5,985 research outputs found
Trust in the US-EU fruit and vegetable chain: Do US exporters understand EU importers?
Research on organizational and inter organizational trust has become an important field in management and marketing literature, as it is perceived as a pivotal aspect of business transactions. However, clarifications are still needed on the issue of whom we trust; is the person whom we are trading with trusted, or the organization, or just the product‐quality? Not only has this question not been answered within this field of research, neither have cultural differences have been described to any great extent. Additionally, if the perceived factors important to establish trusting relationships may or may not be the same on the buyers and the sellers side in international business transaction in food chains. The primary objective of this research study therefore is to identify how well US exporters understand the elements of trust that establish strong relationships with EU importers. The Analytical Hierarchy Process was used to evaluate the importance of different trust elements in interviews conducted with US exporters and EU importers of fruits and vegetables. Results are compared, providing both a picture of the important facets of trust, as well as whether the partners understand the perspectives of the other partner
Post-Pancreatoduodenectomy Outcomes and Epidural Analgesia: A 5-Year Single Institution Experience
Introduction
Optimal pain control post-pancreatoduodenectomy is a challenge. Epidural analgesia (EDA) is increasingly utilized despite inherent risks and unclear effects on outcomes.
Methods
All pancreatoduodenectomies (PD) performed from 1/2013-12/2017 were included. Clinical parameters were obtained from retrospective review of a prospective clinical database, the ACS NSQIP prospective institutional database and medical record review. Chi-Square/Fisher’s Exact and Independent-Samples t-Tests were used for univariable analyses; multivariable regression (MVR) was performed.
Results
671 consecutive PD from a single institution were included (429 EDA, 242 non-EDA). On univariable analysis, EDA patients experienced significantly less wound disruption (0.2% vs. 2.1%), unplanned intubation (3.0% vs. 7.9%), pulmonary embolism (0.5% vs. 2.5%), mechanical-ventilation >48hrs (2.1% vs. 7.9%), septic shock (2.6% vs. 5.8%), and lower pain scores. On MVR accounting for baseline group differences (gender, hypertension, pre-operative transfusion, labs, approach, pancreatic duct size), EDA was associated with less superficial wound infections (OR 0.34; CI 0.14-0.83; P=0.017), unplanned intubations (OR 0.36; CI 0.14-0.88; P=0.024), mechanical ventilation >48 hrs (OR 0.22; CI 0.08-0.62; P=0.004), and septic shock (OR 0.39; CI 0.15-1.00; P=0.050). EDA improved pain scores post-PD days 1-3 (P<0.001). No differences were seen in cardiac or renal complications; pancreatic fistula (B+C) or delayed gastric emptying; 30/90-day mortality; length of stay, readmission, discharge destination, or unplanned reoperation.
Conclusion
Based on the largest single institution series published to date, our data support the use of EDA for optimization of pain control. More importantly, our data document that EDA significantly improved infectious and pulmonary complications
Neighborhood disadvantage and neural correlates of threat and reward processing in survivors of recent trauma
IMPORTANCE: Differences in neighborhood socioeconomic characteristics are important considerations in understanding differences in risk vs resilience in mental health. Neighborhood disadvantage is associated with alterations in the function and structure of threat neurocircuitry.
OBJECTIVE: To investigate associations of neighborhood disadvantage with white and gray matter and neural reactivity to positive and negative stimuli in the context of trauma exposure.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, survivors of trauma who completed sociodemographic and posttraumatic symptom assessments and neuroimaging were recruited as part of the Advancing Understanding of Recovery After Trauma (AURORA) study between September 2017 and June 2021. Data analysis was performed from October 25, 2022, to February 15, 2023.
EXPOSURE: Neighborhood disadvantage was measured with the Area Deprivation Index (ADI) for each participant home address.
MAIN OUTCOMES AND MEASURES: Participants completed separate threat and reward tasks during functional magnetic resonance imaging. Diffusion-weighted and high-resolution structural images were also collected. Linear models assessed the association of ADI with reactivity, microstructure, and macrostructure of a priori regions of interest after adjusting for income, lifetime trauma, sex at birth, and age. A moderated-mediation model tested whether ADI was associated with neural activity via microstructural changes and if this was modulated by PTSD symptoms.
