Balancing a Hybrid Business Model : The Search for Equilibrium at Cafédirect

This paper investigates the difficulties of creating economic, social, and environmental values when operating as a hybrid venture. Drawing on hybrid organizing and sustainable business model research, it explores the implications of alternative forms of business model experimented with by farmer owned, fairtrade social enterprise Cafédirect. Responding to changes and challenges in the market and societal environment, Cafédirect has tried multiple business model innovations to deliver on all three forms of value capture, with differing levels of success. This longitudinal case study, therefore, provides a contribution to our understanding of how business models enact hybrid mission, providing a platform for triple-bottom-line value capture. In doing so, we are able to expand on the normative understandings of integrating hybrid objectives, and the complications of multiple types of value capture

Molecular basis of gap junctional communication in the CNS of the leech Hirudo medicinalis

Gap junctions are intercellular channels that allow the passage of ions and small molecules between cells. In the nervous system, gap junctions mediate electrical coupling between neurons. Despite sharing a common topology and similar physiology, two unrelated gap junction protein families exist in the animal kingdom. Vertebrate gap junctions are formed by members of the connexin family, whereas invertebrate gap junctions are composed of innexin proteins. Here we report the cloning of two innexins from the leech Hirudo medicinalis. These innexins show a differential expression in the leech CNS: Hm-inx1 is expressed by every neuron in the CNS but not in glia, whereas Hm-inx2 is expressed in glia but not neurons. Heterologous expression in the paired Xenopus oocyte system demonstrated that both innexins are able to form functional homotypic gap junctions. Hm-inx1 forms channels that are not strongly gated. In contrast, Hm-inx2 forms channels that are highly voltage-dependent; these channels demonstrate properties resembling those of a double rectifier. In addition, Hm-inx1 and Hm-inx2 are able to cooperate to form heterotypic gap junctions in Xenopus oocytes. The behavior of these channels is primarily that predicted from the properties of the constituent hemichannels but also demonstrates evidence of an interaction between the two. This work represents the first demonstration of a functional gap junction protein from a Lophotrochozoan animal and supports the hypothesis that connexin-based communication is restricted to the deuterostome clade

Where now for fair trade?

This paper critically examines the discourse surrounding fair trade mainstreaming, and discusses the potential avenues for the future of the social movement. The authors have a unique insight into the fair trade market having a combined experience of over 30 years in practice and 15 as fair trade scholars. The paper highlights a number of benefits of mainstreaming, not least the continued growth of the global fair trade market (tipped to top $7bn in 2012). However, the paper also highlights the negative consequences of mainstreaming on the long-term viability of fair trade as a credible ethical standard

Cytomegalovirus as a driver of excess cardiovascular mortality in rheumatoid arthritis: a red herring or a smoking gun?

Rheumatoid arthritis (RA) is the most common inflammatory arthritis worldwide. Apart from its well known manifestations involving the joints (e.g. deformity, swelling, synovial inflammation), there are widespread, extra-articular manifestations that also involve the cardiovascular (CV) system. The consequences of CV involvement are often serious; cerebrovascular disease, ischemic heart disease and CV disease (CVD)-associated death are up to 50% higher in the context of RA leading to a reduction of life-expectancy in these patients of 3-10 years compared with the general population. To date, no satisfactory explanation of this phenomenon has been found, or maybe, it has been overlooked

Attitudes and behaviours of key account managers:Are they really any different to senior sales professionals?

This study investigates the range of attitudes and behaviours exhibited by Key Account Managers (KAMs) in their roles as customer relationship managers. Specifically, we test whether KAMs exhibit different behaviours and attitudes towards relationship management compared to other sales professionals based on a range of assumptions currently theorized but untested in the Key Account Management (KAM) literature. Utilizing the existing theoretical models of a KAM role we identify six major areas of relational behaviour assumed in the literature to separate the KAM from the sales professional. Drawing on a cross sectional quantitative study of 10 organizations and 409 key account managers, sales managers, and senior sales executives we explore goal orientation, planning, customer embeddedness, strategic prioritization, adaptability and internal management behaviours of our groups and find that, in certain managerial tasks, KAMs do indeed exhibit many of the different behaviours and attitudes predicted in the literature. However, in many customer-facing, goal orientated and revenue generating activities, contrary to expectations, they display similar attitudes and behaviours to those in senior sales roles. This challenges the way that the KAM role has previously been conceptualized. Our findings raise a potential issue for senior managers, since KAMs' unexpectedly short term orientation may lead to insufficient consideration of the strategic consequences of their decisions for these key customer relationships

