The Impact of the Entrepreneurial Orientation in Achieving Strategic Leadership Success

The objective of this is to investigate and identify the impact of entrepreneurial orientation in achieving strategic leadership success. To accomplish the objective, the study sampled commissioners of the higher and middle administrations in the Municipality of Greater Amman, Jordan. Total valid sample consists a total of (174) analyzed utilizing (SPSSv.20).The research results identified an effect of Entrepreneurial Orientation on the achieving strategic leadership success. Recommendations include the taking on the idea of entrepreneurial orientation and investing in the needed resources that can assist in formulating the trends of power and leadership, as well as implement guidelines and rules that would spearhead the policies for strategic leadership success

Orientasi Nilai Budaya Petani Tembakau di Dataran Tinggi Gayo

The rise of noble tobacco farming is seen again today in the Gayo Highlands after it was once glorious in the 1980s. There were many things that reference ideas, motivations, values, and orientations behind them. This study analyzed the cultural value orientation of tobacco farmers in Gayo so that it continues to carry out planting practices to this day. Furthermore, this study also explored the various habits tobacco farmers have in developing tobacco, including the inheritance pattern of tobacco planting culture between generations. The research, which took the locus in Central Aceh, used a qualitative approach by referring to C. Kluckhohn's concept of "value orientation" analysis and Pierre Bourdie's concept of "habitus". The data collection techniques used were participation observation, in-depth interviews, literature studies, and document studies. Field findings showed that tobacco plants were once the primadonna of the Gayo people in the 80s, but after that began to be abandoned by the community due to economic factors. Over the last 7 years, the Gayo people have begun to look back at tobacco plants along with tobacco products, which has become one of the essential concerns of the government in developing the economy of the Gayo community. The Gayo people still practice growing tobacco because this plant does not require special treatment, the planting period is relatively short, and this plant product is easy to process.Geliat pertanian tembakau mulia terlihat kembali saat ini di Dataran Tinggi Gayo setelah pernah jaya di era 1980-an. Tentu saja, ada banyak hal yang menjadi rujukan ide, motivasi, nilai serta orientasi yang melatarbelakanginya. Studi ini menganalisis orientasi nilai budaya para petani tembakau di bumi Gayo sehingga terus menjalankan praktek tanam hingga saat ini. Lebih lanjut, studi ini juga menggali bagaimana ragam habitus yang dimiliki petani tembakau dalam mengembangkan tembakau, termasuk pola pewarisan budaya tanam tembakau antar generasi. Penelitian yang mengambil lokus di Aceh Tengah ini menggunakan pendekatan kualitatif dengan mengacu pada konsep analisis “orientasi nilai” C. Kluckhohn dan konsep “habitus” Pierre Bourdie. Teknik pengumpulan data yang digunakan adalah observasi partisipasi, wawancara mendalam, studi literatur, dan studi dokumen. Hasil temuan lapangan menunjukkan bahwa tanaman tembakau pernah menjadi primadona masyarakat Gayo pada era 80-an, namun setelah itu mulai ditinggalkan oleh masyarakat karena faktor ekonomi. Sejak 7 tahun terakhir, masyarakat Gayo mulai melirik kembali tanaman tembakau seiring dengan produk tembakau menjadi salah satu perhatian penting pemerintah dalam mengembangkan ekonomi masyarakat Gayo. Masyarakat Gayo masih melakukan praktek tanam tembakau karena tanaman ini tidak membutuhkan perlakuan khusus, masa tanam yang relatif singkat, dan produk tanaman ini mudah diolah

Diagnostic performance and predictive value of rheumatoid factor, anti-cyclic-citrullinated peptide antibodies and HLA-DRB1 locus genes in rheumatoid arthritis