RESULTS: A total of 280 participants (183 females [65.4%]; mean [SD] age, 35.39 [13.29] years) completed the threat task and 244 participants (156 females [63.9%]; mean [SD] age, 35.10 [13.26] years) completed the reward task. Higher ADI (per 1-unit increase) was associated with greater insula (t274 = 3.20; β = 0.20; corrected P = .008) and anterior cingulate cortex (ACC; t274 = 2.56; β = 0.16; corrected P = .04) threat-related activity after considering covariates, but ADI was not associated with reward reactivity. Greater disadvantage was also associated with altered microstructure of the cingulum bundle (t274 = 3.48; β = 0.21; corrected P = .001) and gray matter morphology of the ACC (cortical thickness: t273 = -2.29; β = -0.13; corrected P = .02; surface area: t273 = 2.53; β = 0.13; corrected P = .02). The moderated-mediation model revealed that ADI was associated with ACC threat reactivity via cingulum microstructural changes (index of moderated mediation = -0.02). However, this mediation was only present in individuals with greater PTSD symptom severity (at the mean: β = -0.17; standard error = 0.06, t= -2.28; P = .007; at 1 SD above the mean: β = -0.28; standard error = 0.08; t = -3.35; P \u3c .001).
CONCLUSIONS AND RELEVANCE: In this study, neighborhood disadvantage was associated with neurobiology that supports threat processing, revealing associations of neighborhood disadvantage with neural susceptibility for PTSD and suggesting how altered structure-function associations may complicate symptoms. Future work should investigate specific components of neighborhood disadvantage that may be associated with these outcomes
Predicting at-risk opioid use three months after ED visit for trauma: Results from the AURORA study
OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.
METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months.
RESULTS: Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5).
CONCLUSIONS: ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making
Histopathology of the Chimpanzee Ear
Four female and two male chimpanzees were secured in various positions on a Daisy Decelerator and subjected to forces ranging from 54 to 180 G. It was found that forces in excess of 54 G may rupture the tympanic membranes and cause subepithelial hemorrhages in the middle ear. The majority of cases showed proteinaceous material, with or without cells in the petrous air spaces. When exposed to forces above 119 G, there was engorgement and often rupture of the pericarotid venous plexus. When supine, distortion of both superior and posterior semicircular canals was found. With forces in excess of 54 G, the cupulae of the cristae ampullaris were either elevated or destroyed. The hair processes were also often broken off. The otolithic membranes, especially of the maculae utriculi were also elevated or otherwise distorted and the saccule was often partially collapsed. In several instances, there was an overabundance of a proteinaceous substance in the lumina of the vestibular apparatus and in the cochlear ducts with their associated scalae. In half the cases, the cochlear duct was narrowed by the depression of the vestibular membrane. Although there seems to be considerable individual variation in ability to withstand these forces, neither age, sex nor weight appear to directly influence the results. The possible sources for the materials found both in the air cells and labyrinth are discussed
Beyond clustering: mean-field dynamics on networks with arbitrary subgraph composition
Clustering is the propensity of nodes that share a common neighbour to be connected. It is ubiquitous in many networks but poses many modelling challenges. Clustering typically manifests itself by a higher than expected frequency of triangles, and this has led to the principle of constructing networks from such building blocks. This approach has been generalised to networks being constructed from a set of more exotic subgraphs. As long as these are fully connected, it is then possible to derive mean-field models that approximate epidemic dynamics well. However, there are virtually no results for non-fully connected subgraphs. In this paper, we provide a general and automated approach to deriving a set of ordinary differential equations, or mean-field model, that describes, to a high degree of accuracy, the expected values of system-level quantities, such as the prevalence of infection. Our approach offers a previously unattainable degree of control over the arrangement of subgraphs and network characteristics such as classical node degree, variance and clustering. The combination of these features makes it possible to generate families of networks with different subgraph compositions while keeping classical network metrics constant. Using our approach, we show that higher-order structure realised either through the introduction of loops of different sizes or by generating networks based on different subgraphs but with identical degree distribution and clustering, leads to non-negligible differences in epidemic dynamics
The stellar metallicity distribution of disc galaxies and bulges in cosmological simulations
By means of high-resolution cosmological hydrodynamical simulations of Milky
Way-like disc galaxies, we conduct an analysis of the associated stellar
metallicity distribution functions (MDFs). After undertaking a kinematic
decomposition of each simulation into spheroid and disc sub-components, we
compare the predicted MDFs to those observed in the solar neighbourhood and the
Galactic bulge. The effects of the star formation density threshold are visible
in the star formation histories, which show a modulation in their behaviour
driven by the threshold. The derived MDFs show median metallicities lower by
0.2-0.3 dex than the MDF observed locally in the disc and in the Galactic
