Goal importance, use of performance measures, and knowledge exchange: An empirical study on general practitioners' performance.

BACKGROUND: In many health systems, general practitioners (GPs) exhibit high levels of isolation and, at the same time, low levels of organizational identification, which can hinder their individual performance. The extant health care literature suggests that the physicians' belief that organizational goals are important, the adoption of performance measurement systems, and knowledge-sharing practices affect their individual performance. Most research has investigated these constructs in isolation, however, rather than explored their collective impact on GPs' individual performance. PURPOSE: The aim of this study was to explore how GPs' belief in goal importance, use of performance measures, and knowledge exchange affect their individual performance, here defined as their individual achievement of organizational goals. METHODOLOGY: We developed five hypotheses regarding how GPs' belief in goal importance and use of performance measures may affect individual performance, as well as how knowledge exchange may moderate these relationships. We tested our theoretical conjectures using data collected in a community of GPs in the Italian National Health Service. A survey questionnaire was administered to gather information about the GPs' level of belief in goal importance, use of performance measures, and perception about knowledge exchange in their primary care units. We considered two measures of GPs' individual performance: efficiency and appropriateness of drug prescription. We tested our hypotheses using probit regressions. RESULTS: Our findings show that perceived importance of organizational goals and use of performance measures have a positive effect on GPs' individual performance. Meanwhile, GPs' use of performance measures moderates the relationship between their belief in goal importance and individual performance. Finally, perceived knowledge exchange moderates the relationships between belief in goal importance/use of performance measures and individual performance. PRACTICE IMPLICATIONS: Executives could improve GPs' individual performance through interventions that reinforce their belief that organizational goals are important, facilitate a more intensive use of performance measures, and encourage knowledge exchange practices.

Thermal aggregation of bovine serum albumin in trehalose and sucrose aqueous solutions.

We report results of static and dynamic light scattering measurements performed on bovine serum albumin (BSA) in saccharide (trehalose and sucrose) solutions. Our aim is to study the effects of the two disaccharides on the first steps of thermal aggregation of BSA in aqueous solutions at two protein concentrations (1 and 30 mg/mL) at increasing sugar/water ratio. Results show that sugars modify early stages of aggregation mainly by perturbing the thermodynamic behavior of the solvent (i.e., general solvent effects) without involving direct, specific sugar-protein interactions. This agrees with current hypotheses on sugar action in protein solutions. (1-3) The linear correlation detected between the characteristic temperature of the aggregation process and the glass transition temperature of the water-sugar solvent strengthens the above suggestions.

Y:BaZrO3 perovskite compounds I: DFT study on the unprotonated and protonated local structures.

Y-doped BaZrO(3) derivatives were studied by density functional theory (DFT) to investigate the local arrangements of the octahedral sites in Pm3m cubic frameworks. Single- and double substitution of zirconium by yttrium were considered, including in the presence of a nearby oxygen vacancy. Although the structural symmetry of undoped barium zirconate was not modified after yttrium doping, the presence of yttrium induced several differences in the oxygen sites around it, according to the local geometrical arrangement of yttrium in the host matrix. As an example, the differences between such oxygen sites were shown in the presence of a proton. In this case, different stabilization energies characterized the protonated fragments. Only in those structures, in which two yttrium atoms were neighbors (i.e., formed Y-O-Y moieties), were the relative energy differences between the corresponding proton stable sites in agreement with the order of magnitude of the experimental proton-hopping activation energies. The distribution of such energy differences suggested a grouping of the oxygen atoms into three sets, which had peculiar structural features that weren't easily deducible from their topologies. The existence of proton traps was also discussed on the basis of the energy-difference distributions.

Y:BaZrO3 perovskite compounds II: designing protonic conduction by using MD models.

