Sustainable Business Models

The dynamically changing world economy, in an era of intensive development and globalization, creates new needs in both the theoretical models of management and in the practical discussion related to the perception of business. Because of new economic phenomena related to the crisis, there is a need for the design and operationalization of innovative business models for companies. Due to the fact that in times of crisis, the principles of strategic balance are particularly important; these business models can be sustainable business models. Moreover, it is essential to skillfully use different methods and concepts of management to ensure the continuity of business. It seems that sustainable business models, in their essence, can support companies' effectiveness and contribute to their stable, sustainable functioning in the difficult, ever-changing market. This Special Issue aims to discuss the key mechanisms concerning the design and operationalization of sustainable business models, from a strategic perspective. We invite you to contribute to this Issue by submitting comprehensive reviews, case studies, or research articles. Papers selected for this Special Issue are subject to a rigorous peer review procedure, with the aim of rapid and wide dissemination of research results, developments, and applications

Measuring and predicting early functioning post-stroke

Functioning, the most important outcome of stroke interventions, is complex to characterize. Stroke survivors measure functioning compared to what they did in their prestroke lives; hence equating functioning with recovery. To optimize the recovery of functioning, research suggests that rehabilitation interventions should start early post-stroke. To quantify changes in function owing to different interventions, the average value on an index comprised of multiple items related to function is compared or the proportions of people categorized into different functional levels are compared. Currently, there is no agreed upon method of quantifying improvements in functioning and using multiple indices is problematic. This thesis examined combining a method of quantifying behaviours, Rasch analysis that produces measures with interval properties from ordinal observations, with the component of the International Classification of Functioning (ICF), to conceptualize, define, and quantify functioning in a single measure. The ensuing prototype measure was limited in scope. Therefore, using data from a longitudinal prognostic study involving people with acute stroke assessed at three days and followed up at three months, a Functioning measure at three months, the F3m, was developed. The F3m is a valid and reliable measure that amalgamates tests where performance is observed and self-report questionnaires where people rate their difficulties in performing physical activities. The F3m covers all ICF components and can be used to quantify recovery at three months. Interventions to improve early functioning post-stroke must impact favourably on the factors that affect early recovery. The most influential factor related to recovery, to date, has been early functioning. As a measure of such early functioning did not exist, a measure of functioning at three days, the FM, was constructed in a manner similar to the F3m. Univariate and multivariate analyses were then used to identify strong early factors collected 24-72 hours post-stroke, and link the factors to function at 3 months. A seven-variable predictive model of functioning was derived. The most important influential predictor of functioning in the model, the comprehensive FM measure, can now be used to evaluate and develop early interventions to enhance functioning, and to act as a covariate explaining the recovery of functioning

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

BACKGROUND: Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES: We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN: A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. SETTING: Trauma and orthopaedic departments of 24 NHS hospitals. PARTICIPANTS: Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. INTERVENTIONS: CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. MAIN OUTCOME MEASURES: Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. RESULTS: We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle function compared with ORIF at 6 months {OMAS 64.5 points [standard deviation (SD) 22.4 points] vs. OMAS 66.0 points (SD 21.1 points); mean difference -0.65 points, 95% confidence interval (CI) -3.98 to 2.68 points; standardised effect size -0.04, 95% CI -0.23 to 0.15}. There were no differences in quality of life, ankle motion, pain, mobility and patient satisfaction. Infection and/or wound problems were more common with ORIF [29/298 (10%) vs. 4/275 (1%)], as were additional operating theatre procedures [17/298 (6%) vs. 3/275 (1%)]. Malunion was more common with CCC [38/249 (15%) vs. 8/274 (3%); p  95% from NHS perspective and 85% from societal perspective). Experiences of treatments were similar; both groups endured the impact of fracture, uncertainty regarding future function and the need for further interventions. LIMITATIONS: Assessors at 6 weeks were necessarily not blinded. The learning-effect analysis was inconclusive because of limited CCC applications per surgeon. CONCLUSIONS: CCC provides a clinically equivalent outcome to ORIF at reduced cost to the NHS and to society at 6 months. FUTURE WORK: Longer-term follow-up of trial participants is under way to address concerns over potential later complications or additional procedures and their potential to impact on ankle function. Further study of the patient factors, radiological fracture patterns and outcomes, treatment responses and prognosis would also contribute to understanding the treatment pathway. TRIAL REGISTRATION: Current Controlled Trials ISRCTN04180738. FUNDING: The National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 75. See the NIHR Journals Library website for further project information. This report was developed in association with the National Institute for Health Research Oxford Biomedical Research Unit funding scheme. The pilot phase was funded by the AO Research Foundation

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

Virginia Commonwealth University Courses

Listing of courses for the 2019-2020 year

Virginia Commonwealth University Courses

Listing of courses for the 2021-2022 year