Competitive advantage of independent small businesses in Soweto

Small businesses in Soweto face increasing competition from large retail chains located in shopping malls. In order to survive and grow, small business owners need to identify and focus on the competitive advantage they have over competing businesses. The aim of this article is to explore the various sources of a competitive advantage, focusing specifi cally on differentiation and a unique value package as a market strategy to ensure competitiveness and sustainability for formal independent small businesses in Soweto. In this study, it was found that sustainable businesses (older small businesses with a growing income tendency) tend to perform a competitor analysis regularly. It was further determined that sustainable businesses regard price, shopping hours, personal attention and close relationships as important differentiating elements. They also include product quality, best brands and variety as important elements of their value package. It was found that sustainable small businesses use the elements of their value packages better than stagnating or shrinking businesses. The conclusion can be reached that sustainable formal independent small businesses stay competitive by differentiating themselves on the elements of the unique value package they offer to customers.Key words: competitive advantage, competitive strategies, differentiation, wholesalers, retailers, small business, Soweto, sustainability, product value, formal small busines

Medication decision making and patient outcomes in GP, nurse and pharmacist prescriber consultations

UNLABELLED: Aim The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy.BACKGROUND: There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups.METHODS: Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation. Findings A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient's treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient's preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer's V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit

Phosphorylation of GRK7 by PKA in cone photoreceptor cells is regulated by light

The retina specific G protein-coupled receptor kinases, GRK1 and GRK7, have been implicated in the shutoff of the photoresponse and adaptation to changing light conditions via rod and cone opsin phosphorylation. Recently, we have defined sites of phosphorylation by cAMP-dependent protein kinase (PKA) in the amino termini of both GRK1 and GRK7 in vitro. To determine the conditions under which GRK7 is phosphorylated in vivo, we have generated an antibody that recognizes GRK7 phosphorylated on Ser-36, the PKA phosphorylation site. Using this phospho-specific antibody, we have shown that GRK7 is phosphorylated in vivo and is located in the cone inner and outer segments of mammalian, amphibian and fish retinas. Using Xenopus laevis as a model, GRK7 is phosphorylated under dark-adapted conditions, but becomes dephosphorylated when the animals are exposed to light. The conservation of phosphorylation at Ser-36 in GRK7 in these different species (which span a 400 million-year evolutionary period), and its light-dependent regulation, indicate that phosphorylation plays an important role in the function of GRK7. Our work demonstrates for the first time that cAMP can regulate proteins involved in the photoresponse in cones and introduces a novel mode of regulation for the retinal GRKs by PKA

Physical therapy intervention studies on idiopathic scoliosis-review with the focus on inclusion criteria1

<p>Abstract</p> <p>Background</p> <p>Studies investigating the outcome of conservative scoliosis treatment differ widely with respect to the inclusion criteria used. This study has been performed to investigate the possibility to find useful inclusion criteria for future prospective studies on physiotherapy (PT).</p> <p>Materials and methods</p> <p>A PubMed search for outcome papers on PT was performed in order to detect study designs and inclusion criteria used.</p> <p>Results</p> <p>Real outcome papers (start of treatment in immature samples/end results after the end of growth; controlled studies in adults with scoliosis with a follow-up of more than 5 years) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications.</p> <p>Conclusion</p> <p>There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive in adults or in adolescents followed from premenarchial status until skeletal maturity. However, papers on bracing are more frequently found and bracing can be regarded as evidence-based in the conservative management and rehabilitation of idiopathic scoliosis in adolescents.</p

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: Repeated cross-sectional population-based surveys from the HUNT Study, Norway

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