Business relationships and perceived environmental uncertainty : should I stay or should I go now?

This paper investigates the association between perceived environmental uncertainty (PEU) and instrumental, affective and normative commitment, testing the null hypotheses that there is no significant association between PEU and the three components of commitment. The results indicate that there is a negative direct association between instrumental and normative commitment and PEU but no significant direct association between affective commitment and PEU (however there is a strong indirect effect). The conclusions drawn are that feelings of attachment, obligation and perceived need (affective, normative and instrumental commitment respectively) dissipate in environments perceived to be turbulent. Implications for the management of business-to-business relationships are canvassed

Adding a Computationally-Tractable Probabilistic Dimension to Meta-Heuristic-Based Microgrid Sizing

A robust solution to the optimal micro-grid (MG) sizing problem requires comprehensive quantification of the underlying parametric uncertainties-particularly, the uncertainty in forecasts of meteorological, load demand, and wholesale electricity price time-series data. However, the associated data-driven processes for probabilistic uncertainty quantification are computationally expensive. Accordingly, the mainstream meta-heuristic-based MG sizing literature has failed to concurrently quantify more than four sources of forecast uncertainty. To address this knowledge gap, this paper introduces a novel computationally efficient, probabilistic MG sizing model that enables the simultaneous treatment of any (reasonable) number of data uncertainty. This provides a platform to characterize the uncertainty in ambient temperature and river streamflow for the first time in the MG optimal sizing literature. Importantly, the model supports the associated long-Term strategic MG energy planning optimization processes through in-depth analyses of the worst-case, most likely case, and best-case planning scenarios. To demonstrate the utility of the proposed model for community MG projects, a case study is presented for the town of Ohakune, New Zealand. Notably, the numeric simulation results have shown that the whole-life cost of the conceptualized MG would have been underestimated and overestimated by as much as 17% and 30% respectively in the best-case and worst-case scenarios if the problem-inherent uncertainties were not explicitly factored into the associated techno-economic analyses

Acute and chronic demyelinating polyneuropathy post AstraZeneca Covid-19 vaccine

With the rollout of worldwide Covid-19 vaccination programmes, there have been reports of  potential neurological complications which may be attributable to the vaccines. These include cerebral venous sinus thrombosis (CVST)1, which appears to be a complication of thrombosis with  thrombocytopenia syndrome (TTS). This has been documented as a rare complication of the  AstraZeneca and Ad26.COV2.S (Janssen) Covid-19 vaccines </p

Acute and chronic demyelinating polyneuropathy post AstraZeneca Covid-19 vaccine

With the rollout of worldwide Covid-19 vaccination programmes, there have been reports of  potential neurological complications which may be attributable to the vaccines. These include cerebral venous sinus thrombosis (CVST)1, which appears to be a complication of thrombosis with  thrombocytopenia syndrome (TTS). This has been documented as a rare complication of the  AstraZeneca and Ad26.COV2.S (Janssen) Covid-19 vaccines </p

How rapidly gastroenterology has evolved over time: a review of four decades of published research

Medicine evolves with time. What was once accepted dogma often becomes supplanted by newer concepts. Our aim was to quantitatively assess the evolution of practices in gastroenterology. Research published in the journal Gastroenterology between 1971-2010 were reviewed by two independent assessors (GCH, DC). Data was analysed in 5-year time periods. Studies were deemed to be either valid or outdated based on present-day practice. A total of 245 studies were analysed; 94 were diagnostic and 151 were therapeutic. A steady increase in relevance of published studies over time is observed. Fewer than 50% of research studies in diagnostics published prior to 2000 are still relevant, and fewer than 30% of studies in therapeutics published prior to 1995 are still relevant. A nadir in the relevance of research in therapeutics in 2001-2010 could be accounted for by the discovery of novel Hepatitis C antiviral treatment, which rendered prior trials obsolete.</p

Long term health outcomes in people with diabetes 12 months after hospitalisation with COVID-19 in the UK: a prospective cohort study

Background: People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes. Methods: The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions. Findings: People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions. Interpretation: People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes. Funding: UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107)

Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2–3 years were associated with occupation change. People with lived experience were involved in the study. Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2–3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16–1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2–3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2–3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0–48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0–17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6–31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04–2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21–1·98] for every point increase in CCI-20). Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.</p