Transition Processes Towards Internal Networks

As a result of many changes in the competitive landscape, knowledge has become a crucial resource of firms, which has impelled firms to change their forms of organizing. Evidence suggests that internal networks, as such an alternative form of organizing, progress to emerge to facilitate the organization and management of knowledge. Insights into how firms actually change into internal networks have been sparse, however. On the basis of three case studies conducted at Rabobank-one at the group level, one at the local member banks, and one at the business unit Spectrum-this paper furnishes this lack of inquiry with new insights. The evidence illustrates that when firms change into internal network forms of organizing, horizontal knowledge flows between subunits are facilitated

Creating the N-Form Corporation as a Managerial Competence

This paper discusses key properties of the N-form corporation or internal network forms of organizing from three mutually related perspectives: structure, knowledge flows and management processes. To operationalize knowledge flows, a key property of N-forms, the paper suggests a new measure, the H/V ratio, to empirically assess the configuration of knowledge flows. The argument is illustrated by a case study of a firm showing that top management's perception about having an internal network contradicts with reality as vertical knowledge flows appear to dominate the horizontal ones. The managerial competence required for creating internal networks aimed at knowledge creation and sharing will be discussed

De ontwikkeling van interne netwerken als een duurzame kenniscreatie strategie

Op basis van een theoretische analyse en empirisch onderzoek analyseren de auteurs het transitieproces van bestaande organisatievormen naar interne netwerkvormen. Dit geschiedt vanuit drie complementaire perspectieven: organisatiestructuur, managementprocessen en kennisstromen. Na een beknopt overzicht van de literatuur wordt middels een longitudinale casestudie zo’n transitieproces nader onderzocht. Er worden aandachtspunten voor het management geformuleerd voor het implementeren van een duurzame kenniscreatiestrategie

Creation of Managerial Capabilities Through Managerial Knowledge Integration

The purpose of this paper is to develop a conceptual framework of managerial knowledge integration and to illustrate the framework for three levels of management: front-line, middle, and top management. Based on the framework, propositions will be derived relating managerial knowledge integration with the creation of managerial capabilities and a firm's managerial competences

Interne netwerken en intraorganisationele kennisdeling

Zowel in de managementpraktijk als in de theorievorming is sprake van grote belangstelling voor interne netwerken en hun betekenis voor intraorganisationele kenniscreatie en -verspreiding. Empirisch onderzoek hiernaar is evenwel schaars. Dit artikel gaat aan de hand van de literatuur beknopt in op de relatie tussen horizontale en verticale kennisstromen in interne netwerken en stelt ter indicatie van de mate van interne netwerkvorming de H/Vratio voor. Middels een exploratief empirisch onderzoek wordt een en ander toegelicht

Absorptive Capacity: Antecedents, Models and Outcomes

This chapter focuses on the gap between the speed of proliferation of theoretical and empirical contributions and the speed of accumulation of the acquired scientific knowledge regarding absorptive capacity. To contribute to narrowing this gap, we will in particular review the conceptual developments of the absorptive capacity construct. Based on the seminal contributions of Cohen & Levinthal (1989, 1990) we will provide a brief overview of the various conceptual attributes of this construct, like the definition, antecedents and consequences, and levels of analysis involved. Next, we will assess the refinements, extensions and reconceptualizations of this construct in the literature. Furthermore, from the perspective of viewing models as mediating instruments between theory and empirical phenomena (Morgan and Morrison, 1999), we will analyze efforts to build conceptual models. Finally, we will address the progress made, select key problems and we will formulate future research directions to improve the multilevel and transdisciplinary characteristics of absorptive capacity

Reciprocity of Knowledge Flows in Internal Network Forms of Organizing

Fundamental changes in the competitive landscape triggered many firms to leverage and build competencies by focusing on transition processes towards internal network forms of organizing. These forms ameliorate exploration through knowledge creation and transfer. Internal networks are characterized by horizontal knowledge flows that supplement and supplant the vertical knowledge flows that characterize other organization forms like the functional and multi-divisional forms. As these horizontal knowledge flows facilitate knowledge integration, internal networks have an advantage over other organization forms in leveraging and building competencies. One characteristic that makes these horizontal knowledge flows work is the reciprocity ensuing them. Reciprocity relates to the interdependence and coordination modes that characterize internal networks. As reciprocity is influenced by managerial coordination, by the intention to deploy knowledge, and by goal attainment, creating and maintaining reciprocity of knowledge flows can be considered as a managerial competence. In this paper, the attributes of organization form that impact the reciprocity in a firm are explored from structural, managerial and knowledge perspectives. Hypotheses are developed which suggest that specialization and the use of formal meetings restrict reciprocity, whereas job rotation, the number of employees with a coordination function, and teams have a positive effect on the level of reciprocity. These hypotheses are tested by means of a questionnaire administered in a business unit of a multinational financial services firm. Reciprocity of knowledge flows was found to be dependent on the characteristics mentioned above in a predicted way. Since none of the hypotheses needed to be rejected, the evidence suggests that reciprocity is a fundamental feature of internal networks and the horizontal knowledge flows that characterize them. This suggests reciprocity to be an important managerial competence

