Ambiguity tolerance in organizations: definitional clarification and perspectives on future research.

Ambiguity tolerance is an increasingly popular subject for study in a wide variety of fields. The definition of ambiguity tolerance has changed since its inception, and accompanying that change are changes in measurement and the research questions that interest researchers. There is a wealth of opportunity for research related to ambiguity tolerance and recent advances in neuroscience, measurement, trait research, perception, problem solving, and other fields highlight areas of interest and point to issues that need further attention. The future of ambiguity tolerance research is promising and it is expected that future studies will yield new insights into individual differences in reactions to the complex, unfamiliar, confusing, indeterminate, and incomplete stimuli that fall within the conceptual domain of ambiguity.

Sensitivity to social information, social referencing, and safety attitudes in a hazardous occupation.

Social referencing, or seeking information cues from others, occurs when a worker must make sense of those aspects of work, like safety hazards, that are ambiguous. This is a central argument of Social Information Processing Theory (SIPT), a social referencing and job characteristics theory of work attitudes. Adapting SIPT to the understanding of safety perceptions and attitudes, this paper hypothesizes relationships between the worker's sensitivity to social information, the worker's social safety cognitions, and the worker's own safety attitudes. Findings from a field study of workers in a hazardous occupation, emergency care/firefighting, confirmed SIPT-predicted relationships among these factors: the worker's belief in management's willingness to provide a safe work environment, the degree of risk the worker associates with his or her job, the worker's concern about the frequency of exposure to hazards, and the worker's personal experiences with hazards. These findings also suggest that a social referencing and job characteristics perspective like SIPT provides a logical and useful theoretical framework for understanding workers' interpretations of safety conditions. This perspective also helps relate theories of safety attitudes to a broad set of theories of social information and organizational behavior.

The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain.

Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn's disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated. Despite initial promise of efficacy, the use of LDN for chronic disorders is still highly experimental. Published trials have low sample sizes, and few replications have been performed. We cover the typical usage of LDN in clinical trials, caveats to using the medication, and recommendations for future research and clinical work. LDN may represent one of the first glial cell modulators to be used for the management of chronic pain disorders.

Cost analysis of flavocoxid compared to naproxen for management of mild to moderate OA.

OBJECTIVE: Flavocoxid is a medical food used for the clinical dietary management of osteoarthritis (OA). The acquisition cost of flavocoxid is higher than most traditional, generic NSAIDs. However, flavocoxid may have more favorable gastrointestinal (GI) toxicity resulting in lower overall costs. These costs have not been previously examined. This study provides a decision analytic model to assess the net costs of using flavocoxid for OA from a Medicare perspective. RESEARCH DESIGN AND METHODS: A decision model was developed to estimate the total costs associated with flavocoxid versus naproxen for the management of Medicare patients with mild to moderate OA. Probabilities were obtained from literature and expert opinion, and costs were obtained from Medicare. Sensitivity analyses were conducted by varying probabilities and costs within clinically relevant ranges. RESULTS: The base case resulted in flavocoxid having lower total annual costs ($1482 per patient) compared to naproxen ($1592). Flavocoxid remained the lowest cost option when the cost inputs were varied by 25% (above and below the base case), and when the probability of GI events with flavocoxid were varied by 25%. However, when GI rates from the literature and implied relative risks from the expert panel were used, or if the cost of PPIs was $0, then naproxen was the less costly alternative, though saving less than the annual cost of flavocoxid. Key limitations were the limited outcomes in the model (only GI events), lack of consideration of adherence or combination therapy, and the reliance on expert opinion due to a lack of data for flavocoxid. CONCLUSIONS: In patients over 65 years of age who suffer from mild to moderate OA, flavocoxid may result in lower overall costs, despite a higher acquisition cost. Managed care organizations should consider total health care costs in the decision to include flavocoxid as a covered benefit.

Preliminary validation of the Spanish version of the Multiple Stimulus Types Ambiguity Tolerance Scale (MSTAT-II).

