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1.
With teams growing in all areas of scientific and scholarly research, we explore the relationship between team structure and the character of knowledge they produce. Drawing on 89,575 self-reports of team member research activity underlying scientific publications, we show how individual activities cohere into broad roles of 1) leadership through the direction and presentation of research and 2) support through data collection, analysis, and discussion. The hidden hierarchy of a scientific team is characterized by its lead (or L) ratio of members playing leadership roles to total team size. The L ratio is validated through correlation with imputed contributions to the specific paper and to science as a whole, which we use to effectively extrapolate the L ratio for 16,397,750 papers where roles are not explicit. We find that, relative to flat, egalitarian teams, tall, hierarchical teams produce less novelty and more often develop existing ideas, increase productivity for those on top and decrease it for those beneath, and increase short-term citations but decrease long-term influence. These effects hold within person—the same person on the same-sized team produces science much more likely to disruptively innovate if they work on a flat, high-L-ratio team. These results suggest the critical role flat teams play for sustainable scientific advance and the training and advancement of scientists.  相似文献   
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Background: It has been reported that cystine and theanine, amino acids related to glutathione synthesis, have immunomodulatory effects, such as suppressing inflammation after strenuous exercise. In this study, we examined the effects of oral administration of cystine and theanine during the perioperative period as a pilot study. Methods: Forty‐three cases of distal gastrectomy for cancer conducted in our department were assigned to the cystine and theanine group (CT group) or to the placebo control group (P group), and a randomized, single‐blind, parallel‐group study was then performed. Cystine (700 mg) and theanine (280 mg) or a placebo was administered to participants for 10 continuous days (4 days before to 5 days after surgery). Changes in pre‐ and postoperative interleukin (IL)–6, C‐reactive protein (CRP), albumin, white blood cell (WBC) count, neutrophil count, total lymphocyte count, resting energy expenditure (REE), and body temperature were compared and examined. Results: Ten patients were excluded, leaving 33 patients in the study. The CT group had significantly lower IL‐6 values (postoperative day [POD] 4), CRP levels (POD 7), neutrophil counts (POD 4), and body temperatures (POD 5) than the P group (P < .05). In addition, REE in the P group peaked on day 1 (1.14 ± 0.16 [pre‐ and postoperative ratio]), whereas the CT group did not show any increase on POD 1 (0.99 ± 0.21, P < .05 vs P group). Conclusions: This study suggests that oral administration of cystine and theanine during the perioperative period may alleviate postgastrectomy inflammation and promote recovery after surgery.  相似文献   
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The Housing Department of the Philadelphia Corporation for Aging (PCA) has administered home repair and modification programs for seniors since 1980. PCA now provides services to 1500 people annually through six programs. Currently funded at approximately four million dollars per year, PCA's Housing Department is the largest in any Area Agency on Aging.

In all these programs, PCA contracts with Occupational Therapist Consultants to assist the consumers and the programs to develop the most useful and appropriate modifications. In one program, serving Philadel-phians of all ages, PCA has recently initiated a follow-up inspection by the therapist. These inspections are not only of benefit to the particular consumer, but also yield useful information on construction specifications and on the modification process.  相似文献   
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Objective It is mandatory for treatment decisions for patients with colorectal cancer to be made within the context of a multi‐disciplinary team (MDT) meeting. It is currently uncertain, however, how to best evaluate the quality of MDT decision‐making. This study examined MDT decision‐making by studying whether MDT treatment decisions were implemented and investigated the reasons why some decisions changed after the meeting. Method Consecutive MDT treatment decisions were prospectively recorded. Implementation of decisions was studied by examining hospital records. Reasons for changes in MDT decisions were identified. Results In all, 201 consecutive treatment decisions were analysed, concerning 157 patients. Twenty decisions (10.0%, 95% confidence interval 6.3–15.2%) were not implemented. Looking at the reasons for nonimplementation, nine (40%) related to co‐morbidity, seven (35%) to patient choice, two changed in light of new clinical information, one doctor changed a decision and for one changed decision, no reason was apparent. When decisions changed, the final treatment was always more conservative than was originally planned and decisions were more likely to change for colon rather than rectal cancer (P = 0.024). Conclusion The vast majority of colorectal MDT decisions were implemented and when decisions changed, it mostly related to patient factors that had not been taken into account. Analysis of the implementation of team decisions is an informative process to monitor the quality of MDT decision‐making.  相似文献   
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Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.  相似文献   
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Objective: To monitor key processes and outcomes in joint health and social services community psychogeriatric teams. Design: Six month follow-up of new referrals to 4 teams in Cambridge. Data collected from structured clinical assessment forms at baseline and interviews with keyworkers at follow-up. Data for groups with and without dementia were compared. Setting: Two rural and two urban teams in area with relatively large long stay inpatient facility but low independent sector provision. All were routine service teams, rather than run for research purposes. Main outcome measures: The main outcome measures were survival, institutionalisation, key worker assessments of avoidable admissions, appropriateness of placement, unmet needs, carer stress and global outcome for patient and carers. Results: Rates of referral to urban teams were double rural rates. Around forty percent of the dementia group had a social worker as assessor and keyworker. The dementia group was significantly more dependent and received more informal and formal care. After six months, only 54% of the dementia group were alive and living outside institutional care, compared to 79% in the functionally ill group. Unplanned admissions to hospitals or homes were rarely judged avoidable by keyworkers. Outcomes for carers were judged poor in 15% of both groups, and 13% and 11% of carers respectively were judged to be under severe stress. Unmet needs were more common in the dementia group, and related principally to residential care and carer respite. A number of measures, including evidence of geographical inequity and identification of unmet needs, provided an important contribution to local policy development. Further work is needed on the validity of keyworker assessments of carer stress, given the findings of the carer interview sub-study.  相似文献   
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