Entrepreneurial becoming: an educational pathway out of poverty

This paper reports a longitudinal analysis of 20 necessity driven micro-entrepreneurs operating in Beira, Central Mozambique, who received funding and training from the same NGO to establish or grow their business activities and reports the development of these entrepreneurs in terms of their acquired entrepreneurial potential for long-term success. The results indicate there is a process of entrepreneurial becoming that is not just about access to finance but especially learning and, when successful, this process supports the transformation of survival micro-enterprises into entrepreneurial micro-businesses. The concept of ‘becoming’ contains an implicit temporal dimension. Becoming suggests a transformation over time: a change from what one is already. In this study, we witness a significant change in understanding how a business needs to operate, in recognizing opportunities, thinking more creatively, and building self-confidence

What entropy at the edge of chaos?

Numerical experiments support the interesting conjecture that statistical methods be applicable not only to fully-chaotic systems, but also at the edge of chaos by using Tsallis' generalizations of the standard exponential and entropy. In particular, the entropy increases linearly and the sensitivity to initial conditions grows as a generalized exponential. We show that this conjecture has actually a broader validity by using a large class of deformed entropies and exponentials and the logistic map as test cases.Comment: 6 pages, 6 figures, uses ws-procs975x65.cls. Proceedings of the Workshop "Complexity, Metastability and Nonextensivity" held in Erice 20-26 July 2004. New version: minor changes (one reference added, typos corrected, positions of figures changed, some comments added

Chronic Kidney Disease and the Aging Population

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Increasing the uptake of exercise programs in the dialysis unit: A protocol for a realist synthesis

Background: For people with end-stage kidney disease on hemodialysis, exercise during the dialysis treatment ( intradialytic exercise ) may promote exercise adherence and enhance aspects of the dialysis treatment. However, intradialytic exercise programs are complex and how to adapt program components to local context so that the program is more likely to attain its intended health outcomes have not been well described. To increase the uptake of exercise in clinical practice, more evidence is needed on how contextual factors influence the program’s impact. Methods: Using the realist approach, we aim to understand how the processes and structures of intradialytic exercise programs work to influence patient participation according to different contextual factors. The focus of a realist review is explanatory and aims to develop and test theory on how contextual factors trigger specific processes or behaviors ( or “mechanisms” ) to produce outcomes. Using the realist context-mechanism-outcome configuration of theory development, we will use a range of sources to develop initial candidate theories: a scoping review of published papers and the gray literature, and discussion with stakeholders. To provide a theoretical basis for how contextual factors could work to influence patient participation in intradialytic exercise ( IDE ), several of our preliminary theories will be based on dominant theories of exercise adherence and behavior change. To support or refute these initial theories, we will synthesize data from a systematic literature review and semi-structured interviews with intradialytic exercise program stakeholders, sampled from a range of programs worldwide. Discussion: The complexity of intradialytic exercise programs poses challenges to their implementation. Using the “context, mechanism, outcome” approach, the knowledge gained from this study will be used to develop general recommendations for renal care providers and administration on how to adapt components of an intradialytic exercise programs according to different contextual factors in order to promote patient participation. Systematic review registration: PROSPERO CRD4201603333

The effects of nocturnal hemodialysis compared to conventional hemodialysis on change in left ventricular mass: Rationale and study design of a randomized controlled pilot study

BACKGROUND: Nocturnal hemodialysis (NHD) is an alternative to conventional three times per week hemodialysis (CvHD) and has been reported to improve several health outcomes. To date, no randomized controlled trial (RCT) has compared NHD and CvHD. We have undertaken a multi-center RCT in hemodialysis patients comparing the effect of NHD to CvHD on left ventricular (LV) mass, as measured by cardiac magnetic resonance imaging (cMR). METHODOLOGY/DESIGN: All patients in Alberta, Canada, expressing an interest in performing NHD are eligible for the study. Patients enrolled in the study will be randomized to either NHD or CvHD for a six month period. All patients will have a full clinical assessment, including collection of biochemical and cMR data at baseline and at 6 months. Both groups of patients will be monitored biweekly to optimize blood pressure (BP) to a goal of <130/80 mmHg post-dialysis using a predefined BP management protocol. The primary outcome is change in LV mass, a surrogate marker for cardiac mortality, measured at baseline and 6 months. The high sensitivity and reproducibility of cMR facilitates reduction of the required sample size and the time needed between measures compared with echocardiography. Secondary outcomes include BP control, anemia, mineral metabolism, health-related quality of life, and costs. DISCUSSION: To our knowledge, this study will be the first RCT evaluating health outcomes in NHD. The impact of NHD on LV mass represents a clinically important outcome which will further elucidate the potential benefits of NHD and guide future clinical endpoint studies

Population based screening for chronic kidney disease: cost effectiveness study

Objective To determine the cost effectiveness of one-off population based screening for chronic kidney disease based on estimated glomerular filtration rate