Bench-to-bedside review: Association of genetic variation with sepsis

Susceptibility and response to infectious disease is, in part, heritable. Initial attempts to identify the causal genetic polymorphisms have not been entirely successful because of the complexity of the genetic, epigenetic, and environmental factors that influence susceptibility and response to infectious disease and because of flaws in study design. Potential associations between clinical outcome from sepsis and many inflammatory cytokine gene polymorphisms, innate immunity pathway gene polymorphisms, and coagulation cascade polymorphisms have been observed. Confirmation in large, well conducted, multicenter studies is required to confirm current findings and to make them clinically applicable. Unbiased investigation of all genes in the human genome is an emerging approach. New, economical, high-throughput technologies may make this possible. It is now feasible to genotype thousands of tag single nucleotide polymorphisms across the genome in thousands of patients, thus addressing the issues of small sample size and bias in selecting candidate polymorphisms and genes for genetic association studies. By performing genome-wide association studies, genome-wide scans of nonsynonymous single nucleotide polymorphisms, and testing for differential allelic expression and copy number polymorphisms, we may yet be able to tease out the complex influence of genetic variation on susceptibility and response to infectious disease

Clinical review: Guyton - the role of mean circulatory filling pressure and right atrial pressure in controlling cardiac output

Arthur Guyton's concepts of the determinative role of right heart filling in cardiac output continue to be controversial. This paper reviews his seminal experiments in detail and clarifies the often confusing concepts underpinning his model. One primary criticism of Guyton's model is that the parameters describing venous return had not been measured in a functioning cardiovascular system in humans. Thus, concerns have been expressed in regard to the ability of Guyton's simplistic model, with few parameters, to model the complex human circulation. Further concerns have been raised in regard to the artificial experimental preparations that Guyton used. Recently reported measurements in humans support Guyton's theoretical and animal work

Co-Produced Care in Veterinary Services: A Qualitative Study of UK Stakeholders' Perspectives

Changes in client behaviour and expectations, and a dynamic business landscape, amplify the already complex nature of veterinary and animal health service provision. Drawing on prior experiences, veterinary clients increasingly pursue enhanced involvement in services and have expectations of relationship-centred care. Co-production as a conceptualisation of reciprocity in service provision is a fundamental offering in the services sector, including human medicine, yet the role of co-production in veterinary services has been minimally explored. Utilising a service satisfaction framework, semi-structured interviews (n = 13) were completed with three veterinary stakeholder groups, veterinarians, allied animal health practitioners, and veterinary clients. Interview transcript data were subject to the qualitative data analysis techniques, thematic analysis and grounded theory, to explore relationship-centred care and subsequently conceptualise co-production service for the sector. Six latent dimensions of service were emergent, defined as: empathy, bespoke care, professional integrity, value for money, confident relationships, and accessibility. The dimensions strongly advocate wider sector adoption of a co-produced service, and a contextualised co-production framework is presented. Pragmatic challenges associated with integration of active veterinary clients in a practitioner–client partnership are evident. However, adopting a people-centric approach to veterinary services and partnerships with clients can confer the advantages of improved client satisfaction, enhanced treatment adherence and outcomes, and business sustainability

Digital Entrepreneurship in China: Insight into Online Business Start-up Among Chinese University Students Based On Entrepreneurial Intention

This paper investigates the entrepreneurial intention of Chinese university students to provide insight into digital entrepreneurship. An online survey of 305 university students in Beijing was the basis for the data used to test a logistic regression model of the variables underpinning entrepreneurial intention. Factors determining whether Chinese students intend to engage in digital entrepreneurship were “family business”, “perceived motivations” (especially “Self-achievement”), and “perceived barriers” (especially “Lack of experience”). These are a subset of the antecedent factors influencing entrepreneurship more broadly. The nature of digital entrepreneurship may negate some of the factors, especially culture, that serve as barriers to entrepreneurship in the Chinese context. Although this study is limited by its quantitative methodology and focus on Chinese students attending a single university in Beijing, it contributes to knowledge regarding student engagement with digital entrepreneurship

Failure demand: a concept evaluation in UK primary care

Purpose: Our purpose was to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. We assess whether the concept’s limited use is a missed opportunity to help us understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed. Design/methodology/approach: We look at the literature across the public sector and then apply the failure demand concept to the UK’s primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews. Findings: The study highlighted the concept’s value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience. Research implications: More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application. Practical implications: We highlight three practical barriers to using failure demand: (i) demand within the healthcare system is poorly understood; (ii) systems improvement understanding is limited; and (iii) need to apply the concept for improvement and not just for reporting purposes. Originality/value: We provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare