ErbB2 overexpressing breast tumors have a poor prognosis and a high risk to develop chemoresistance to therapeutic treatment. "Chemoresistance" is a response of cells to toxic stress, and, although it is a common phenomenon, it is still poorly defined. However, a detailed understanding is required to target desensitized pathways and mechanisms for successful reactivation as part of a tailored therapy. To gain insight, which malfunctions contribute to chemoresistance, two mechanisms relevant for tissue homeostasis, the regulation of the cell cycle and of apoptosis, were investigated. Maternal MCF-7- and ErbB2-overexpressing MCF-7(erbB2) breast cancer cells were long term pretreated with 2'-deoxy-5-fluorodeoxyuridine (5-FdUrd) or 1-beta-d-arabinofuranosylcytosine (AraC) and the acquisition of drug-insensitivity was analyzed. A phosphate-conjugated heterodinucleoside consisting of one 5-FdUrd- and one AraC-moiety (5-fluoro-2'-desoxyuridylyl-(3'-->5')-Arabinocytidine) was utilized as a tool to assess the type of acquired resistances. ErbB2-overexpression disrupted proper cell cycle regulation and furthermore facilitated the development of an apoptosis-refractory phenotype upon exposure to 5-FdUrd. Experiments with dimer 5-FdUrd-araC in ErbB2-overexpressing MCF-7(erbB2) cells, and also with nucleoside 5-FdUrd in maternal MCF-7 cells, evidenced that the phenotypes of resistance to cell cycle inhibition and to apoptosis induction were differently affected. The expression profile of cyclin D1 (but not that of p53, p21, or p27) correlated with the proliferative phenotypes and nuclear accumulation of apoptosis inducing factor (but not activation of caspase 7) with apoptotic phenotypes. Dimer 5-FdUrd-araC overrode acquired chemoresistances, whereas combined application of 5-FdUrd and AraC exhibited significantly less activity. Dimer 5-FdUrd-araC remained active in MCF-7 clones most likely by circumventing the prerequisite of first-step phosphorylation. The acquisition of chemoresistance encompassed the affection of apoptosis- and cell-cycle regulation to, respectively, different extents. Thus, drug-induced cell cycle arrest and apoptosis induction are independent of each other.

The relationship between pay level and pay satisfaction was modeled in a field study with 456 employees of nursing departments in a large hospital. After controlling for person, job, and pay system characteristics, pay satisfaction variance was better explained by treating pay level as a power function rather than a linear function. This result was expected given the low wage rate relative to the market, the lack of a formal rewards system, and the high level of tenure in the workforce. Implications of this finding for theory, research, and practice were discussed.

Objective To identify leadership qualities of clinical nutrition managers and associate these leadership qualities with selected demographic variables (eg, training/degree, length of time in management, number df people supervised, income, and participation in advanced practice activities).Design The theory of transformational leadership, that is, leadership that incorporates specific interpersonal behaviors of the leader and his or her actions within the organization, provided the framework for the study. Specific transformational leadership qualities-leader behavior, leader personal characteristics, and the effect of the leader on organizational functioning and culture-were measured using the Leader ship Behavior Questionnaire (LBQ). The reliability and validity of the LBQ have been reported previously. Other data were obtained using two demographic surveys.Sample Demographic surveys were mailed to 1,599 members of the Clinical Nutrition Management dietetic practice group. From the 951 (59.8%) respondents, a study sample of 150 clinical nutrition managers and their subordinates was selected to receive the LBQ; 116 (77.3%) instrument sets were used for analysis.Statistical Analysis Descriptive statistics were used to analyze the demographic surveys. A specified mixed linear model repeated measures Statistical Analysis System procedure was used to compare clinical manager and subordinate LBQ scores. Association of the selected demographic variables with leadership qualities was measured by lambda, a predictive value measure, using the BMDP 4F program.Results Clinical nutrition managers exhibited transformational leadership qualities as rated by the LBQ, rating lowest on the communication leadership score and highest on the respectful leadership score. Most of the clinical nutrition manager self LBQ scores were significantly higher than the clinical nutrition manager LBQ scores rated by subordinates. The selected demographic variables appeared to have the strongest predictive effect for the visionary culture building subscore of the LBQ. The visionary culture building subscore is a measure of how well the leader interacts with and affects the functioning of an organization.Applications/Conclusions More research is needed to define leadership in dietetics: this study can serve as a possible model. One way clinical nutrition managers may be able to enhance their leadership behaviors is to strengthen their skills in communicating their vision. Programs are needed to help clinical nutrition managers shape their organizations to foster leadership development in their subordinates.

