerosing cholangitis in patients who have received long-term treatment in an ICU is a rare event of unknown pathophysiology, but patients demonstrate characteristic findings on ERCP. It is not known whether endotherapy can delay the progress of the condition in the long term.

Effects of chronic administration of delta-9-tetrahydrocannabinol on early embryogenesis of the mouse.

The effects of chronic administration of delta-9-tetrahydrocannabinol (THC), the major psychoactive component of marihuana, on embryogenesis were investigated in the mouse treated with THC prior to sexual maturation. The study was designed to imitate the prolonged abuse of marihuana by sexually immature and adolescent girls. Female Swiss-Webster mice were injected, intraperitoneally, with THC 5 mg/kg per day or with the vehicle for 21 consecutive days, starting on the 30th day of life, which is prior to their sexual maturation. The dose of THC was approximately equivalent to that absorbed by a man smoking 1 to 2 marihuana cigarettes per day. Superovulation was then induced, and the mice were mated with untreated males. Ova were recovered from the oviducts just prior to the first cleavage division, and at about the time of the second cleavage division. The incidence of degenerative ova increased from 13.6% in the controls to 19.1% in the THC-treated group (P less than 0.001) at the time of the second cleavage division, but there was no difference in the incidence of morphologically abnormal ova between the two groups just prior to the first cleavage division. The rate of successful completion of the first cleavage division, but not the second cleavage division, was adversely affected by THC, resulting in accumulation of morphologically abnormal ova at the later stage. In view of the known disruptive effect of THC on the process of cell division, it was postulated that THC might have adversely affected meiosis, leading to the inability of the ova to undergo the first cleavage division.

[Psychiatry in Emden--the 1st year]. / Psychiatrie in Emden--das erste Jahr.

The article reports on the first developmental stage of a psychiatric department in a location close to the place of residence of the majority of patients. This psychiatric clinic has at present 60 beds and facilities for 20 outpatients. The location of the clinic is in the area of a medium-sized town in a rural district classified as an area in which Public Health services are required to be active. First of all, the article gives a detailed description of the clinic itself and of the population and district it has to look after. Secondly, the article describes the present state and development of negotiations regarding the setting-up of an outpatient treatment ward. In this connection, it became unavoidable to point out the discrepancies between the need of the population to receive adequate psychiatric outpatient treatment on the one hand, and the policy followed by the relevant authorities on the other, the latter being unfortunately coloured by vested interests, both politically and by the class-consciousness of representatives of certain trade guilds and corporations. This is followed by a statistical evaluation of the patients treated on an inpatient, outpatient and consultant basis, together with an attempt to give a brief outline of the relevant epidemiology. Since the Social Psychiatric Service of Emden has close associations with the clinic--a fact which is rather untypical--the authors included a report on the starting-up phase and activity characteristics of that service.

In vitro induction of segregational errors of chromosomes by natural cannabinoids in normal human lymphocytes.

It has been shown that segregational errors (SE) of chromosomes can be induced by olivetol and several halogenated inhalation anesthetics. The purpose of this study was to examine the effects of natural cannabinoids - including delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), and cannabidiol (CBD) - on chromosome segregation. Lymphocytes obtained from healthy adult males were incubated with various concentrations of natural cannabinoids for 72 hours. Anaphase preparations were made from these cultures. A statistically significant increase in the incidence of SE of chromosomes was observed in the lymphocytes exposed to THC at a concentration of 3.2 x 10(-6) M, but not to CBN or CBD. A greater incidence of bridge formations, anaphase lags, micronuclei, and unequal segregations in bipolar divisions and multipolar divisions were observed in THC-treated lymphocytes, compared with the controls. However, only anaphase lags and unequal segregations in bipolar divisions reached statistically significant levels. It appears that THC affects the formation of microtubules and spindles and may be considered as a mitotic poison. The value of examining SE as a part of cytogenetic studies on chemical mutagens is emphasized. A description of a classification system of SE developed in our laboratory is also presented. This system can be applied to studies using both normal human lymphocyte cultures and lymphoid cell lines.

