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Background Children’s Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs’ capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. Methods We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers’ understanding of their child’s mental health needs and caregivers’ intentions to initiate mental health services (effectiveness aim). Conclusions Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. Trial registration Clinicaltrials.gov, NCT05679154. Registered on January 10, 2023.

Purpose Teams play a central role in the implementation of new practices in settings providing team-based care. However, the implementation science literature has paid little attention to potentially important team-level constructs. Aspects of teamwork, including team interdependence, team functioning, and team performance, may affect implementation processes and outcomes. This cross-sectional study tests associations between teamwork and implementation antecedents and outcomes in a statewide initiative to implement a standardized mental health screening/referral protocol in Child Advocacy Centers (CACs). Methods Multidisciplinary team members (N = 433) from 21 CACs completed measures of team interdependence; affective, behavioral, and cognitive team functioning; and team performance. Team members also rated the acceptability, appropriateness, and feasibility of the screening/referral protocol and implementation climate. The implementation outcomes of days to adoption and reach were independently assessed with administrative data. Associations between team constructs and implementation antecedents and outcomes were tested with linear mixed models and regression analyses. Results Team task interdependence was positively associated with implementation climate and reach, and outcome interdependence was negatively correlated with days to adoption. Task and outcome interdependence were not associated with acceptability, appropriateness, or feasibility of the screening/referral protocol. Affective team functioning (i.e., greater liking, trust, and respect) was associated with greater acceptability, appropriateness, and feasibility. Behavioral and cognitive team functioning were not associated with any implementation outcomes in multivariable models. Team performance was positively associated with acceptability, appropriateness, feasibility, and implementation climate; performance was not associated with days to adoption or reach. Conclusions We found associations of team interdependence, functioning, and performance with both individual- and center-level implementation outcomes. Implementation strategies targeting teamwork, especially task interdependence, affective functioning, and performance, may contribute to improving implementation outcomes in team-based service settings.

PurposeThis paper aims to add to the current knowledge about conflict management by examining the relationships between conflict type, conflict expression intensity and the use of the conflict management approach.Design/methodology/approachThe authors test theory-based hypotheses using a field study of new product development teams in an interdisciplinary Masters program (Study 1) and an experimental vignette study (Study 2).FindingsResults show that people are more likely to respond to task conflict and conflicts expressed with less intensity using collectivistic conflict management approaches (i.e. problem-solving, compromising and yielding), and to relationship conflicts and conflicts expressed with higher intensity through forcing, an individualistic conflict management approach. Information acquisition and negative emotions experienced by team members mediate these relationships.Practical implicationsKnowing how the characteristics of the conflict (type and expression intensity) affect conflict management, managers can counteract the tendency to use dysfunctional, forcing conflict management approaches in response to high intensity conflicts, as well as to relationship conflicts and support the tendency to use collectivistic conflict management approaches in response to low intensity conflict, as well as task conflicts.Originality/valueThe authors examine an alternative to the prevailing view that conflict management serves as a moderator of the relationship between conflict and team outcomes. The research shows that conflict type and intensity of conflict expression influence the conflict management approach as a result of the information and emotion they evoke. The authors open avenues for future research on the complex and intriguing relationships between conflict characteristics and the conflict management approach.

