Entrepreneurship, identity, and their overlap in the slum: an ethnographic study of the Mukuru slum in Nairobi, Kenya

This study explores the relationship between entrepreneurship and collective identity in an informal, or ‘slum’, community in Nairobi, Kenya. In Nairobi, as in cities across the Developing World, slum communities stand out as islands of poverty and neglect amidst increasingly cosmopolitan urban surroundings. Extant research, much of which centres on the so-called ‘Base of the Pyramid’ (BoP), has shown that where social groups experience levels of social and economic disadvantage which are far in excess of comparable groups, entrepreneurship is often underpinned by a strong collective orientation. This can have a profound and wide-ranging bearing on the venturing process. Slum communities, however, have yet to be considered in this research and, moreover, they remain largely neglected within the broader literature on entrepreneurship at the BoP. Drawing on ethnographic data collected during four-and-a-half months of fieldwork, I observed that collective identity was closely tied up with economic informality. Entrepreneurs believed that their community’s marginal status afforded them a de facto right to circumvent the costs of registration and taxation, considerably reducing the barriers to market entry in an environment characterised by widespread and acute resource deprivation. However, for most entrepreneurs this was the only facet of the venturing process that was permeated by collective identity. Navigating the many challenges of their market context was seen as an individual rather than a collective concern. This was observed to differ, however, among the slum’s younger generation, who, for the most part, had grown up there or moved there as adolescents. This cohort exhibited a stronger proclivity towards collaboration in entrepreneurial venturing, and their ventures were firmly rooted in dense, close-knit friendship networks. This study extends current understandings of how entrepreneurship is affected by social-group membership, particularly in a BoP context

Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

Objective: To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS). Design: Cross-sectional study. Setting: Regional specialist WMS located in the West of Scotland. Participants: 9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing. Primary and secondary outcome measures: Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions. Analysis: Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion. Results: Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas. Conclusions: There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation

Is there a link between agricultural land-use management and flooding?

International audienceOver the past fifty years, significant changes in UK land use and management practices have occurred, driven by UK and EU agricultural policies. There is substantial evidence that modern land-use management practices have enhanced surface runoff generation at the local scale, frequently creating impacts through "muddy floods". Such local impacts can be avoided or mitigated through the adoption of better land management practices and/or small scale surface runoff control measures. There is little evidence that local scale changes in runoff generation propagate downstream to create impacts at the larger catchment scale. This does not imply that impacts do not exist, but the very few studies in which evidence has been sought have not produced any conclusive findings. Multiscale catchment experimentation, linked to new developments in modelling, is needed which can lead to a better understanding of how small scale changes to runoff generation propagate to larger catchment scales. To facilitate the tracking of changes from the local to the catchment scale, a new modelling approach is demonstrated which allows a downstream flood hydrograph to be mapped back onto its source areas, thus presenting impact information to users in a useful and comprehensible form

Rethinking the 'necessity' in necessity entrepreneurship

Original paper: John C. Dencker, Sophie Bacq, Marc Gruber, and Melvin Haas, Reconceptualizing necessity entrepreneurship: A contextualized framework of entrepreneurial processes under the condition of basic needs, https://doi.org/10.5465/amr.2017.047

The disappearance of the "revolving door" patient in Scottish general practice: successful policies

<b>Background</b> We describe the health of "revolving door" patients in general practice in Scotland, estimate changes in their number over the timescale of the study, and explore reasons for changes, particularly related to NHS and government policy.<p></p> <b>Methods</b> A mixed methods predominantly qualitative study, using a grounded theory approach, set in Scottish general practice. Semi-structured interviews were conducted with professional key informants, 6 Practitioner Services staff who administer the GP registration system and 6 GPs with managerial or clinical experience of working with "revolving door" patients. Descriptive statistical analysis and qualitative analysis of patient removal episodes linked with routine hospital admissions, outpatient appointments, drug misuse treatment episodes and deaths were carried out with cohorts of "revolving door" patients identified from 1999 to 2005 in Scotland.<p></p> <b>Results</b> A "revolving door" patient is removed 4 or more times from GP lists in 7 years. Patients had complex health issues including substance misuse, psychiatric and physical health problems and were at high risk of dying. There was a dramatic reduction in the number of "revolving door" patients during the course of the study.<p></p> <b>Conclusions</b> "Revolving door" patients in general practice had significant health problems. Their numbers have reduced dramatically since 2004 and this probably resulted from improved drug treatment services, pressure from professional bodies to reduce patient removals and the positive ethical regulatory and financial climate of the 2004 GMS GP contract. This is a positive development for the NHS