[Infection with fasciola hepatica causing elevated liver-enzyme results and eosinophilia - serologic and endoscopic diagnosis and therapy]. / Fasciola hepatica als Ursache einer Leberwerterhöhung mit Eosinophilie - serologische und endoskopische Diagnostik und Therapie.

A 36 year old man was diagnosed with eosinophilia and elevated liver-enzyme levels in a preoperative routine laboratory testing. In the course of the evaluation we found high levels of Fasciola hepatica specific antibodies which lead to an ERC with biliary aspiration after choleretic stimulation. The bile showed Fasciola eggs and subsequently we recovered a parasite from the bile duct. Abdominal CT- and MRI-Scans showed lesions of the liver consistent with hepatic fascioliasis. Focussed patient's history revealed ingestion of contaminated watercress in Turkey as the most likely source of infection. For patients with elevated liver-enzymes of unknown etiology with eosinophilia or in combination with a congruent patient's history even without eosinophilia serologic studies of Fasciola hepatica seem to be advisable. We suggest an ERC with biliary aspiration to prove the diagnosis in case of positive results, if the prepatency period of 4 months after the ingestion is over. Fasciola hepatica is rarely diagnosed in Germany probably due to the lack of awareness of the disease.

A review of carbon disulfide exposure data and the association between carbon disulfide exposure and ischemic heart disease mortality.

Recent regulatory efforts have devoted attention to carbon disulfide (CS2) exposure and its potential effects on the cardiovascular system. To investigate the association between CS2 exposure and ischemic heart disease (IHD) mortality, the analysis presented here had the following objectives: (i) to review historical CS2 exposure data in the viscose rayon industry and identify trends and (ii) to use these historical data to suggest a standard mortality ratio (SMR)-exposure relationship and a threshold level for occupational exposure to CS2, CS2 exposure data were extracted from published studies and used with the SMR versus exposure score relationship developed by Sweetnam et al. (Br. J. Ind. Med. 44, 220-227, 1987) to relate SMRs directly to exposure. Upper and lower bound exposure profiles were derived and used to identify exposure thresholds. For an IHD SMR equal to 100, the upper and lower bound exposures were 60 and 20 ppm, respectively. The analysis indicates that the risk of IHD mortality and its relationship to CS2 exposure is meaningful only for workers exposed to high level for many years. These high levels, which existed many years ago, are no longer found in the workplace. The results of this analysis suggest a safe regulatory exposure level for CS2 between 15 and 20 ppm.

A benchmark concentration for carbon disulfide: analysis of the NIOSH carbon disulfide exposure database.

A statistical analysis of the NIOSH (National Institute for Occupational Safety and Health) carbon disulfide (CS2) exposure database was conducted for purposes of establishing a benchmark concentration (BMC) for CS2. The analysis addressed the effects of CS2 exposure on the peripheral nervous system and on ischemic heart disease risk factors. The BMC is based on models relating response to exposure determined from statistical analysis of the continuous exposure data for individuals recorded in the NIOSH database. The results demonstrate that changes in the responses associated with increases in CS2 exposure at levels represented in the NIOSH database are relatively small after adjustment for confounders. The only response variables that had statistically significant relationships with CS2 were the peroneal nerve MCV (motor conduction velocity) and the peroneal nerve amplitude ratio. Based on these results, BMCs of 16.2 and 18.5 ppm were derived for MCV and amplitude ratio, respectively.

The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.