Rationale: Psychological safety is the condition by which members of an organization feel safe to voice concerns and take risks. Although psychological safety is an important determinant of team performance, little is known about its role in the intensive care unit (ICU). Objectives: To identify the factors associated with psychological safety and the potential influence of psychological safety on team performance in critical care. Methods: We performed daily surveys of healthcare providers in 12 ICUs within an integrated health system over a 2-week period. Survey domains included psychological safety, leader familiarity, leader inclusiveness, role clarity, job strain, and teamwork. These data were linked to daily performance on lung-protective ventilation and spontaneous breathing trials. We used regression models to examine the antecedents of psychological safety as well as the influence of psychological safety on both perceived teamwork and actual performance. Results: We received 553 responses from 270 unique providers. At the individual provider level, higher leader inclusiveness (adjusted β = 0.32; 95% confidence interval [CI], 0.24 to 0.41) and lower job strain (adjusted β = −0.07, 95% CI, −0.13 to −0.02) were independently associated with greater psychological safety. Higher psychological safety was independently associated with greater perception of teamwork (adjusted β = 0.30; 95% CI, 0.25 to 0.36). There was no association between team psychological safety and performance on either spontaneous breathing trials (incident rate ratio for each 1-unit change in team psychological safety, 0.85; 95% CI, 0.81 to 1.10) or lung-protective ventilation (incident rate ratio, 0.77; 95% CI, 0.57 to 1.04). Conclusions: Psychological safety is associated with several modifiable factors in the ICU but is not associated with actual use of evidence-based practices.

Background Healthcare and human services increasingly rely on teams of individuals to deliver services. Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review will identify and summarize empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings. Methods We will conduct a comprehensive search of bibliographic databases (e.g., MEDLINE, PsycINFO, CINAHL, ERIC) for articles published from January 2000 or later. We will include peer-reviewed empirical articles and conference abstracts using quantitative, qualitative, or mixed methods. We will include experimental or observational studies that report on the implementation of an innovation in a healthcare or human service setting and examine associations between team functioning and implementation outcomes. Implementation outcomes of interest are acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. Two reviewers will independently screen all titles/abstracts, review full-text articles, and extract data from included articles. We will use the Mixed Methods Appraisal Tool to assess methodological quality/bias and conduct a narrative synthesis without meta-analysis. Discussion Understanding how team functioning influences implementation outcomes will contribute to our understanding of team-level barriers and facilitators of change. The results of this systematic review will inform efforts to implement evidence-based practices in team-based service settings. Systematic review registration PROSPERO CRD42020220168

Individualized work arrangements (“i-deals”) negotiated by employees are increasingly common in contemporary employment. Existing research largely focuses on phenomena emerging after the creation of i-deals, particularly their consequences for employees and organizations. This focus overlooks the fundamental processes associated with negotiating i-deals in the first place. I-deals research originating in the last two decades can benefit from the more advanced body of research on negotiations, particularly in its attention to negotiation preparation and the bargaining process. We examine how negotiation research and theory inform our understanding of the dynamics operating in the creation of i-deals. In doing so, we identify key features of negotiation research that apply to i-deal formulation and use these to develop an agenda for future research on i-deals.

Intensive care units (ICUs) provide care to the most severely ill hospitalized patients. Although ICUs increasingly rely on interprofessional teams to provide critical care, little about actual teamwork in this context is well understood. The ICU team is typically comprised of physicians or intensivists, clinical pharmacists, respiratory therapists, dieticians, bedside nurses, clinical psychologists, and clinicians-in-training. ICU teams are distinguished from other health care teams in that they are low in temporal stability, which can impede important team dynamics. Furthermore, ICU teams must work in physically and emotionally challenging environments. Our review of the literature reveals the importance of information sharing and decision-making processes, and identifies potential barriers to successful team performance, including the lack of effective conflict management and the presence of multiple and sometimes conflicting goals. Key knowledge gaps about ICU teams include the need for more actionable data linking ICU team structure to team functioning and patient-, family-, ICU-, and hospital-level outcomes. In particular, research is needed to better delineate and define the ICU team, identify additional psychosocial phenomena that impact ICU team performance, and address varying and often competing indicators of ICU team effectiveness as a multivariate and multilevel problem that requires better understanding of the independent effects and interdependencies between nested elements (i.e., hospitals, ICUs, and ICU teams). Ultimately, efforts to advance team-based care are essential for improving ICU performance, but more work is needed to develop actionable interventions that ensure that critically ill patients receive the best care possible. (PsycINFO Database Record

