Business Service Firms and Market Share

Traditional thinking suggests that profitability is linearly dependent upon market share, an assumption not carefully tested/or services. This assumption is examined in this study for business services in light of the apparent opportunity in this sector for entrepreneurs. Cross-sectional data from secondary sources suggest that a V-shaped relationship may be a better description of variation up to nine times average firm size in this sector. This interpretation of results is important to the strategy of small business managers became it relates to the plans they might make in growing their businesses. Normative recommendations promise improvements/or firms entering the critical intermediate share stage. These include focusing on revenue per employee as an objective, developing professional management assistance, formal projectfication of work (thus utilizing "virtual organizations'), and paying a11ention to organization while growing

Who wants to be involved in health care decisions? Comparing preferences for individual and collective involvement in England and Sweden

Background: Patient and public involvement (PPI) is framed as positive for individuals, the health system, public health, as well as for communities and society as a whole. We investigated whether preferences for PPI differed between two countries with Beveridge type health systems-Sweden and England. We measured willingness to be involved in individual treatment decisions and in decisions about the organization and provision of local health and social care services. Methods: This was a comparative cross-sectional study of the general population's preferences. Together, the two samples included 3125 respondents; 1625 in England and 1500 in Sweden. Country differences were analysed in a multinomial regression model controlling for gender, age and educational attainment. Results: Overall, 68% of respondents wanted a passive patient role and 44% wanted to be involved in local decisions about organization and provision of services. In comparison with in Sweden, they were in England less likely to want a health professional such as a GP or consultant to make decisions about their treatment and also more likely to want to make their own decisions. They were also less likely to want to be involved in local service development decisions. An increased likelihood of wanting to be involved in organizational decision-making was associated with individuals wanting to make their own treatment decisions. Women were less likely to want health professionals to make decisions and more likely to want to be involved in organizational decisions. Conclusions: An effective health system that ensures public health must integrate an effective approach to PPI both in individual treatment decisions and shaping local health and social care priorities. To be effective, involvement activities must take in to account the variation in the desire for involvement and the implications that this has for equity. More work is needed to understand the relationship between the desire to be involved and actually being involved, but both appear related to judgements of the impact of involvement on health care decisions

Night nursing – staff's working experiences

<p>Abstract</p> <p>Background</p> <p>Although the duties and working conditions of registered, and enrolled nurses have previously been described from different perspectives, they have not been examined from the night nursing aspect. The aim of the study was to describe the night nursing staff's working experiences.</p> <p>Methods</p> <p>The design of the study is qualitative and descriptive. Interviews were conducted with 10 registered and 10 enrolled nurses working as night staff at a Swedish University Hospital. The interview guide was thematic and concerned the content of their tasks, as well as the working conditions that constitute night nursing. In addition, the interviews were transcribed verbatim and analyzed using content analysis.</p> <p>Results</p> <p>The night duties have to be performed under difficult conditions that include working silently in dimmed lighting, and making decisions when fatigue threatens. According to the night staff, its main goals are to provide the patients with rest and simultaneously ensure qualified care. Furthermore, the night nursing staff must prepare the ward for the daytime activities.</p> <p>Conclusion</p> <p>The most important point is the team work, which developed between the registered and enrolled nurses and how necessary this team work is when working at night. In order for nurses working at night to be fully appreciated, the communication between day and night staff in health care organizations needs to be developed. Furthermore, it is important to give the night staff opportunities to use its whole field of competence.</p

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

The role of salt basins in the race to net zero: a focus on Australian basins and key research topics

Globally, many salt basins host highly productive fossil fuel resources and provide excellent opportunities for developing economically viable clean energy systems such as (1) energy storage in salt caverns, including hydrogen, helium, natural gas, and other economic gases; (2) permanent sequestration of carbon dioxide; (3) development of geothermal energy; (4) critical mineral exploration and extraction, and (5) natural hydrogen production. Despite the high potential to deploy financially viable clean energy solutions related to the formation and evolution of salt basins, our current knowledge regarding critical aspects of salt basin characterisation in Australia is limited. New research is necessary to develop these sustainable energy systems and achieve net zero emissions; therefore, it is critical to re-evaluate the geology of salt basins. Key research areas to enable these opportunities relate to the precipitation, deposition, and deformation of salt basins. This paper reviews the potential for a range of energy systems within salt basins, outlines emerging research topics, and demonstrates the value of Australian salt basin outcrop analogues for improved subsurface interpretation globally.Rachelle Kernen, Kathryn J. Amos, Ingrid Anell, Sian Evans and Leticia Rodriguez-Blanc

Architecture of growth basins in a tidally influenced, prodelta to delta-front setting: The Triassic succession of Kvalpynten, East Svalbard

World-class examples of fault-controlled growth basins with associated syn-kinematic sedimentary fill are developed in Upper Triassic prodelta to delta-front deposits exposed at Kvalpynten, SW Edgeøya in East Svalbard. They are interpreted to have interacted with north-westerly progradation of a regional delta system. The syn-kinematic successions consist of 4 to 5 coarsening-upward units spanning from offshore mudstones to subtidal heterolithic bars and compound tidal dunes, which were blanketed by regional, post-kinematic sandstone sheets deposited as laterally continuous, subaqueous tidal dune fields. The rate of growth faulting is reflected in the distribution of accommodation, which governs sedimentary architecture and stacking patterns within the coarsening-upward units. Fully compartmentalized basins (12, 200–800 m wide and c. 150 m high grabens and half grabens) are characterized by syn-kinematic sedimentary infill. These grabens and half-grabens are separated by 60–150 m high horsts composed of pro-delta to distal delta-front mudstones. Grabens host tabular tidal dunes (sandwaves), whereas half-grabens bound by listric faults (mainly south-dipping) consist of wedge-shaped, rotated strata with erosive boundaries proximal to the uplifted fault block crests. Heterolithic tidal bars (sand ridges) occur in narrow half-grabens, showing migration oblique to the faults, up the dipslope. Structureless sandstone wedges and localized subaqueous slumps that formed in response to collapse of the block crests were only documented in half-grabens. Late-kinematic deposition during the final stages of faulting occurred in partly compartmentalized basins, filled with variably thick sets of continuous sandstone belts (compound tidal dunes)