Values as Motives: Implications for theory, methods, and practice.

The concept of human values is central to the study of culture, ethics, politics, anthropology, sociology, social psychology, environmental studies, health policy, education, management, and human capital. Because it represents the ultimate "why" behind decisions and behaviors, as a concept it plays an outsized role in both theory and practice in each of these fields. Despite the centrality of human values in these domains, the concept lacks theoretical consensus among scholars and practitioners. Like the concepts of subjective well-being, organizational culture, employee engagement, and leadership, the values literature suffers from concept proliferation and cries out for clearly stated definitions that embed the concept within a solid theoretical framework. In this article, we advocate for a fundamental reconsideration of the concept of values, anchoring it within a new psychological theory of human motivation based on first principles. Our primary contribution lies in demonstrating that the operational definitions utilized by academics and practitioners alike can be thought of as attempts to approach concepts of human motivation, specifically, emotional needs, without fully getting there. We review the leading definitions of human values in the literature, concluding that they can be distilled to a fundamental set of human emotional needs, each associated with extensive literatures of their own. We introduce a comprehensive framework of 12 human emotional needs and argue that a comprehensive motivational framework offers significant advantages over current theoretical approaches, which tend to spin off an ever-expanding list of concepts. We consider the impact of embedding values concepts within existing motivational constructs with clear benefits for: (a) theory development, (b) method development, and (c) practical applications, emphasizing the advantages of clear operational definitions.

The structure of human motivation.

BACKGROUND: A unified model of human motivation has been recently introduced that integrates all prior "mini-theories" of motivation into a single, symmetrical model based on first principles: four life domains crossed by three levels of attainment, resulting in 12 discrete motivations. Evidence from a series of studies using a novel image-based method is used to test structural hypotheses derived from a unified model of human motivation. METHOD: The studies employ large samples (810n to 986n) of working adults who conducted a time-constrained image-based exercise to measure the relative presence or absence of different emotional needs. RESULTS: These studies provide support for the theoretical model, suggesting that there is substantial heuristic and practical value in a structured framework of motivating needs. CONCLUSIONS: Findings suggest that our theoretical model reflects deep interrelationships between discrete types of human motivation, and by linking specific measures to a comprehensive model of human motivation, researchers can have confidence that they have adequately measured the motivation construct.

Well-being as Need Fulfillment: Implications for Theory, Methods, and Practice.

The most prominent concept championed by human resource professionals, point solution providers, and the mental health care industry is the construct of holistic well-being. Despite the tremendous attention focused on well-being, the concept lacks theoretical consensus among its proponents. Like the concept of engagement, this field cries out for clearly stated definitions that embed the concept within a theoretical framework, allowing theory development to avoid the prolific category errors of the past 50 years. This paper argues for a more sophisticated approach to the concept of well-being, grounding it in the vast psychological literature on human motivation. Herein lies the contribution of our paper; we argue that the apparent diversity of operational definitions employed by academics and practitioners can be understood as tentative attempts to draw ever nearer to key motivational concepts, without ever quite getting there. We review the leading definitions of well-being in the literature and find that they are reducible to a core set of human motives, each backed by full research traditions of their own, which populate a comprehensive model of twelve human motivations. We propose that there is substantial value in adopting a comprehensive motivational taxonomy over current approaches, which have the effect of "snowballing" ever more dimensions and elements. We consider the impact of setting well-being concepts in existing motivational constructs for each of the following: (a) theory, especially the development of well-being frameworks; (b) methods, including the value of applying a comprehensive, structural approach; and (c) practice, where we emphasize the practical advantages of clear operational definitions.

Employee Engagement as Human Motivation: Implications for Theory, Methods, and Practice.

The central theoretical construct in human resource management today is employee engagement. Despite its centrality, clear theoretical and operational definitions are few and far between, with most treatments failing to separate causes from effects, psychological variables from organizational variables, and internal from external mechanisms. This paper argues for a more sophisticated approach to the engagement concept, grounding it in the vast psychological literature on human motivation. Herein lies the contribution of our paper; we argue that the apparent diversity of operational definitions employed by academics and practitioners can be understood as tentative attempts to draw ever nearer to key motivational concepts, but never quite get there. We review the leading definitions of employee engagement in the literature and find that they are reducible to a core set of human motives, each backed by full literatures of their own, which populate a comprehensive model of twelve human motivations. We propose that there is substantial value in adopting a comprehensive motivational taxonomy over current approaches, which have the effect of "snowballing" ever more constructs adopted from a variety of fields and theoretical traditions. We consider the impact of rooting engagement concepts in existing motivational constructs for each of the following: (a) theory, especially the development of engagement systems; (b) methods, including the value of applying a comprehensive, structural approach; and (c) practice, where we emphasize the practical advantages of clear operational definitions.

Theoretical and Empirical Foundations for a Unified Pyramid of Human Motivation.