In this study, the authors determined the effect of a structured Internet-delivered Mantram Repetition Program (MRP) on burnout and stress of conscience (SOC), stress related to ambiguity from ethical or moral conflicts among health care workers (HCWs) within the Veteran Affairs (VA) Healthcare System. A secondary purpose was to determine whether practicing meditation prior to the study combined with MRP affected burnout or SOC. The MRP teaches the mindful practices of repeating a mantram, slowing down, and one-pointed attention for managing stress. Thirty-nine HCW volunteers who provided direct patient care completed the Internet-delivered MRP. The outcomes of burnout (i.e., exhaustion, cynicism, and professional efficacy) and SOC (i.e., frequency of stressful events and troubled conscience about those events) were measured at baseline (T1), postintervention (T2), and 3-months postintervention (T3). Repeated measures ANOVA indicated that exhaustion significantly ( p < .05) declined between T1 and T3; professional efficacy and cynicism did not change during the study. The same statistical model also indicated the frequency of stressful events significantly declined between T1 and T2 and troubled conscience declined between T1 and T3. Secondary analysis demonstrated that individuals who did not practice meditation at baseline ( n = 16, 41%) significantly decreased exhaustion, frequency of stressful events, and troubled conscience between T1 and T3, and improved professional efficacy between T1 and T2. Individuals who practiced meditation at baseline ( n = 23, 59%) did not demonstrate significant change on any study outcomes. An MRP intervention may reduce burnout and SOC in those individuals who are naïve to practicing meditation.

Gender differences in task allocations may sustain vertical gender segregation in labor markets. We examine the allocation of a task that everyone prefers be completed by someone else (writing a report, serving on a committee, etc.) and find evidence that women, more than men, volunteer, are asked to volunteer, and accept requests to volunteer for such tasks. Beliefs that women, more than men, say yes to tasks with low promotability appear as an important driver of these differences. If women hold tasks that are less promotable than those held by men, then women will progress more slowly in organizations. (JEL I23, J16, J44, J71, M12, M51)

Often, the senders and receivers of scientific communication have different knowledge bases. While such communication is essential for solving the complex social and technological problems that affect multiple stakeholders, a diversity of knowledge among communicators can create representational gaps (rGaps). rGaps occur when senders make assumptions that receivers do not, creating conflict over the meaning and value of the information communicated. Such conflict could, if managed, promote learning and innovation as communicators reconcile their assumptions. More often, however, rGaps cause conflict to transform from a debate that informs to an argument that divides. Managing rGap conflict so that it does not degrade communication requires relationship building to mitigate the negative by-products of persistent conflict while maintaining appropriate levels of cognitive distinctiveness among diverse stakeholders. Thus, we provide a framework for identifying and leveraging rGaps through managed conflict so that communication between those with different perspectives builds rather than burns bridges.

Conflicts in the workplace have been characterized by their type (task, process, relationship), but little attention has been paid to how conflicts are expressed. We present a conceptual framework of conflict expression and argue that understanding how conflicts are expressed can help us gain new insights about the effects of conflict. We propose that conflict expressions vary in their directness and oppositional intensity and that these differences directly influence how people experience and react to conflict, resulting in dynamic escalatory or de-escalatory conflict spirals. We argue that directness of conflict expression is a function of the ambiguity of expression and who is involved (antagonists versus involving other people). Oppositional intensity of conflict expression is indicated by the communicated entrenchment in positions and subversiveness of actions. We argue that while oppositional intensity and directness are universal dimensions characterizing conflict expression, the cultural context and characteristics of the disputants will influence how conflict is expressed and perceived. We consider the implications of our conceptual framework for related research examining conflict.