Despite widespread interest in ambiguity tolerance and other information-related individual differences, existing measures are conceptually dispersed and psychometrically weak. This paper presents the Spanish version of MSTAT-II, a short, stimulus-oriented, and psychometrically improved measure of an individual's orientation toward ambiguous stimuli. Results obtained reveal adequate reliability, validity, and temporal stability. These results support the use of MSTAT-II as an adequate measure of ambiguity tolerance.

Preliminary validation of the Spanish version of the multiple stimulus types ambiguity tolerance scale (MSTAT-II)

Despite widespread interest in ambiguity tolerance and other information-related individual differences, existing measures are conceptually dispersed and psychometrically weak. This paper presents the Spanish version of MSTAT-II, a short, stimulus-oriented, and psychometrically improved measure of an individual’s orientation toward ambiguous stimuli. Results obtained reveal adequate reliability, validity, and temporal stability. These results support the use of MSTAT-II as an adequate measure of ambiguity tolerance (AU)

A pesar del amplio interés en la tolerancia a la ambigüedad y a otras diferencias individuales relacionadas con la información, las medidas existentes son conceptualmente dispersas y presentan deficiencias psicométricas. El propósito de este trabajo es presentar la versión española del MSTAT II, un instrumento de medida de las orientaciones de un individuo respecto a estímulos ambiguos con mejoras psicométricas sustanciales, independiente del contexto y suficientemente corto para ser utilizado junto con otras medidas. Los resultados obtenidos en cuanto a consistencia interna, estabilidad temporal y validez son satisfactorios. Estos resultados apoyan el uso del MSTAT-II en su versión española como una medida adecuada de tolerancia a la ambigüedad (AU)

Herpes simplex encephalitis during treatment with tumor necrosis factor-alpha inhibitors.

We report 3 cases of herpes simplex virus encephalitis in patients receiving tumor necrosis factor-alpha (TNF-alpha) inhibitors for rheumatologic disorders. Although TNF-alpha inhibitors have been reported to increase the risk of other infectious diseases, to our knowledge, an association between anti-TNF-alpha drugs and herpes simplex virus encephalitis has not been previously described.

Evidence of the properties of an ambiguity tolerance measure: the Multiple Stimulus Types Ambiguity Tolerance Scale-II (MSTAT-II).

Despite widespread interest in ambiguity tolerance and other information-related individual differences, existing measures of ambiguity tolerance are conceptually disparate and are often psychometrically weak. This paper presents evidence of reliability and validity for a 13-item measure of ambiguity tolerance (MSTAT-II) based on a definition of ambiguity tolerance as an orientation, ranging from aversion to attraction, toward stimuli that are complex, unfamiliar, and insoluble. The MSTAT-II addresses each basic type of ambiguous stimulus, contains fewer items than many other scales, and reduces references to specific contexts and objects not directly related to ambiguity. Data from three studies using diverse samples and measures, including other popular ambiguity tolerance scales, were examined, and the results suggest the MSTAT-II may improve upon other paper-and-pencil measures of ambiguity tolerance.

The perceived compatibility of safety and production expectations in hazardous occupations.

INTRODUCTION: Safety hazards are unavoidable in many work environments. Employees must be both productive and safe, however, conflicting safety and production demands can negatively affect safety, production, or both. The employee's perception of the compatibility of management's safety and production expectations is a possible predictor of such consequences. This paper defines "safety-production compatibility" and describes how measures of safety-production compatibility, as well as safety pressure and production pressure, were developed. METHOD: We used LISREL structural equation modeling to test the influences of safety-production compatibility, safety pressure, and production pressure on safe work behavior and interference with performing other work tasks. The 239 study participants were workers employed in diverse but hazardous occupations. RESULTS: Pressure to work safely was positively associated with safe work behavior. The perceived compatibility of safety and production demands positively influenced safe work behavior and reduced the interference of safety hazards performing other tasks. Safety-production compatibility was also found to mediate the relationship between trust in management and safe work behavior. CONCLUSIONS: The results of this field study suggest increased compatibility, and thus less conflict, between safety and production demands influences safe work behavior and the interference of safety hazards with performing other work tasks. More broadly, the worker's reaction to multiple work demands is a safety and performance influence. IMPACT ON INDUSTRY: Safety management efforts that focus only on the hazards fail to eliminate many accidents because accidents arise from many factors including technology, safety climate, social influences, production, and safety demands. This study suggests that workers differ in their perception of the compatibility of safety and production demands. These differences will show up in safe work behavior, influencing the effectiveness of safety management efforts and the trust workers have in management's concern for safety.