For a number of reasons, the topic of patient satisfaction has recently gained much attention by academicians and practitioners alike. First, there has been a proliferation of total quality management (TQM) programs in which patients are targeted as a critical consumer group (Berwick 1989). Second is the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO’s) requirement that all hospitals have a formal complaint management system (Section MA.1.4.11). A third reason is management’s recognition that satisfied patients are more likely to continue using medical care services (Ware et al. 1975; Thomas and

Service recovery is defined as that part of quality management designed to alter the negative perceptions of dissatisfied consumers and to ultimately maintain a business relationship with these consumers. This article explores the theoretical and operational implications of service recovery in health services organizations. A framework that defines the range of possible service recovery actions is presented. Next, the benefits of and obstacles to service recovery in health services firms are discussed, and solutions for overcoming these obstacles are presented. Finally, the critical components of an effective service recovery program are described, and an agenda for empirical research on the efficacy of service recovery activities is proposed.

Traditional managerial attempts to maintain control over subordinates may cause the subordinates to behave in ways to enhance or regain their control. In the present research, organization members were hypothesized to have characteristic ways of enhancing their control that, in turn, were expected to influence the likelihood that they would engage in certain behavioral responses. Using samples of students and persons employed in a variety of organizations, eight predispositions were identified, reflecting individuals' tendencies to employ different control‐enhancing strategies at work, and these predispositions were found to predict different behavioral responses. Future research directions and implications for management practice are discussed.

Two separate longitudinal field studies were conducted to assess the relationship between personal control and job satisfaction and performance. In the first study, a sample of nursing service personnel from a variety of functional and hierarchical levels who were working in a hospital were utilized; in the second study, clerical workers in two regional offices of an insurance company were employed. After statistically controlling for locus of control, it was found that personal control significantly predicted job satisfaction and performance. Time lag analyses suggest that control may also be an outcome of these variables. The implications of these results for theories of motivation are discussed.

A study was conducted with 104 hospital employees to assess the relationship between pay‐for‐performance perceptions and pay satisfaction. Unlike previous research examining this relationship, a multi‐item measure of pay‐for‐performance perceptions and a multidimensional measure of pay satisfaction were used. As hypothesized, the results indicated a positive relationship between pay‐for‐performance perceptions and pay‐raise satisfaction, pay‐level satisfaction, and overall pay satisfaction even after the effects of salary level, salary increases, performance ratings, job tenure, job satisfaction, and promotions were controlled. The importance of gathering perceptual data on characteristics of the pay system believed to have differential relationships with the subdimensions of pay satisfaction are discussed.

The article assesses the construct of personal control in an organizational setting using a base model of personal control in organizations. The difference between control possessed and control des...

A dynamic model of personal control is proposed in this paper. Personal control is defined as the individual's beliefs, at a given point in time, in his or her ability to effect a change, in a desired direction, on the environment. Individuals in organizations are viewed as desirous of increasing their personal control. It is argued that employees of organizations persist in their attempts to restore a balance in their control perceptions, even when desired outcomes may not be attainable. Managerial implications of the model are described.

From longitudinal data from 129 nursing department employees, organizational commitment was found to be antecedent to job satisfaction rather than an outcome of it. Furthermore, several other variables were found to be causally related to satisfaction but not commitment. Implications of unsubstantiated assumptions regarding causes of commitment are discussed.

Qualitative data from management and non‐management employees were content analyzed to assess their perceptions of what organizational problems they would most like academic researchers to study. These data are then compared to the publications that have appeared in empirical journals over ten journal years (Campbell, Daft, and Hulin, 1982). Results indicate: (1) specific problem areas health care practitioners want studied: (2) strong congruence between the interests of the management and non‐management subsamples; and (3) areas where academicians are not meeting the research needs of this sample.

This investigation looks at the moderating effects of job involvement on the relationships between leaders' punitive behavior and job satisfaction. The focal research hypothesis was tested with measures having well established psychometric properties and including the Job Descriptive Index, the Job Involvement instrument, and Measures of Leader Reward and Punishment Behavior. For a sample of 323 hospital nursing department employees, negative effects of leaders' punitive behavior on job satisfaction were evident only among employees with low levels of job involvement. For those highly involved with their jobs, compensatory or buffer processes are postulated as explanations for their apparent immunity to the negative effects of punishment.