Importance Less than one-third of patients with major depressive disorder (MDD) achieve remission with their first antidepressant. Objective To determine the relative effectiveness and safety of 3 common alternate treatments for MDD. Design, Setting, and Participants From December 2012 to May 2015, 1522 patients at 35 US Veterans Health Administration medical centers who were diagnosed with nonpsychotic MDD, unresponsive to at least 1 antidepressant course meeting minimal standards for treatment dose and duration, participated in the study. Patients were randomly assigned (1:1:1) to 1 of 3 treatments and evaluated for up to 36 weeks. Interventions Switch to a different antidepressant, bupropion (switch group, n = 511); augment current treatment with bupropion (augment-bupropion group, n = 506); or augment with an atypical antipsychotic, aripiprazole (augment-aripiprazole group, n = 505) for 12 weeks (acute treatment phase) and up to 36 weeks for longer-term follow-up (continuation phase). Main Outcomes and Measures The primary outcome was remission during the acute treatment phase (16-item Quick Inventory of Depressive Symptomatology-Clinician Rated [QIDS-C 16 ] score ≤5 at 2 consecutive visits). Secondary outcomes included response (≥50% reduction in QIDS-C 16 score or improvement on the Clinical Global Impression Improvement scale), relapse, and adverse effects. Results Among 1522 randomized patients (mean age, 54.4 years; men, 1296 [85.2%]), 1137 (74.7%) completed the acute treatment phase. Remission rates at 12 weeks were 22.3% (n = 114) for the switch group, 26.9% (n = 136)for the augment-bupropion group, and 28.9% (n = 146) for the augment-aripiprazole group. The augment-aripiprazole group exceeded the switch group in remission (relative risk [RR], 1.30 [95% CI, 1.05-1.60]; P = .02), but other remission comparisons were not significant. Response was greater for the augment-aripiprazole group (74.3%) than for either the switch group (62.4%; RR, 1.19 [95% CI, 1.09-1.29]) or the augment-bupropion group (65.6%; RR, 1.13 [95% CI, 1.04-1.23]). No significant treatment differences were observed for relapse. Anxiety was more frequent in the 2 bupropion groups (24.3% in the switch group [n = 124] vs 16.6% in the augment-aripiprazole group [n = 84]; and 22.5% in augment-bupropion group [n = 114]). Adverse effects more frequent in the augment-aripiprazole group included somnolence, akathisia, and weight gain. Conclusions and Relevance Among a predominantly male population with major depressive disorder unresponsive to antidepressant treatment, augmentation with aripiprazole resulted in a statistically significant but only modestly increased likelihood of remission during 12 weeks of treatment compared with switching to bupropion monotherapy. Given the small effect size and adverse effects associated with aripiprazole, further analysis including cost-effectiveness is needed to understand the net utility of this approach. Trial Registration clinicaltrials.gov Identifier:NCT01421342

Conflict research has shown that managing relationship conflict via avoidance is beneficial for team performance, but it is unclear whether avoidant conflict management benefits individuals on an affective level. Drawing on theories of gender roles, we proposed that gender is an important factor that influences whether avoidant conflict management mitigates the negative affective effects of relationship conflict. In a field study of a healthcare organization, we found that relationship conflict resulted in negative emotions, which, in turn, were positively associated with emotional exhaustion two months later. Avoidant conflict management attenuated the relationship between negative emotions engendered by relationship conflict and emotional exhaustion, but this effect depended on gender. Among men, the extent to which they used an avoidant conflict management style mitigated the association between negative emotions and emotional exhaustion, whereas among women, avoidant conflict management did not attenuate this relationship. Findings are discussed in terms of theoretical and practical implications.

We examine the effect of friendship in triads on retaliatory responses to unfair outcomes that originate from a group member. Drawing on Simmel’s classic discussion of relationships in social triads versus dyads, we hypothesized that the effect of unfairness on retaliation between friends is stronger when the third party in the triad is a mutual friend, rather than a stranger. We also draw on social categorization theory to hypothesize that the effect of unfairness on retaliation between strangers is stronger when the third party is a friend of that stranger than when the triad consists of all strangers. Hypotheses were tested in an experiment where participants negotiated with one another in a three-person exchange network. The results supported our hypothesis that between friends, the increase in retaliation was stronger following an unfair deal when third parties were mutual friends, rather than strangers.