Revisions are proposed to the taxonomic model of human motivation of Forbes (Review of General Psychology, 15(2), 85-98, 2011) in order to incorporate a heretofore missing fourth life domain, the spiritual. The growing literature on spiritual motives is systematically reviewed in accordance with literature review standards for theory development (Templier & Paré, 2018) focusing on the objective of identifying comprehensive theoretical systems that explicitly incorporate the spiritual domain as one of a limited set of human life domains. The structure of the Forbes model is contrasted with thirteen theoretical systems that explicitly incorporate the spiritual as a fourth life domain. Consistent with the Forbes model, the spiritual domain is proposed to consist of three modes of existence (Being, Doing, Having) represented as justice motivation, moral motivation, and transcendental motivation, respectively, as well as both promotion and prevention goals within each of the three motives. Empirical evidence is reviewed in support of a revised heuristic device wherein the Spiritual domain is closely linked with the Intrapsychic and Interpersonal domains, but not the Instrumental domain, resulting in a pyramidal structure and corresponding set of testable hypotheses.

Development and testing of a low cost simulation manikin for extracorporeal cardiopulmonary resuscitation (ECPR) using 3-dimensional printing.

BACKGROUND: There has been an explosive growth of ECPR within new and established ECMO programs worldwide with the concomitant need for simulation trainers. However, current commercially available ECMO simulation models are expensive and lack many standard cardiorespiratory resuscitative (CPR) features. OBJECTIVE: To use 3-dimensional (3D) printing to develop a training manikin for comprehensive ECPR simulation. METHODS: A standard commercially available CPR manikin with airway model was used as the base model for modification. An inexpensive 3D printer was used to print a modular plastic pelvis. A medical silicone gel incorporated silicone femoral vasculature component was manufactured with connection to a gravity fed vascular system. RESULTS: The resulting modified manikin included the modular in-house designed ECMO cannulation and vascular structures wedded to the commercially available airway and CPR components. In simulation exercise involving first responders, paramedics, and emergency and critical care physicians, the model was reported as realistic with ultrasound views, cannulation, and resuscitative components functional. The entire cost for development of the ECMO component was estimated at $2000 Australian dollars AUD, including the printer purchase and supplies. Future reuse of components is estimated to cost less than $5 AUD per simulation run. CONCLUSIONS: A novel in-house modified manikin for ECPR was developed that was cost-efficient and realistic to use from first response through to establishment of ECMO circulation.

Gender and pramipexole effects on levodopa pharmacokinetics and pharmacodynamics.

The authors studied the pharmacokinetics of levodopa (LD) with and without pramipexole (PPX) in men and postmenopausal women with PD. Patients on stable dose of carbidopa/LD were randomized to receive escalating doses of placebo or PPX over 7 weeks. LD and PPX pharmacokinetics were performed after a single test dose 25/100 of carbidopa/LD, before initiation of PPX or placebo, at 1.5 mg/d and 4.5 mg/d of PPX or placebo. Compared to men, women had greater LD bioavailability. PPX did not alter LD bioavailability, and PPX pharmacokinetics were equivalent in men and women.

Positional dissociation between the genetic mutation responsible for pseudohypoparathyroidism type Ib and the associated methylation defect at exon A/B: evidence for a long-range regulatory element within the imprinted GNAS1 locus.

Pseudohypoparathyroidism type Ib (PHP-Ib) is a paternally imprinted disorder which maps to a region on chromosome 20q13.3 that comprises GNAS1 at its telomeric boundary. Exon A/B of this gene was recently shown to display a loss of methylation in several PHP-Ib patients. In nine unrelated PHP-Ib kindreds, in whom haplotype analysis and mode of inheritance provided no evidence against linkage to this chromosomal region, we confirmed lack of exon A/B methylation for affected individuals, while unaffected carriers showed no epigenetic abnormality at this locus. However, affected individuals in one kindred (Y2) displayed additional methylation defects involving exons NESP55, AS and XL, and unaffected carriers in this family showed an abnormal methylation at exon NESP55, but not at other exons. Taken together, current evidence thus suggests that distinct mutations within or close to GNAS1 can lead to PHP-Ib and the associated epigenetic changes. To further delineate the telomeric boundary of the PHP-Ib locus, the previously reported kindred F, in which patient F-V/51 is recombinant within GNAS1, was investigated with several new markers and direct nucleotide sequence analysis. These studies revealed that F-V/51 remains recombinant at a single nucleotide polymorphism (SNP) located 1.2 kb upstream of XL. No heterozygous mutation was identified between exon XL and an SNP approximately 8 kb upstream of NESP55, where this affected individual becomes linked, suggesting that the genetic defect responsible for parathyroid hormone resistance in kindred F, and probably other PHP-Ib patients, is located >or=56 kb centromeric of the abnormally methylated exon A/B. A region upstream of the known coding exons of GNAS1 is therefore predicted to exert, presumably through imprinting of exon A/B, long-range effects on G(s)alpha expression.

