Information Technology Sourcing Across Cultures: Preparing Leaders for Cross-Cultural Engagements and Implementing Best Practices with Cultural Sensitivity

This research exercised a mixed method exploratory sequential design inquiry into the topical area of leadership behaviors and cross-cultural awareness that permeate successful global information technology (IT) outsource alliances. When IT is aligned with an entity\u27s objectives, strategic technology leadership is actively engaged in governance, infrastructure architecture, planning, and cross-cultural collaboration. Bilateral contracting foster and forge interactive organizational cultures however, the advent of right shoring has introduced cultural complexity for IT leadership roles born of national, international, and sub-culture global dimensions. This research surfaced significant variations in IT professional opinions as to the leadership practices, cultural compatibility and service fulfillment performance factors in IT outsourcing alliances. The variations in response levels exceeded my expectation and raised my cultural awareness that when cross-cultural differences exist in global IT outsourcing alliance operations, virtual team members must accept such differences with applied cultural sensitivity. Also, while task-related conflicts may help to surface different perspectives and viewpoints and provide opportunities for exploring innovation, relationship and process conflicts may affect team cohesiveness and have negative influences on team performances regardless of adhering to agreed governance principles. To produce the proper group member interaction across cultures, individuals must reflectively monitor their sensitivity to combinations of internally diverse and potentially contested ways of acting to create highly distinctive and desirable group behavior across cultural clusters. This research demonstrates the strength of the situating cultural theory, applies it to specific domains of globally distributed IT service operations and contributes to literature by generating an in-depth understanding of cultural influences on global IT alliances. The electronic version of this Dissertation is at Ohio Link ETD Center, http://www.ohiolink.edu/et

Acetarsol in the management of mesalazine refractory ulcerative proctitis: a tertiary-level care experience

© 2018 Wolters Kluwer Health, Inc. All rights reserved. Background Mesalazine-refractory ulcerative proctitis is common, with a significant proportion of the patients requiring escalation to immunomodulators or biological therapy. Three small preliminary cohort studies suggested good clinical efficacy for the organic arsenic derivative acetarsol in the management of proctitis. Our aim was to describe our experience on the use of acetarsol in proctitis and to review all existing evidence on its safety and efficacy.Patients and methodsWe retrospectively reviewed clinical records of all ulcerative colitis patients exposed to acetarsol at Nottingham University Hospitals since 2012. Clinical response was determined basing on physicians' global assessments and patients' improvement over the baseline (reduction in stool frequency and rectal bleeding). Clinical remission was defined as total resolution of symptoms including bleeding cessation. Serum arsenic, C-reactive protein and faecal calprotectin levels reviewed when available. Nonparametric analysis performed.ResultsTwenty-eight (16 males) patients with median (range) age 39 (35) and 9 (19) years disease duration received acetarsol suppositories for proctitis. All had failed mesalazine or corticosteroid topical therapy, with 50% having additionally failed immunomodulators. Median treatment duration was 70 (64) days. 16/28 were prescribed acetarsol more than once. 67.9% achieved clinical response and 46.4% clinical remission. 32.1% required treatment escalation to steroids, thiopurines or antitumour necrosis factor agents. 6/28 patients stopped acetarsol due to side effects.ConclusionAcetarsol could be an effective and safe option in the management of refractory proctitis. A definitive trial with long-term safety follow-up is required to investigate the efficacy and safety of this promising drug

Evolution of treatment targets in Crohn’s disease

Crohn’s disease is a chronic relapsing and remitting inflammatory disorder of the gastrointestinal tract, associated with significantly morbidity due to both symptoms and complications that have a considerable detrimental impact on a patient’s quality of life. An early treat to target approach with disease modifying agents has been shown to significantly improve long term outcomes, demonstrated by a number of therapeutic targets in a number of modalities. This review will outline the current treatment targets and measures of disease burden in Crohn’s disease

Physical activity and fatigue in adults with Inflammatory Bowel Disease (IBD): a systematic review

Background: Fatigue is frequently reported in inflammatory bowel disease (IBD). IBD has been shown to have an impact on, and be impacted by, physical activity levels in IBD patients, Yet, to date, there have been no systematic reviews considering the impact of physical activity on levels of IBD fatigue.Aim: This aim of this review is to explore the current body of knowledge of what kind of physical activity interventions are available to treat IBD fatigue.Methods: Systematic database searchs (CINAHL, EMBASE, PsychInfo, PsycARTICLES, AMED, Medline) and hand searching were conducted on 03/03/2019. Searches were restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’publications. No time limit was set. Quality appraisal and data extraction was undertaken by at least 2 reviewers.Results: searches yielded 32 publications; 2 studies were included in the review. Physical activity is inhibited by higher fatigue levels, lowering HRQoL, but also as a means of reducing fatigue, subsequently improving HRQoL.Conclusion: There was very little data eligible for inclusion in this review, and it was not of a high quality. The findings of the review suggest that physical activity may be beneficial for IBD fatigue, but this cannot be definitively stated. Evidence suggests physical activity is safe to undertake in active disease, therefore better-quality studiesare needed in this area

Cine MRI assessment of motility in the unprepared small bowel in the fasting and fed state: beyond the breath-hold

