7,974 research outputs found
Perceptions of knowledge sharing among small family firm leaders: a structural equation model
Small family firms have many unique relational qualities with implications for how knowledge is passed between individuals. Extant literature posits leadership approach as important in explaining differences in knowledge-sharing climate from one firm to another. This study investigates how leadership approaches interact with family influence to inform perceptions of knowledge sharing. We utilize survey data (n = 110) from owner-managers of knowledge-intensive small family firms in Scotland. Our findings present a choice in leadership intention, contrasting organization-focused participation against family-influenced guidance. Insight is offered on the implications of this leadership choice at both organizational and familial level
The association between retinal vein ophthalmodynamometric force change and optic disc excavation
Aim: Retinal vein ophthalmodynamometric force (ODF) is predictive of future optic disc excavation in glaucoma, but it is not known if variation in ODF affects prognosis. We aimed to assess whether a change in ODF provides additional prognostic information. Methods: 135 eyes of 75 patients with glaucoma or being glaucoma suspects had intraocular pressure (IOP), visual fields, stereo optic disc photography and ODF measured on an initial visit and a subsequent visit at mean 82 (SD 7.3) months later. Corneal thickness and blood pressure were recorded on the latter visit. When venous pulsation was spontaneous, the ODF was recorded as 0 g. Change in ODF was calculated. Flicker stereochronoscopy was used to determine the occurrence of optic disc excavation, which was modelled against the measured variables using multiple mixed effects logistic regression. Results: Change in ODF (p=0.046) was associated with increased excavation. Average IOP (p=0.66) and other variables were not associated. Odds ratio for increased optic disc excavation of 1.045 per gram ODF change (95% CI 1.001 to 1.090) was calculated. Conclusion: Change in retinal vein ODF may provide additional information to assist with glaucoma prognostication and implies a significant relationship between venous change and glaucoma patho-physiology
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/Fisherâs 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
Transgastric Pancreatic Necrosectomy: How I Do It
Necrotizing pancreatitis is a serious medical problem that often requires intervention to debride necrotic pancreatic and peripancreatic tissue. Recently, minimally invasive approaches have been applied to pancreatic necrosectomy. The purpose of this report is to review the history of transgastric pancreatic debridement, identify appropriate patient selection criteria, and highlight technical âpearls.â We present this subject matter in the context of our own clinical experience, with a primary focus on a âHow I Do Itâ type of technical description
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 governmentâs 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 âsuccess factorsâ in government intervention that support the diffusion of technology with a view to render favourable results if applied to other national settings
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
A multilevel review of stressor research in teams
The contemporary work environment is characterized by an ongoing trend to embed employees in teams because of their expected abilities for handling complex tasks and integrating diverse sets of knowledge and skills. However, leveraging this potential is endangered by stimuli within and outside of teams that take a toll on cohesion and teamwork among team members. Understanding the role that stressors and demands play in the workârelated functioning of teams and their members is therefore an increasingly important challenge in the organizational behavior literature. Whereas research on stressors and demands has primarily focused on the individual level, we expand the research scope by considering these phenomena to be multilevel. We perform an interdisciplinary review of the literature on these stimuli in teams and show how related research, such as that on destructive leadership, may benefit from a more balanced account and integration of frameworks on stressors. Our multilevel review is informative for the literature on stressors and demands at the individual and team levels, as it offers an important conceptual grounding for how and why various stimuli in this social environment differentially influence both the collective entity and its individual team members
Reflections on the implementation of the Gifted and Talented policy in England, 1999â2011
This paper, as part of an on-going study looking at the impact of gifted and talented policies on an inner-city school, explores the role of the local authority in implementing the various gifted and talented initiatives since 1999, when local authority gifted and talented co-ordinators were first appointed under the Excellence in Cities (DfEE, 1999) programme
Reflections on the implementation of the Gifted and Talented policy in England, 1999â2011
This paper, as part of an on-going study looking at the impact of gifted and talented policies on an inner-city school, explores the role of the local authority in implementing the various gifted and talented initiatives since 1999, when local authority gifted and talented co-ordinators were first appointed under the Excellence in Cities (DfEE, 1999) programme
Understanding and developing procedures for video-based assessment in medical education
Introduction
Novel uses of video aim to enhance assessment in health-professionals education. Whilst these uses presume equivalence between video and live scoring, some research suggests that poorly understood variations could challenge validity. We aimed to understand examinersâ and studentsâ interaction with video whilst developing procedures to promote its optimal use.
Methods
Using design-based research we developed theory and procedures for video use in assessment, iteratively adapting conditions across simulated OSCE stations. We explored examinersâ and studentsâ perceptions using think-aloud, interviews and focus group. Data were analysed using constructivist grounded-theory methods.
Results
Video-based assessment produced detachment and reduced volitional control for examiners. Examiners ability to make valid video-based judgements was mediated by the interaction of station content and specifically selected filming parameters. Examiners displayed several judgemental tendencies which helped them manage videosâ limitations but could also bias judgements in some circumstances. Students rarely found carefully-placed cameras intrusive and considered filming acceptable if adequately justified.
Discussion
Successful use of video-based assessment relies on balancing the need to ensure station-specific information adequacy; avoiding disruptive intrusion; and the degree of justification provided by videoâs educational purpose. Video has the potential to enhance assessment validity and studentsâ learning when an appropriate balance is achieved
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