This study investigates cycles of planning, enacting, and reviewing activities over time in teams engaged in creative projects. Drawing on longitudinal case studies of two interactive media development teams, two distinct cycles of planning, enacting, and reviewing activities are identified: experimentation cycles and validation cycles. Experimentation cycles are discovery-oriented processes where teams gather insights into project requirements, constraints, and design specifications through trial-and-error. Validation cycles are correction-oriented processes where teams align their output with project requirements through incremental modifications. These findings are then built on to develop testable propositions about the relationship between the duration of planning, enacting, and reviewing activities and the innovativeness and quality of team outcomes.

We sought to develop a reliable and valid tool for measuring teamwork among emergency medical technician (EMT) partnerships.We adapted existing scales and developed new items to measure components of teamwork. After recruiting a convenience sample of 39 agencies, we tested a 122-item draft survey tool (EMT-TEAMWORK). We performed a series of exploratory factor analyses (EFAs) and confirmatory factor analysis (CFA) to test reliability and construct validity, describing variation in domain and global scores using descriptive statistics.We received 687 completed surveys. The EFAs identified a nine-factor solution. We labeled these factors 1) Team Orientation, 2) Team StructureLeadership, 3) Partner Communication, Team Support,Monitoring, 4) Partner Trust and Shared Mental Models, 5) Partner AdaptabilityBack-Up Behavior, 6) Process Conflict, 7) Strong Task Conflict, 8) Mild Task Conflict, and 9) Interpersonal Conflict. We tested a short-form (30-item SF) and long-form (45-item LF) version. The CFAs determined that both the SF and the LF possess positive psychometric properties of reliability and construct validity. The EMT-TEAMWORK-SF has positive internal consistency properties, with a mean Cronbach's alpha coefficient ≥0.70 across all nine factors (mean = 0.84; minimum = 0.78, maximum = 0.94). The mean Cronbach's alpha coefficient for the EMT-TEAMWORK-LF was 0.87 (minimum = 0.79, maximum = 0.94). There was wide variation in weighted scores across all nine factors and the global score for the SF and LF. Mean scores were lowest for the Team Orientation factor (48.1, standard deviation [SD] 21.5, SF; 49.3, SD 19.8, LF) and highest (more positive) for the Interpersonal Conflict factor (87.7, SD 18.1, for both SF and LF).We developed a reliable and valid survey to evaluate teamwork between EMT partners.

A key component of negotiation dynamics is the search for mutually beneficial agreements, and offer exchange is a key element of that process. Rooted in the tradition of information processing psychology, we develop a theoretical model that conceives of negotiation as the collaborative search of a complex offer space. Negotiators simplify and coordinate search via information contained in offer exchanges, isolating subregions of the offer space for potential solutions. We suggest that early search is more exploratory and primarily influenced by the value of offers; later search is more focused on refinement and is influenced by the content of offers. In that, search by value is substantially more difficult than search by content, and parties seek value through communicating about content. Important information about the negotiators’ perspectives is revealed in comprehensive offers, and critical insight into this search process can be gained by examining the pattern of comprehensive offers.

Although interdisciplinary research attracts more and more interest and effort, the benefits of this type of research are not always realized. To understand when expertise diversity will have posit...

Although research on team cognition has focused mostly on sharedness and its benefits, differences in team member cognition (i.e., representational gaps) may not always have negative effects. In this article, we develop theory and test the positive and negative effects of representational gaps (rGaps) among team members in cross-functional product development teams and the central role of task conflict and conflict management (problem-solving and yielding) in predicting team cognition. rGaps are examined both in terms of average level within the team and the patterns of shared representations across members from different functional areas. These patterns capture potential asymmetries within the team.