BACKGROUND AND STUDY AIMS: In chronic gastrointestinal bleeding (CGB), bleeding sites located in the small bowel are difficult to detect with conventional radiological or scintigraphic techniques. Push enteroscopy (PE) is at present considered to be the most effective diagnostic procedure. The aim of this prospective trial was to compare the efficacy of wireless capsule endoscopy (CE) with PE. PATIENTS AND METHODS: Between April and October 2001, 65 patients with CGB were referred to our unit. Complete conventional diagnostic work-up (including small-bowel enteroclysis, angiography, and scintigraphy), as well as PE and CE, were performed in 32 patients. RESULTS: On average, the patients had been suffering from CGB for 29 +/- 24 months (6 - 126); the lowest hemoglobin level varied between 3.0 and 9.9 g/dl (mean 5.9 +/- 1.4); 17 +/- 18 blood units (0 - 60) were transfused. Each patient underwent 6 +/- 7 (range 1 - 38) hospitalizations, with a mean of 14 +/- 9 diagnostic procedures before CE was used. Conventional diagnostic procedures revealed relevant pathological findings in five of the 32 patients (16 %). Definite bleeding sites diagnosed by PE in nine patients (28 %) included angiodysplasia (seven patients), small-bowel cancer (one patient) and lymphoma (one patient). CE detected the definite source in 21 of the 32 patients (66 %) ( P < 0.001). Definite bleeding sources included angiodysplasia (17 patients), malignant stenoses (two patients) and inflammatory small-bowel disease (two patients). Questionable bleeding sources were seen on PE in three additional patients (9 %), and using CE in a further seven patients (22 %). Both CE and PE were safe and were not associated with any morbidity. CONCLUSIONS: In the present trial in patients with CGB, wireless CE had the highest diagnostic yield and was significantly superior to PE. CE can help reduce the number of diagnostic procedures and could become the initial diagnostic choice in patients with CGB and negative upper and lower gastrointestinal endoscopy.

Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.

BACKGROUND & AIMS: In view of the mortality and morbidity rates of esophagectomy and the relatively large group of inoperable patients, local therapeutic techniques are required for high-grade dysplasia and early Barrett's cancer. METHODS: A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carcinoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esophagus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and histological grades G1 and G2 and/or high-grade dysplasia (group A). The remaining 29 patients were included in group B (high risk). RESULTS: A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1. 3 +/- 0.6 in group A and 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred, a case of spurting bleeding, which was managed endoscopically. Complete local remission was achieved significantly earlier (P = 0.008) in group A than in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or metachronous carcinomas were found in 14%. CONCLUSIONS: Endoscopic mucosal resection of early carcinoma in Barrett's esophagus is associated with promisingly low morbidity and mortality rates. The procedure may offer a new minimally invasive therapeutic alternative to esophagectomy, especially in low-risk situations. Comparisons with surgical results will need to be done when the long-term results of this procedure become available.

Two-generation reproductive toxicity study of dietary tributyl phosphate in CD rats.

Tributyl phosphate (TBP) was tested for reproductive toxicity in rats. Thirty weanlings/sex (F0) were exposed to TBP in the diet ad libitum at 0, 200, 700, or 3000 ppm for 10 weeks and then randomly mated within groups for 3 weeks with continued exposure. F0 parents and 10 F1 weanlings/sex/dose were necropsied, and adult reproductive organs, urinary bladders (both sexes), kidneys (males), and livers (females) were evaluated histologically. Thirty F1 weanlings/sex/dose continued exposure for 11 weeks and were bred as described above. F1 parents and F2 weanlings, 10/sex/dose, were then necropsied as described above. Adult toxicity was observed in both sexes and generations at 700 and 3000 ppm; observations included reduced body weights, weight gain and feed consumption, urinary bladder epithelial hyperplasia (both sexes), renal pelvis epithelial hyperplasia only at 3000 ppm (male kidneys), and centrilobular hypertrophy (female livers). At 200 ppm, transient reductions in body weight were observed in F0 and F1 females, with urinary bladder epithelial hyperplasia in F0 males and females and in F1 males. There was no evidence of reproductive toxicity, of reproductive organ pathology, or of effects on gestation or lactation at any dose tested. Postnatal toxicity was evidenced by consistent reductions in F1 and F2 pup body weights at 3000 ppm and by occasional weight reductions in F2 litters at 700 ppm, and was associated with maternal toxicity observed at these doses and times. Under the conditions of this study, a NOAEL was not determined for adult toxicity; the NOAEL for reproductive toxicity was at least 3000 ppm and the NOAEL for postnatal toxicity was approximately 200 ppm.