The prevalence of undiagnosed pulmonary arterial hypertension in subjects with connective tissue disease at the secondary health care level of community-based rheumatologists (the UNCOVER study).

OBJECTIVE: Most of the data about the prevalence of pulmonary arterial hypertension (PAH) are from tertiary centers that are biased toward seeing more severe cases; therefore, the true prevalence of PAH among patients with connective tissue disease is unknown. We sought to determine the point prevalence of undiagnosed PAH in community-based rheumatology practices. METHODS: The study design was a multicenter, prospective and retrospective survey and analysis of clinical cases in 50 community rheumatology practices. We evaluated a total of 909 patients with either scleroderma (systemic sclerosis [SSc]) or mixed connective tissue disease (MCTD). If a subject had not been diagnosed as having PAH, then a new Doppler echocardiogram was obtained to measure cardiac parameters, including estimated right ventricular systolic pressure (ERVSP), and a full review of medical records was done. RESULTS: Of 909 screened patients, 791 were evaluable and completed the study; 669 had not previously been studied for PAH. Of these 669 patients, 89 (13.3%) were found by Doppler echocardiography to have an ERVSP of > or = 40 mm Hg. Of these 89 patients, 82 (92.1%) had SSc and 7 (7.9%) had MCTD. The total prevalence of PAH in the survey was 26.7% (211 of 791 patients, including 122 with known PAH and 89 newly diagnosed as having PAH). Doppler echocardiographic data showed 20 of 89 patients (22.5%) with ERVSP of > or = 50 mm Hg, 20 of 89 patients (22.5%) with increased RV dimension, and 25 of 89 patients (28.1%) with right atrial enlargement. Patients with ERVSP > or = 40 mm Hg had decreased exercise tolerance compared with those with ERVSP <40 mm Hg (27% compared with 9.5%, respectively, were severely symptomatic). CONCLUSION: A significant number of patients with SSc or MCTD (13.3%) followed up in a community rheumatology practice setting have undiagnosed elevated ERVSP consistent with PAH.

Lessons from fibromyalgia: abnormal pain sensitivity in knee osteoarthritis.

Fibromyalgia (FM) is a disorder that is characterized by widespread, musculoskeletal pain and abnormal pain sensitivity at multiple anatomic sites. Laboratory studies involving psychophysical and neuroimaging methods suggest that central augmentation of low intensity stimulation may contribute to abnormal pain sensitivity in FM. Recently, several investigators, using similar laboratory methods, have shown that patients with knee or hip osteoarthritis (OA) exhibit abnormal pain sensitivity or abnormal pain inhibition at anatomic sites distal to affected joints. Consistent with animal models of central sensitization, differences between patients and healthy controls in pain processing and pain inhibition at these distal sites are eliminated after nociceptive input is eliminated following total joint replacement surgery. This paper reviews these findings from our laboratory and those of independent investigators. It also presents verbal, psychophysical and neuroimaging data concerning ethnic group differences in affective and cognitive pain responses among patients with knee OA. We suggest that central sensitization as well as centrally-mediated cognitive and affective factors influence the pain responses of patients with knee OA. In addition, ethnic group differences in pain cognition and affect may contribute to differences among these groups in preferences for healthcare interventions such as total joint replacement.