Toward an understanding of violence: neurobehavioral aspects of unwarranted physical aggression: Aspen Neurobehavioral Conference consensus statement.

OBJECTIVE: Violence is a global problem that poses a major challenge to individuals and society. This document is a consensus statement on neurobehavioral aspects of violence as one approach to its understanding and control. BACKGROUND: This consensus group was convened under the auspices of the Aspen Neurobehavioral Conference, an annual consensus conference devoted to the understanding of issues related to mind and brain. The conference is supported by the Brain Injury Association and by individual philanthropic contributions. Participants were selected by conference organizers to represent leading opinion in neurology, neuropsychology, psychiatry, trauma surgery, nursing, evolutionary psychology, medical ethics, and law. METHODS: A literature review of the role of the brain in violent behavior was conducted and combined with expert opinion from the group. The major goal was to survey this field so as to identify major areas of interest that could be targeted for further research. Additional review was secured from the other attendees at the Aspen Neurobehavioral Conference. RESULTS: The group met in the spring of 1998 and 1999 for two 5-day sessions, between which individual assignments were carried out. The consensus statement was prepared after the second meeting, and agreement on the statement was reached by participants after final review of the document. CONCLUSIONS: Violence can result from brain dysfunction, although social and evolutionary factors also contribute. Study of the neurobehavioral aspects of violence, particularly frontal lobe dysfunction, altered serotonin metabolism, and the influence of heredity, promises to lead to a deeper understanding of the causes and solution of this urgent problem.

Neurologic evaluation of violent juveniles.

Any juvenile who has acted violently requires a systematic, meticulous neurologic evaluation. There is no substitute for an adequate medical, family, and social history, the latter focusing on abuse and neglect. Evaluation should include a full physical and a conventional neurologic examination. Additionally, the physical, neurologic examination must include tests of cerebral-cortical function. The history and physical examination usually will indicate the diagnosis. A neuropsychologic evaluation of higher cerebral functions, including tests of frontal functions, should also be done in most cases. Some specific causes of brain disease can be identified by appropriate blood and urine tests, waking and sleep EEGs, and neuroimaging investigations. In general, positive findings are more significant than negative findings. If the physical examination and psychological tests are negative and the MR imaging shows a brain tumor, the patient has a brain tumor. If the neurologic or neuropsychological examinations demonstrate brain dysfunction, the patient has brain dysfunction, even if MR imaging is normal.

Employer-sponsored long-term care insurance: best practices for increasing sponsorship.

Behind the enthusiasm of policymakers for long-term care (LTC) insurance is the belief that increased ownership of private LTC insurance will reduce the government's future liability for financing the nation's LTC needs, currently projected by the Congressional Budget Office to increase by 2.6 percent annually between 2000 and 2040. Some observers say that sustained economic growth could keep these increased expenditures at the same share of total GDP; others argue that current federal expenditure trends will become unsustainable without large tax increases. The potential of the employer-sponsored group LTC market to stave off a national LTC financing crisis has recently started to receive popular notice in the news media. However, for the potential of the group LTC market to be realized, there must be widespread employer sponsorship of group LTC plans and significant participation levels among eligible employees in these plans. The present analysis of industry data estimates the LTC plan sponsorship rate for all U.S. employers with 10 or more employees at 0.2 percent. The sponsorship rate among large employers is significantly higher (8.7 percent). The greatest growth opportunities are projected to lie in the smaller employer market, because it is enormous and virtually untapped. Nonsponsors cite a variety of barriers to employer sponsorship of LTC plans. For many nonsponsors, the most important obstacles are the intrinsic characteristics of their work forces: employees are too young, transient, part-time, and/or low-income to be suitable for LTC insurance. For many others, lack of awareness and low priority are the primary obstacles. Because group LTC insurance has been widely available for only 10 years, many benefits managers view it as "too new and untested." Prior to the passage of the Health Insurance Portability and Accountability Act (HIPAA), in August 1996, the tax treatment of long-term care insurance premiums was unclear because Congress had not addressed the issue and the Internal Revenue Service had not issued clear guidance. In essence, HIPAA served to clarify the tax status of LTC insurance and establish product criteria for tax qualification. The interventions contained in HIPAA appear to have been insufficient to stimulate coverage growth rates that will meaningfully reduced the future burden on government financing of LTC. Although employment-based LTC insurance appears to be the best mechanism for mass expansion of coverage at affordable rates, the data suggest that employer sponsorship of LTC plans is relatively rare, especially among smaller employers, and that sponsorship rates may not dramatically increase without significant investments in employer education and new incentives.

Voluntary long-term care insurance: best practices for increasing employee participation.