BackgroundThe symptoms of functional bowel disorders are common in postprandial but investigations are generally undertaken in the fasted state using invasive procedures. MRI provides a noninvasive tool to study the gastrointestinal tract in an unperturbed, fed state. The aim of this study was to develop a technique to assess small bowel motility from cine MRI data in the unprepared bowel in fasting and fed states.MethodsFifteen healthy volunteers underwent a baseline MRI scan after which they consumed a 400 g soup. Subjects then underwent a postprandial scan followed by further scans at regular intervals. Small bowel motility was assessed using single‐slice bTFE cine MRI. An optimized processing technique was used to generate motility data based on power spectrum analysis of voxel‐signal changes with time. Interobserver variability (n = 15) and intra‐observer (n = 6) variability were assessed. Changes in the motility index were compared between fasted and immediate postprandial state.Key ResultsExcellent agreement between observers was seen across the range of motility measurements acquired, with intraclass correlation coefficient (ICC) of 0.979 (P [less than] 0.0001) and Bland‐Altman limits of agreement 95% CI: −28.9 to 45.9 au. Intra‐observer variability was low with ICC of 0.992 and 0.960 (2 observers, P [less than] 0.0001). Changes from the fasted to immediately postprandial state showed an average increase of 122.4% ± 98.7% (n = 15).Conclusions & InferencesThis optimized technique showed excellent inter and intra observer agreement. It was sensitive to changes in motility induced feeding. This technique will be useful to study contractile activity and regional patterns along the gastrointestinal tract under physiological conditions

A multivariate spatial analysis of vowel formants in American English

This paper presents the results of a multivariate spatial analysis of 38 vowel formant variables in the language of 402 informants from 236 cities from across the contiguous United States, based on the acoustic data from the Atlas of North American English (Labov, Ash & Boberg, 2006). The results of the analysis both confirm and challenge the results of the Atlas. Most notably, while the analysis identifies similar patterns as the Atlas in the West and the Southeast, the analysis finds that the Midwest and the Northeast are distinct dialect regions that are considerably stronger than the traditional Midland and Northern dialect region indentified in the Atlas. The analysis also finds evidence that a western vowel shift is actively shaping the language of the Western United States

Systematic review: the impact of inflammatory bowel disease-related fatigue on health-related quality of life

Background: Fatigue is frequently reported in inflammatory bowel disease (IBD) and impacts on Health-Related Quality of Life (HRQoL). HRQoL has not been systematically reviewed in IBD fatigue. Aim: To investigate what impact IBD fatigue has on HRQoL in adults with IBD.Methods: Systematic searches (CINAHL, EMBASE, PsychInfo, Medline) were conducted 25.09.2018, restricted to ‘human’, ‘adult’, ‘primary research’ and ‘English language’. Search terms encompassed concepts of ‘Fatigue’, ‘IBD’ and ‘HRQoL’. A 5 year time limit (2013-2018) was set to include the most relevant publications. Publications were screened, data extracted, and quality appraised by two authors. A narrative synthesis was conducted.Results: Eleven studies were included, presenting data from 2823 participants. Fatigue experiences were significantly related to three HRQoL areas: symptom acceptance, psychosocial wellbeing, and physical activity. Patients reporting high fatigue levels had low symptom acceptance. Psychosocial factors were strongly associated with both, fatigue and HRQoL. Higher social support levels were associated with higher HRQoL. Physical activity was impaired by higher fatigue levels, lowering HRQoL, but it was also used as a means of reducing fatigue and improving HRQoL. Quality appraisal revealed methodological shortcomings in a number of studies. Notably use of multiple measures, comparison without statistical adjustment and fatigue and HRQoL assessment using the same tool

The pattern of underlying cause of death in patients with inflammatory bowel disease in England: a record linkage study

Background and Aims: Numerous studies have established that mortality risk in IBD patients is higher than the general population, but the causes of death have seldom been examined. We aimed to describe causes of death in IBD. Methods: A matched cohort study using UK general practice data from Clinical Practice Research Datalink linked to death registration records. We described the distribution of causes of death among IBD patients by age at death and time since IBD diagnosis. We estimated age-specific mortality rates and hazard ratios of death in multivariable Cox proportional hazards models. Results: 20,293 IBD patients were matched to 83,261 non-IBD patients. The mortality rate was 40% higher in IBD patients (2005 deaths) than in non-IBD patients (6024 deaths) (adjusted overall hazard ratio = 1.4, 95% CI = 1.4—1.5), with greater risk of death in Crohn’s disease (hazard ratio = 1.6, 1.5—1.7) than in ulcerative colitis (1.3, 1.3—1.4). Causes attributable to IBD constituted 3.7% of all deaths in ulcerative colitis and 8.3% in Crohn’s disease. Among IBD patients, death was less likely to be due to circulatory, respiratory or neoplastic diseases than non-IBD patients. In both IBD and non-IBD patients all these causes became more clinically important with advancing age, with the commonest neoplastic cause of death being lung cancer, rather than gastrointestinal cancers. Conclusion: IBD patients have an additional risk of death. Most IBD patients die of circulatory or respiratory causes, and the contribution to mortality from long-term complications of IBD are clinically less important

The Gut–Brain Axis and Its Role in Controlling Eating Behavior in Intestinal Inflammation

Malnutrition represents a major problem in the clinical management of the inflammatorybowel disease (IBD). Presently, our understanding of the cross-link between eating behavior andintestinal inflammation is still in its infancy. Crohn’s disease patients with active disease exhibit stronghedonic desires for food and emotional eating patterns possibly to ameliorate feelings of low mood,anxiety, and depression. Impulsivity traits seen in IBD patients may predispose them to palatablefood intake as an immediate reward rather than concerns for future health. The upregulation ofenteroendocrine cells (EEC) peptide response to food intake has been described in ileal inflammation,which may lead to alterations in gut–brain signaling with implications for appetite and eatingbehavior. In summary, a complex interplay of gut peptides, psychological, cognitive factors, diseaserelatedsymptoms, and inflammatory burden may ultimately govern eating behavior in intestinalinflammation