The proton dynamics in Y-doped BaZrO(3) derivatives, in particular the different dopant environments within a Pm3m cubic framework, were studied by using classical molecular dynamics (MD) calculations. Single- and double substitution of zirconium by yttrium atoms was considered. The presence of yttrium induced variations in the surrounding oxygen sites, according to their local geometrical arrangements. The differences among such distinct oxygen sites became evident when protons interacted with them and upon changes in the temperature. So, different proton transfer pathways, which had different energy barriers, characterized the topologically different oxygen sites. The experimental proton-hopping activation energy was only reproduced in those structures in which two yttrium atoms formed a Y-O-Y arrangement, which also acted as multilevel protonic traps. Protonic conduction in these materials could be improved by avoiding such yttrium clustering, hence preventing the formation of the protonic traps.

Cation environment of BaCeO3-based protonic conductors II: new computational models.

Quantum chemical calculations have been carried out to simulate Y-doped BaCeO(3) derivatives. Hartree-Fock energy functional was used to study octahedral site environments embedded in a Pmcn orthorhombic framework, showing local arrangement characterized by Ce-O-Ce, Ce-O-Y, and Y-O-Y (Z-O-Ξ) configurations and including or not hydrogen close to the moieties encompassing those configurations. The latter are, in fact, representative of - and, in our modeling approach, were treated as - local arrangements that could be found in Y:BaCeO(3)-doped materials. The geometrical optimizations performed on the structural models and a detailed orbital analysis of these systems allowed us to confirm and deepen new interpretations, concerning experimental findings already reported in the literature. In particular, the bimodal distribution characterizing the Y-O first coordination shell, found by EXAFS analysis, could be attributed to a local clustering of Y atoms showing characteristic Y-O-Y arrangements. Moreover, the local charge analysis, characterizing the models containing or not hydrogen atoms, showed that the moving protons are able to dynamically change the properties of their near environment, in any case, leaving unaltered the global protonic conduction features of the material, irrespective of the kind of cation in a given Z-O-Ξ moiety.

Early stages of beta2-microglobulin aggregation and the inhibiting action of alphaB-crystallin.

Static and dynamic light scattering experiments on extremely clean (nanofiltered) samples of the well-known amyloidogenic protein beta2-microglobulin (R3Abeta2m and WTbeta2m) evidence the self-assembly of early aggregates showing unexpected features. Further, we find that alphaB-crystallin effectively inhibits aggregation of beta2m in a far less than stoichiometric proportion, from 1:60 alphaB-crystallin monomer to beta2m monomer ratio, down to at least a 1:2 x 10(3) alphaB-crystallin oligomerto beta2m monomer ratio. Therefore, inhibition of the early stage of beta2m aggregation by alphaB-crystallin does not necessarily require a mechanicistic chaperon-like action implying one-to-one binding. This highlights the role of the free energy landscape of the system and of related modifications of solute-solvent thermodynamics caused by co-solutes, in agreement with recent work from our and other laboratories.

Aggregation kinetics of bovine serum albumin studied by FTIR spectroscopy and light scattering.

To investigate which type of structural and conformational changes is involved in the aggregation processes of bovine serum albumin (BSA), we have performed thermal aggregation kinetics in D(2)O solutions of this protein. The tertiary conformational changes are followed by Amide II band, the secondary structural changes and the formation of beta-aggregates by the Amide I' band and, finally, the hydrodynamic radius of aggregates by dynamic light scattering. The results show, as a function of pD, that: tertiary conformational changes are more rapid as pD increases; the aggregation proceeds through formation of ordered aggregates (oligomers) at pD far from the isoelectric point of the protein; disordered structures add as the pD decreases. Moreover, beta-aggregates seem to contribute only to oligomers formation, as showed by the good correlation between kinetics of scattering intensity and IR absorption intensity. These results indicate for BSA a general mechanism of aggregation composed by partial unfolding of the tertiary structure and by the decrease of alpha-helix and random coil contents in favor of beta-sheet aggregates. This mechanism strictly depends on pD and gives rise to almost two distinct types of macromolecular aggregates.