We examine the effects of subjectively experienced (as opposed to objectively prescribed) subgroups in a team. We propose two mechanisms that might explain the consequences of subgroup perceptions in teams: Affective integration (the degree to which teammates think they have quality interpersonal relationships) and cognitive integration (CI) (the degree to which teammates have learned to understand others interpretive frameworks). We test our theory using 64 MBA project teams. Cognitive integration moderated the effect of subgroup formation on team effectiveness, while affective integration mediated the decrement that subgroup formation had on team satisfaction. Our model is general for any team that has subgroups (regardless of their reason for forming), and so provides prescriptions as to how to maximize the benefits of subgroups while minimizing their liabilities. Copyright © 2010 John Wiley & Sons, Ltd.

The focus on entrepreneurship in business schools has never been stronger; however, preparing students for a career in developing new business innovations and ventures is challenging, and no shared...

Negotiation is a dynamic process in which negotiators change their strategies in response to each other. We believe mutual adaptation is best conceptualized as an emergent process and is a critical determinant of negotiators’ abilities to identify mutually beneficial solutions. We argue that three factors drive the process of negotiation and influence the quality of agreements: alignment of negotiators’ strategies across individuals (strategy sequences), alignment of negotiators’ strategies with the negotiation-wide dynamic (phases), and congruence of negotiators’ goals.

Functional diversity in teams, while potentially beneficial, increases the likelihood that individual team members will perceive the team's task differently, leading to gaps between teammates' interpretations of what is needed for the team to be successful. These representational gaps are likely to create conflict as teammates try to solve what are essentially incompatible problems. Understanding how these general mechanisms work should deepen our understanding of information processing and conflict in diverse teams.

Increasing competition resulting from the global and technological nature of markets has heightened the need for businesses to rely on cross-functional new product teams to produce innovations in a...

While there has been a large body of negotiation literature in both Behavioral Science (behavioral) and Artificial Intelligence/Game Theory (computational) communities, there has not been an attempt to bridge the two communities to our best knowledge. In this chapter, we compare and contrast the characteristics of behavioral and computational literature in negotiation. We propose that incorporating the strengths of two types of literature are valuable in expanding the horizon of research outlook.

The reported research examined the usefulness of placing risk propensity and risk perception in a more central role in models of risky decision making than has been done previously. Specifically, t...

This article focuses on the essentials of building effective, collaborative, team-based organizations. The entrepreneurs and innovators who found and build technology-based organizations comprise out target audience, but most specifically we address the biotechnology and biomedical field. Two perspectives are provided in the article: 1) advice based on the experiential learning provided by years of experience of building and growing entrepreneurial organizations; and 2) identifying the keys to building effective teams based on some selected the academic or scholarly literature on building effective teams. Our goal is to provide a perspective that blends real-world lessons filtered through a more scholarly approach based on case literature and other research-based studies. The material summarized herein is presented as a learning module to the participants in the Biotechnology Entrepreneurship Boot Camp. Our pedagogical approach in the Boot camp is to lead with the background material and perspective contained herein, and to then have a moderated panel discussion around these and other topics. The moderated panel consists of the key members of a real company consisting of key C-level officers and founders and a venture capitalist who funded the company. Thus the “theory and practice” of team-based innovation come together via a real-time case. Â

It has been shown that concession timing can influence a negotiator's satisfaction with and judgment of the negotiation partner, the quality of the object, and the agreed upon price (Kwon & Weingart, 2004). Study 1 tested whether the concession timing effect holds when a negotiator believes the other party is cooperatively oriented. The results suggest that a negotiator's belief about the other party's cooperative social motive overrides the concession timing effect. Specifically, if the other party was believed to be cooperative, negotiators did not feel dissatisfied with the outcome or the negotiating partner and did not evaluate the value of the object as being low, even when the other party made early concessions. Study 2 examined the interaction effects of concession timing and cooperative expectations in a more general setting (i.e., a negotiation between friends or between strangers) and investigated the mechanisms through which cooperative expectations override the concession timing effect. Results showed that trust between negotiators and negotiation scripts both played a role.