bulge. Possible reasons for this apparent discrepancy include the use of low
stellar yields and/or centrally-concentrated star formation. The dispersions
are larger than the one of the observed MDF; this could be due to simulated
discs being kinematically hotter relative to the Milky Way. The fraction of low
metallicity stars is largely overestimated, visible from the more negatively
skewed MDF with respect to the observational sample. For our fiducial Milky Way
analog, we study the metallicity distribution of the stars born "in situ"
relative to those formed via accretion (from disrupted satellites), and
demonstrate that this low-metallicity tail to the MDF is populated primarily by
accreted stars. Enhanced supernova and stellar radiation energy feedback to the
surrounding interstellar media of these pre-disrupted satellites is suggested
as an important regulator of the MDF skewness.Comment: 20 pages, 14 figures, MNRAS, accepte
Assessing the UK policies for broadband adoption
Broadband technology has been introduced to the business community and the public as a rapid way of exploiting the Internet. The benefits of its use (fast reliable connections, and always on) have been widely realised and broadband diffusion is one of the items at the top of the agenda for technology related polices of governments worldwide. In this paper an examination of the impact of the UK government’s polices upon broadband adoption is undertaken. Based on institutional theory a consideration of the manipulation of supply push and demand pull forces in the diffusion of broadband is offered. Using primary and secondary data sources, an analysis of the specific institutional actions related to IT diffusion as pursued by the UK government in the case of broadband is provided. Bringing the time dimension into consideration it is revealed that the UK government has shifted its attention from supply push-only strategies to more interventional ones where the demand pull forces are also mobilised. It is believed that this research will assist in the extraction of the “success factors” in government intervention that support the diffusion of technology with a view to render favourable results if applied to other national settings
The role of regular asymptomatic testing in reducing the impact of a COVID-19 wave
Testing for infection with SARS-CoV-2 is an important intervention in reducing onwards transmission of COVID-19, particularly when combined with the isolation and contact-tracing of positive cases. Many countries with the capacity to do so have made use of lab-processed Polymerase Chain Reaction (PCR) testing targeted at individuals with symptoms and the contacts of confirmed cases. Alternatively, Lateral Flow Tests (LFTs) are able to deliver a result quickly, without lab-processing and at a relatively low cost. Their adoption can support regular mass asymptomatic testing, allowing earlier detection of infection and isolation of infectious individuals. In this paper we extend and apply the agent-based epidemic modelling framework Covasim to explore the impact of regular asymptomatic testing on the peak and total number of infections in an emerging COVID-19 wave. We explore testing with LFTs at different frequency levels within a population with high levels of immunity and with background symptomatic PCR testing, case isolation and contact tracing for testing. The effectiveness of regular asymptomatic testing was compared with ‘lockdown’ interventions seeking to reduce the number of non-household contacts across the whole population through measures such as mandating working from home and restrictions on gatherings. Since regular asymptomatic testing requires only those with a positive result to reduce contact, while lockdown measures require the whole population to reduce contact, any policy decision that seeks to trade off harms from infection against other harms will not automatically favour one over the other. Our results demonstrate that, where such a trade off is being made, at moderate rates of early exponential growth regular asymptomatic testing has the potential to achieve significant infection control without the wider harms associated with additional lockdown measures
Employee Stock Ownership and Financial Performance in European Countries: The Moderating Effects of Uncertainty Avoidance and Social Trust
This study investigates how the effect of employee stock ownership on financial performance may hinge on the diverse cultural and societal contexts of European countries. Based on agency and national culture theories, we hypothesize that the positive relationship between employee stock ownership and return on assets (ROA) is stronger in those nations with lower uncertainty avoidance and higher social trust. Using a multisource, time‐lagged, large‐scale dataset of 1,741 firms from 21 countries in Europe, our multilevel, random coefficient modeling analysis found evidence for these hypotheses, suggesting that uncertainty avoidance and social trust serve as important contextual cues in predicting the linkage between employee stock ownership and financial performance. Our supplemental analysis with distinction between the managerial and nonmanagerial employee stock ownership further indicates managerial employee stock ownership has a direct positive effect on ROA. Although nonmanagerial employee stock ownership had a nonsignificant association with ROA, the relationship was positive and significant when uncertainty avoidance was low and social trust was high. This research contributes to the existing literature by illuminating some of the contextual influences altering the effectiveness of employee stock ownership. Our findings also offer practical suggestions for effectively using employee stock ownership
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