<p>Abstract</p> <p>Background</p> <p>We evaluated the significance of the genes, defined as <it>DRB1*04 </it>or <it>DRB1*01</it>, in rheumatoid arthritis (RA) patients. We focused on the role of genetic and serologic markers to predict disease activity and destructive process of joints.</p> <p>Methods</p> <p>Sixty patients with RA were examined. Radiographic changes were evaluated by (Larsen score) and disease activity was measured by disease activity score 28 (DAS28). The markers analyzed were: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP2) and HLA-<it>DRB1 </it>alleles typed by PCR.</p> <p>Results</p> <p>In this study, anti-CCP antibodies, CRP, RF and AKA were detected in 83.3%, 56.7%, 71.7% and 52% of patients respectively. HLA-<it>DRB1</it>*01 was found in 45% of patients and 35% of them had one or two HLA-<it>DRB1*04 </it>alleles. According to <it>DRB1*04 </it>subtypes, (<it>DRB1* 0405</it>) was present in of 80% them. For prediction of grade of activity, the independent predictors were anti-CCP (OR 19.6), and <it>DRB1*04 </it>positive allele (OR 5.1). The combination of <it>DRB1*04 </it>+ anti-CCP antibodies gave increase in the specificity and positive predictive value to 92% and 90 respectively. As regards to the prediction of radiological joint damage, the independent predictors were HLA-<it>DRB1*04</it>, HLA-<it>DRB1*01</it>, RF, and CRP > 18 (OR 5.5, 4.5, 2.5, 2.0 respectively).</p> <p>Conclusion</p> <p>Our findings suggest that anti-CCP2 is superior to RF for the detection of RA and provided predictive information on joint destruction and disease activity. The presence of RA associated antibodies (ACCP or RF) and/or the SE genes are indicative for a poorer radiological outcome and higher grade of activity.</p

Efficient Multimodal Deep-Learning-Based COVID-19 Diagnostic System for Noisy and Corrupted Images

Introduction: In humanity\u27s ongoing fight against its common enemy of COVID-19, researchers have been relentless in finding efficient technologies to support mitigation, diagnosis, management, contact tracing, and ultimately vaccination. Objectives: Engineers and computer scientists have deployed the potent properties of deep learning models (DLMs) in COVID-19 detection and diagnosis. However, publicly available datasets are often adulterated during collation, transmission, or storage. Meanwhile, inadequate, and corrupted data are known to impact the learnability and efficiency of DLMs. Methods: This study focuses on enhancing previous efforts via two multimodal diagnostic systems to extract required features for COVID-19 detection using adulterated chest X-ray images. Our proposed DLM consists of a hierarchy of convolutional and pooling layers that are combined to support efficient COVID-19 detection using chest X-ray images. Additionally, a batch normalization layer is used to curtail overfitting that usually arises from the convolution and pooling (CP) layers. Results: In addition to matching the performance of standard techniques reported in the literature, our proposed diagnostic systems attain an average accuracy of 98% in the detection of normal, COVID-19, and viral pneumonia cases using corrupted and noisy images. Conclusions: Such robustness is crucial for real-world applications where data is usually unavailable, corrupted, or adulterated

Deep Learning Modalities for Biometric Alteration Detection in 5G Networks-Based Secure Smart Cities

Smart cities and their applications have become attractive research fields birthing numerous technologies. Fifth generation (5G) networks are important components of smart cities, where intelligent access control is deployed for identity authentication, online banking, and cyber security. To assure secure transactions and to protect user’s identities against cybersecurity threats, strong authentication techniques should be used. The prevalence of biometrics, such as fingerprints, in authentication and identification makes the need to safeguard them important across different areas of smart applications. Our study presents a system to detect alterations to biometric modalities to discriminate pristine, adulterated, and fake biometrics in 5G-based smart cities. Specifically, we use deep learning models based on convolutional neural networks (CNN) and a hybrid model that combines CNN with convolutional long-short term memory (ConvLSTM) to compute a three-tier probability that a biometric has been tempered. Simulation-based experiments indicate that the alteration detection accuracy matches those recorded in advanced methods with superior performance in terms of detecting central rotation alteration to fingerprints. This makes the proposed system a veritable solution for different biometric authentication applications in secure smart cities

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)