This study explores the relationship between feedback-seeking behavior and adjustment to a new job for two groups of employees: new hires to thefirm and job changers. Data were collectedfrom 67 managers at a Midwestern consumer products corporation 3 months and 6 months after taking the new job. Results suggest that adjustment leads to feedback-seeking behavior for both new hires and job changers. However, for job changers, poor adjustment appears to stimulate feedback-seeking; in contrast, for new hires, good adjustment seems to stimulate feedback-seeking.

Chronic hepatitis C (HCV) infection affects millions of people in the USA and prevalence rates are higher in US veterans. The consequences of HCV infection include reduced quality of life, liver damage, and reduced longevity.Our objective was to describe the experiences of US veterans living with chronic HCV infection and use this information in the development of an HCV self-management intervention.Twenty-two male HCV-infected veterans completed qualitative interviews. Participants were recruited via flyers and hepatitis C clinic providers at a major VA medical center. Participants were asked about their medical history, being diagnosed with HCV, and general experiences living with HCV.The study gathered the following findings: the impact of HCV on interpersonal relationships was pronounced, recovery from substance use disorders and getting care for HCV were connected, receiving the HCV diagnosis was more troubling to non-IV drug users, participants had misconceptions about HCV and its treatment, psychological problems were prevalent as were barriers to participating in antiviral treatment and HCV care in general.The themes derived from our analysis indicate that affected veterans may benefit from interventions or support to improve HCV-related health education, social/relationship issues, psychological issues, and exploration of the connection between substance use recovery and motivation to get care for HCV infection.

Rhythmic oscillations in the membrane potential of heart cells are important in normal cardiac pacemaker activity as well as cardiac arrhythmias. Two fundamentally different mechanisms of oscillatory activity can be distinguished at the cellular and subcellular level. The first mechanism, referred to as a surface membrane oscillator, can be represented by a control loop in which membrane potential changes evoke delayed conductance changes and vice versa. Since the surface membrane potential is a key variable within the control loop, the oscillation can be interrupted at any time by holding the membrane potential constant with a voltage clamp. This mode of oscillation seems to describe spontaneous pacemaker activity in the primary cardiac pacemaker (sinoatrial node) as well as other regions (Purkinje fibre, atrial or ventricular muscle). In all tissues studied so far, the pacemaker depolarization is dominated by the slow shutting-off of an outward current, largely carried by potassium ions. The second mechanism can be called an internal oscillator since it depends upon a subcellular rhythm generator which is largely independent from the surface membrane. Under voltage clamp, the existence of the internal oscillation is revealed by the presence of oscillations in membrane conductance or contractile force which occur even though the membrane potential is held fixed. The two oscillatory mechanisms are not mutually exclusive; the subcellular mechanism can be preferentially enhanced in any given cardiac cell by conditions which elevate intracellular calcium. Such conditions include digitalis intoxication, high Ca0, low Na0, low or high Ko, cooling, or rapid stimulation. Several lines of evidence suggest that the subcellular mechanism involves oscillatory variations in myoplasmic calcium, probably due to cycles of Ca uptake and release by the sarcoplasmic reticulum. The detailed nature of the Ca1 oscillator and its interaction with the surface membrane await further investigation.

THE positive inotropic effect of digitalis compounds is generally attributed to an increase in the amount of activator calcium1 and not to a change in the calcium sensitivity of regulatory contractile proteins2,3. The main question is the cellular or subcellular basis of the increase in the myoplasmic calcium transient. Since calcium entry through the slow inward current may play an important part in excitation–contraction coupling, it has been suggested that the slow inward current might be enhanced by digitalis4,5. All the evidence has been negative6–11 apart from a report by Dramane et al.12 and results of H. Brown, W. Giles and S. Noble (personal communication). We have re-examined this question and have found that strophanthidin can increase the slow inward current and alter its re-priming kinetics in certain conditions. These observations may provide a partial explanation of the positive inotropic effect observed in the same experiments.