Prolonged PR interval, first-degree heart block and adverse cardiovascular outcomes: a systematic review and meta-analysis

Objective: First-degree atrioventricular block is frequently encountered in clinical practice and is generally considered a benign process. However, there is emerging evidence that prolonged PR interval may be associated with adverse outcomes. This study aims to determine if prolonged PR interval is associated with adverse cardiovascular outcomes and mortality. Methods: We searched MEDLINE and EMBASE for studies that evaluated clinical outcomes associated with prolonged and normal PR intervals. Relevant studies were pooled using random effects meta-analysis for risk of mortality, cardiovascular mortality, heart failure, coronary heart disease, atrial fibrillation and stroke or transient ischaemic attack (TIA). Sensitivity analyses were performed considering the population type and the use of adjustments. Results: Our search yielded 14 studies that were undertaken between 1972 and 2011 with 400 750 participants. Among the studies that adjusted for potential confounders, the pooled results suggest an increased risk of mortality with prolonged PR interval risk ratio (RR) 1.24 95% CI 1.02 to 1.51, five studies. Prolonged PR interval was associated with significant risk of heart failure or left ventricular dysfunction (RR 1.39 95% CI 1.18 to 1.65, three studies) and atrial fibrillation (RR 1.45 95% CI 1.23 to 1.71, eight studies) but not cardiovascular mortality, coronary heart disease or myocardial infarction or stroke or TIA. Similar observations were recorded when limited to studies of first-degree heart block. Conclusions: Data from observational studies suggests a possible association between prolonged PR interval and significant increases in atrial fibrillation, heart failure and mortality. Future prospective studies are needed to confirm the relationships reported, consider possible mechanisms and define the optimal monitoring strategy for such patients

Order alpha_s^2 beta_0 Correction to the Charged Lepton Spectrum in b \to c \ell \bar\nu_\ell decays

We compute the \alpha_s^2\beta_0 part of the two-loop QCD corrections to the charged lepton spectrum in b \to c \ell \bar\nu_\ell decays and find them to be about 50\% of the first order corrections at all lepton energies, except those close to the end point. Including these corrections we extract the central values \bar\Lambda=0.33 GeV and \lambda_1=-0.17 GeV^2 for the HQET matrix elements and use them to determine the $\overline{\rm MS}$ b and c quark masses, and |V_{cb}|.Comment: 15 pages, 1 Postscript figur

Community screening for left ventricular systolic dysfunction using plasma and urinary natriuretic peptides

ObjectivesWe sought to compare urinary and plasma N-terminal pro-brain natriuretic peptide (N-BNP) in left ventricular systolic dysfunction (LVSD) diagnosis.BackgroundPlasma N-BNP is elevated in LVSD. Renal tubule cells produce BNP. We tested the incremental value of urinary N-BNP in LVSD diagnosis.MethodsIn this prospective, community-screening study of undiagnosed LVSD, 1,360 subjects (45 to 80 years of age) were invited, and 1,308 had analyzable echocardiographic scans and urine and plasma specimens. The criterion standard for LVSD was defined as a wall motion score over 1.8 (ejection fraction ≤40%).ResultsTwenty-eight patients with LVSD had elevated urinary and plasma N-BNP levels compared with normal subjects (p < 0.0005). Receiver-operating characteristic (ROC) areas under the curve (AUCs) for urinary and plasma N-BNP were 0.831 and 0.840, respectively. Both tests had high negative predictive values (>99%) for excluding LVSD. Urinary N-BNP was more specific (67.2%) than plasma N-BNP (41%). The plasma/urinary N-BNP product yielded a higher ROC-AUC (0.923) and specificity (78%), reducing the number of cases to scan to detect one case of LVSD to 11.4 (compared with 16.6 [urinary N-BNP] and 29.0 [plasma N-BNP]). Sequential application of tests (urinary N-BNP, then plasma N-BNP in the urine-“positive” cases) achieved similar reductions in the number of cases to scan (10.8), while limiting the number of N-BNP tests to be performed. Urinary N-BNP performed poorly in detection of other cardiac abnormalities with preserved systolic function. It was less costly to test urinary N-BNP in the whole population as compared with other strategies, including scanning high-risk cases with N-BNP testing in the remainder.ConclusionsUrinary N-BNP used together with plasma N-BNP could reduce the echocardiographic burden in screening programs