Predicting deterioration of patients with early sepsis at the emergency department using continuous heart rate variability analysis:a model-based approach

Background: Sepsis is a life-threatening disease with an in-hospital mortality rate of approximately 20%. Physicians at the emergency department (ED) have to estimate the risk of deterioration in the coming hours or days and decide whether the patient should be admitted to the general ward, ICU or can be discharged. Current risk stratification tools are based on measurements of vital parameters at a single timepoint. Here, we performed a time, frequency, and trend analysis on continuous electrocardiograms (ECG) at the ED to try and predict deterioration of septic patients. Methods: Patients were connected to a mobile bedside monitor that continuously recorded ECG waveforms from triage at the ED up to 48 h. Patients were post-hoc stratified into three groups depending on the development of organ dysfunction: no organ dysfunction, stable organ dysfunction or progressive organ dysfunction (i.e., deterioration). Patients with de novo organ dysfunction and those admitted to the ICU or died were also stratified to the group of progressive organ dysfunction. Heart rate variability (HRV) features over time were compared between the three groups. Results: In total 171 unique ED visits with suspected sepsis were included between January 2017 and December 2018. HRV features were calculated over 5-min time windows and summarized into 3-h intervals for analysis. For each interval, the mean and slope of each feature was calculated. Of all analyzed features, the average of the NN-interval, ultra-low frequency, very low frequency, low frequency and total power were different between the groups at multiple points in time. Conclusions: We showed that continuous ECG recordings can be automatically analyzed and used to extract HRV features associated with clinical deterioration in sepsis. The predictive accuracy of our current model based on HRV features derived from the ECG only shows the potential of HRV measurements at the ED. Unlike other risk stratification tools employing multiple vital parameters this does not require manual calculation of the score and can be used on continuous data over time. Trial registration The protocol of this study is published by Quinten et al., 2017.</p

Prognostic value of serial score measurements of the national early warning score, the quick sequential organ failure assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis

BACKGROUND AND IMPORTANCE: Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy. OBJECTIVE: To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy. DESIGN: Post hoc analysis of prospectively collected data. SETTINGS AND PARTICIPANTS: This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included. OUTCOME MEASURES AND ANALYSIS: The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores. RESULTS: In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59-0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56-0.63) and SIRS (AUC, 0.59; 95% CI, 0.56-0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63-0.69) and 150 min after triage (0.64; 95% CI, 0.61-0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58-0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56-0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate. CONCLUSION: NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage

CTLA-4 Signaling Regulates the Intensity of Hypersensitivity Responses to Food Antigens, but is Not Decisive in the Induction of Sensitization

Although food allergy has emerged as a major health problem, the mechanisms that are decisive in the development of sensitization to dietary Ag remain largely unknown. CTLA-4 signaling negatively regulates immune activation, and may play a crucial role in preventing induction and/or progression of sensitization to food Ag. To elucidate the role of CTLA-4 signaling in responses to food allergens, a murine model of peanut allergy was used. During oral exposure to peanut protein extract (PPE) together with the mucosal adjuvant cholera toxin (CT), which induces peanut allergy, CTLA-4 ligation was prevented using a CTLA-4 mAb. Additionally, the effect of inhibition of the CTLA-4 pathway on oral exposure to PPE in the absence of CT, which leads to unresponsiveness to peanut Ag, was explored. During sensitization, anti-CTLA-4 treatment considerably enhanced IgE responses to PPE and the peanut allergens, Ara h 1, Ara h 3, and Ara h 6, resulting in elevated mast cell degranulation upon an oral challenge. Remarkably, antagonizing CTLA-4 during exposure to PPE in the absence of CT resulted in significant induction of Th2 cytokines and an elevation in total serum IgE levels, but failed to induce allergen-specific IgE responses and mast cell degranulation upon a PPE challenge. These results indicate that CTLA-4 signaling is not the crucial factor in preventing sensitization to food allergens, but plays a pivotal role in regulating the intensity of a food allergic sensitization response. Furthermore, these data indicate that a profoundly Th2-biased cytokine environment is insufficient to induce allergic responses against dietary Ag