Cell pairs isolated from adult rat and guinea pig ventricles were used to study the electrical properties of the nexal membrane. Each cell of a pair was connected to a voltage-clamp system so as to enable whole-cell, tight-seal recording. The current-voltage relationship of the nexal membrane was found to be linear, revealing a resistance rn of 2-4 M omega. rn was insensitive to the sarcolemmal membrane potential (range: -90 to +30 mV), and exerted no time-dependent gating behavior (range: 0.1 to 10 s). Lowering pHi yielded a small increase in rn. Vigorous elevations in [Ca2+]i gave rise to an increase in rn which was associated with a cell shortening. Uncoupling caused by aliphatic alcohols or halothane did not produce cell shortening. Cell pairs were also used to study action potential transfer.

1. Cyclic AMP was introduced into ventricular muscle by a cut-end method. Trabecular bundles were pulled through a partition which divided the preparation into a loading region and a test region. The loading region was exposed to Ca-free solution, cut transversely near the partition, and then briefly exposed to cyclic AMP. The test region was continually superfused with Tyrode soltuion. 2. In preliminary experiments, cell-to-cell movements were studied in long bundles by including [3H]cyclic AMP in the loading procedure and allowing redistribution to occur. After suitable test periods, the bundles were removed, frozen, and sliced into segments. Segment radioactivity was plotted against distance and fitted by a theoretical diffusion curve. 3. The results showed longitudinal redistribution of label over many cell lengths with an average effective diffusivity of 8 X 10(-7) cm2/sec. This value did not appear sensitive to the length of the test period or to the presence of a phosphodiesterase inhibitor. 4. The metabolic fate of cyclic AMP introduced by the cut-end method was determined by chromatographic separation of [3H]cyclic AMP and its break-down products. Most of the cyclic AMP was metabolized, but the results suggest that cell-to-cell movements of cyclic AMP contribute to the overall redistribution of label. 5. The cut-end method was used to study the influence of cyclic AMP on the contractile activity in the test region. Introduction of cyclic AMP evoked a delayed increase in twitch tension, about 25% above control. The inotropic effect peaked about 50 min after the end of the loading procedure, a delay which seemed compatible with slow longitudinal diffusion into the test region. 6. In control experiments, the cut-end procedure was repeated with 5'AMP (the immediate break-down product of cyclic AMP) instead of cyclic AMP. No delayed increase in twitch tension was observed. 7. Introduction of dibutyryl cyclic AMP increased twitch amplitude by 130%, with a delayed time course similar to that found for cyclic AMP. 8. The results using the cut-end procedure provide new evidence that cyclic AMP helps mediate adrenergic effects on the strength of contraction.

Cell pairs isolated from adult rat ventricles were used to characterize the electrical properties of the nexal membrane located between the cells. Each cell of a cell pair was connected to a suction pipette so as to enable whole-cell recordings. A double voltage-clamp method was employed which allowed the voltage gradient across the nexal membrane to be controlled. The current-voltage relationship of the nexal membrane was found to be linear over a broad range of transnexal voltages ( +/- 50 mV). The measurements revealed a mean value for the apparent nexal membrane resistance, rn(app), of 3.4 M omega. Taking into account the contribution of an uncompensated series resistance (access resistance), the effective nexal resistance, rn(eff), amounts to 1.7 M omega, approximately. The nexal membrane resistance was found to be insensitive to the sarcolemmal membrane potential, Vm (voltage range tested: -90 mV to +30 mV). The nexal membrane showed no rectifying property, i.e. it allows impulse transmission in both directions equally well. The connexons of the nexal membrane exhibited no time-dependent gating behaviour (time range investigated: 0.1-10 s).