Actor engagement with service providers

Actor engagement has received significant scholarly and practitioner attention in recent years due to its anticipated outcomes and relevance for organisational success. Yet, despite significant interest in the concept, several theoretical gaps remain. Particularly, the literature has largely overlooked actor engagement with focal objects beyond the brand. Similarly, extant discourse lacks a comprehensive understanding of how actors engage differently. Thus, to better understand the nuances and intricacies of actor engagement beyond the existing focus of brands, and to discover how actors engage differently, this thesis centres on actor engagement with a service provider and delves into actor dispositions to engage. The service provider was chosen as a focal object due to their critical role in service organisations and the paucity of research specifically focused on service providers in an engagement context. The importance of service providers is well recognised, given that the success of service organisations largely depends upon their performance. Yet, engagement scholars have given scant attention to these crucial focal objects in the examination of the engagement concept. To address these knowledge gaps, this research presents three distinct but interrelated papers. The first paper examines actor engagement with service providers within a service system and extends the focus of engagement to multiple engagement foci. Specifically, the paper investigates how the individual dimensions of engagement with a service provider and brand combine to lead to engagement with the broader context. In brief, this paper contributes to an increased understanding of the integrated nature of engagement with a range of focal objects across different levels within a service system. The results suggest that engagement with the service provider facilitates engagement with other focal objects, which further validates the importance of examining actor engagement with service providers across the subsequent two papers. Paper two explores the factors that constitute an actor’s disposition to engage and responds to calls by numerous scholars to shed light on the nature of engagement dispositions. The findings of a series of in-depth interviews reveal three dimensions of engagement dispositions, namely individual actor traits, context-related actor characteristics, and focal object-related actor characteristics, with each dimension consisting of a unique make up of attributes. In total, 14 attributes were identified as constituents of an actor’s disposition to engage with a service provider. This paper contributes to the engagement literature by being the first to empirically consider what constitutes an actor’s disposition to engage and provides a conceptual framework that depicts the impact of engagement dispositions on actor engagement activities. Building on these insights, the third paper employs a survey methodology to empirically examine the impact of engagement dispositions on actor engagement activities. Specifically, it investigates the direct effects of individual attributes on affective, behavioural and cognitive engagement with the service provider. The findings illustrate that the dimensions of engagement dispositions and their constituent attributes have varied impacts on the dimensions of engagement. In particular, actor characteristics related to the focal object and context emerged as relevant for engagement activity, whereas no significant associations between individual actor traits and engagement activity were found. This provides insights into how each actor engages in a unique way. In summary, this research offers unique and meaningful theoretical and practical implications by emphasising the importance of the service provider as a focal object of engagement, providing a framework to consider an actor’s engagement disposition, as well as an understanding of the impact of engagement dispositions on specific engagement activities.Thesis (Ph.D.) -- University of Adelaide, Adelaide Business School, 201

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Massive stars and their supernovae

Stars more massive than about 8-10 solar masses evolve differently from their lower-mass counterparts: nuclear energy liberation is possible at higher temperatures and densities, due to gravitational contraction caused by such high masses, until forming an iron core that ends this stellar evolution. The star collapses thereafter, as insufficient pressure support exists when energy release stops due to Fe/Ni possessing the highest nuclear binding per nucleon, and this implosion turns into either a supernova explosion or a compact black hole remnant object. Neutron stars are the likely compact-star remnants after supernova explosions for a certain stellar mass range. In this chapter, we discuss this late-phase evolution of massive stars and their core collapse, including the nuclear reactions and nucleosynthesis products. We also include in this discussion more exotic outcomes, such as magnetic jet supernovae, hypernovae, gamma-ray bursts and neutron star mergers. In all cases we emphasize the viewpoint with respect to the role of radioactivities