This is the second of two Issue Briefs (April and May 2000) on long-term care (LTC) insurance. The previous Issue Brief addressed the problem of increasing sponsorship, while this report addresses the issue of increasing employee participation. Participation rates in group LTC insurance plans tend to be low. A potential watershed event for the development of the employment-based group LTC market is the proposed LTC program for federal employees and retirees (a program that would have to be enacted by Congress). The perception of a successful offering to federal employees could provide an enormous boost to the group LTC insurance market. Employee communication and education are seen as critical to the success of LTC enrollments. The importance of support shown by an employer for a new LTC plan offering cannot be overstated. Unlike 401(k) plan participation trends, LTC participation rates are highest among large companies. Insurers tend to view the 40-60 age range as the primary target for group LTC insurance, and employee salary as the best predictor of LTC insurance enrollment. Higher educational levels also are associated with higher levels of LTC participation. Perceived need for LTC insurance is perhaps the biggest barrier to the purchase of LTC insurance by employees due to competing financial priorities and the fact that LTC issues are generally off the "radar screens" of younger employees. Plans with skilled nursing home and home care benefits experience higher participation rates than plans lacking these benefits. The availability of lower-cost and long duration benefit options can be an important factor in determining participation. Most sponsors have chosen to offer noncontributory (i.e., fully employee-paid) LTC plans. Employer reluctance to make contributions may be caused by HIPAA's prohibition on the inclusion of LTC insurance in cafeteria plans. One of the major advantages of group LTC plans is the availability of guaranteed issue (i.e., issuing coverage without requiring evidence of insurability) for employees, which is not available in the individual LTC market. It is easy for enrollment to be derailed by the presence of any of a number of harmful conditions, such as employer-sponsors who distance themselves from the offer, ineffective communications, or difficult enrollment processes. Achieving consistently strong levels of participation in LTC plans will require employer-sponsors and their insurance carriers to form strong partnerships, with worker participation as their primary stated goal.

Implementation of on-site screening sigmoidoscopy positively influences utilization by primary care providers.

BACKGROUND & AIMS: Sigmoidoscopy is an effective screening strategy for colorectal cancer that is not widely used by primary care providers. The aim of this study was to assess the impact of "academic detailing" in the form of an outreach educational seminar combined with implementation of on-site sigmoidoscopy services performed by university-based gastroenterologists on provider compliance. METHODS: A controlled trial was initiated at 9 urban neighborhood health centers, including 4 intervention and 5 comparison sites. Baseline data on provider attitudes and practice patterns were collected using a validated questionnaire. Outcome measures included a year 1 follow-up survey of provider attitudes and quarterly review of screening sigmoidoscopy referrals using appointment logs to assess utilization. RESULTS: Overall self-reported compliance rates for screening sigmoidoscopy increased by 36% (baseline, 24%; year 1, 60%) for the intervention group vs. only 7% (baseline, 19%; year 1, 26%) for the comparison group (P = 0. 001). When stratified by site, compliance rates increased at each intervention site (range, 7%-92%) but at only 2 control sites. Use of screening sigmoidoscopy was also significantly greater at the intervention sites (47% vs. 4%; P

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

OBJECTIVE: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. METHOD: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

Constitutive activation of the cyclic adenosine 3',5'-monophosphate signaling pathway by parathyroid hormone (PTH)/PTH-related peptide receptors mutated at the two loci for Jansen's metaphyseal chondrodysplasia.

Two different activating PTH/PTH-related peptide (PTHrP) receptor mutations, H223R and T410P, were recently identified as the most likely cause of Jansen's metaphyseal chondrodysplasia. To assess the functional importance of either amino acid position in the human PTH/PTHrP receptor, H223 and T410 were individually replaced by all other amino acids. At position 223, only arginine and lysine led to agonist-independent cAMP accumulation; all other amino acid substitutions resulted in receptor mutants that lacked constitutive activity or were uninformative due to poor cell surface expression. In contrast, most amino acid substitutions at position 410 conferred constitutive cAMP accumulation and affected PTH/PTHrP receptor expression not at all or only mildly. Mutations corresponding to the H223R or T410P exchange in the human PTH/PTHrP receptor also led to constitutive activity when introduced into the opossum receptor homolog, but showed little or no change in basal cAMP accumulation when introduced into the rat PTH/PTHrP receptor. The PTH/PTHrP receptor residues mutated in Jansen's disease are conserved in all mammalian members of this family of G protein-coupled receptors. However, when the equivalent of either the H223R or the T410P mutation was introduced into several other related receptors, including the PTH2 receptor and the receptors for calcitonin, secretin, GH-releasing hormone, glucagon-like peptide I, and CRH, the resulting mutants failed to induce constitutive activity. These studies suggest that two residues in the human PTH/PTHrP receptor, 223 and 410, have critical roles in signal transduction, but with different sequence constrains.