Relationship of Proteinases and Proteinase Inhibitors with Microbial Presence in Chronic Lung Disease of Prematurity

Background: A proteolytic imbalance has been implicated in the development of “classical” chronic lung disease of prematurity (CLD). However, in “new” CLD this pattern has changed. This study examines the longitudinal relationship between neutrophil proteinases and their inhibitors in ventilated preterm infants and their relationship to microbial colonisation. Methods: Serial bronchoalveolar lavage fluid was obtained from ventilated newborn preterm infants. Neutrophil elastase (NE) activity, cell counts, metalloproteinase (MMP)-9, MMP-9/TIMP-1 complex, SerpinB1 concentration and percentage of SerpinB1 and α1-antitrypsin (AAT) in complex with elastase were measured. The presence of microbial genes was examined using PCR for 16S rRNA genes. Results: Statistically more infants who developed CLD had NE activity in at least one sample (10/20) compared with infants with resolved respiratory distress syndrome (RDS) (2/17). However, NE activity was present in a minority of samples, occurring as episodic peaks. Peak levels of MMP-9, MMP-9/TIMP-1 complex, percentage of AAT and SerpinB1 in complex and cell counts were all statistically greater in infants developing CLD than in infants with resolved RDS. Peak values frequently occurred as episodic spikes and strong temporal relationships were noted between all markers. The peak values for all variables were significantly correlated to each other. The presence of bacterial 16S rRNA genes was associated with the development of CLD and with elevated elastase and MMP-9. Conclusion: NE activity and MMP-9 appear to be important in the development of “new” CLD with both proteinase and inhibitor concentrations increasing episodically, possibly in response to postnatal infection

Hemodynamic variability and cerebrovascular control after transient cerebral ischemia

We investigated if hemodynamic variability, cerebral blood flow (CBF) regulation, and their interrelationships differ between patients with transient ischemic attack (TIA) and controls. We recorded blood pressure (BP) and bilateral middle cerebral artery flow velocity (MCAv) in a cohort of TIA patients (n = 17), and age?matched controls (n = 15). Spontaneous fluctuations in BP and MCAv were characterized by spectral power analysis, and CBF regulation was assessed by wavelet phase synchronization analysis in the very low? (0.02–0.07 Hz), low? (0.07–0.20 Hz), and high?frequency (0.20–0.40 Hz) ranges. Furthermore, cerebrovascular CO2 reactivity was assessed as a second metric of CBF regulation by inducing hypercapnia with 8% CO2 inhalation followed by hyperventilation driven hypocapnia. We found that TIA was associated with higher BP power (group effect, P < 0.05), but not MCAv power (P = 0.11). CBF regulation (assessed by wavelet phase synchronization and CO2 reactivity) was intact in patients (all P ? 0.075) across both hemispheres (all P ? 0.51). Pooled data (controls and affected hemisphere of patients) showed that BP and MCAv power were positively correlated at all frequency ranges (R2 = 0.20–0.80, all P < 0.01). Furthermore, LF phase synchronization index was a significant determinant of MCAv power (P < 0.05), while VLF and HF phase synchronization index, and TIA were not (all P ? 0.50). These results indicate that CBF stability and control is maintained in TIA patients, but BPV is markedly elevated. BPV attenuation may be an important therapeutic strategy for enhancing secondary stroke prevention in patients who suffer a TIA

'Divided they stand, divided they fail': opposition politics in Morocco

The literature on democratization emphasises how authoritarian constraints usually lead genuine opposition parties and movements to form alliances in order to make demands for reform to the authoritarian regime. There is significant empirical evidence to support this theoretical point. While this trend is partly visible in the Middle East and North Africa, such coalitions are usually short-lived and limited to a single issue, never reaching the stage of formal and organic alliances. This article, using the case of Morocco, seeks to explain this puzzle by focusing on ideological and strategic differences that exist between the Islamist and the secular/liberal sectors of civil society, where significant opposition politics occurs. In addition, this article also aims to explain how pro-democracy strategies of the European Union further widen this divide, functioning as a key obstacle to democratic reforms