14,664 research outputs found

    The ICD in heart failure - time for a rethink?

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    The importance of ‘goodness of fit’ between organizational culture and climate in the management of change: a case study in the development of online learning

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    This paper explores the nexus between organizational culture and organizational climate in the management of change by presenting a case study wherein an Australian regional university is currently undertaking the development of online courses. Important consideration is given to the complementary roles of culture and climate in managing organizational change. The single most important determinant of success is strong, committed senior management whose task is to articulate the organization's new vision and the manner in which it reshapes the organization's culture. At another level the climate of the organization as reflected in the systems that facilitate people's work (including policies, procedures, rewards and communication) must mesh with the new culture if organizational change is to proceed smoothly. This paper discusses the interactive nature of these two powerful organizational variables. The case study draws on the experiences of a school of academics acting as developers and deliverers of online initiatives and a number of concerns are raised that threaten the goodness of fit between the culture and climate of the organization. Policy issues requisite to the successful delivery of online courses are identified and discussed. The most contentious issue revolves around the question of ownership. Many academics, accustomed to exercising autonomy with respect to determining appropriate learning strategies, openly resisted the role the Information Technology department of the university assumed in making decisions that are often seen as having pedagogical overtones. To the extent that transactional issues such as these detract from the climate of the organization, they prevent academics from performing to their full potential. It is concluded that the climate of the organization, if properly managed, contributes to an enduring organizational culture which in turn is better able to deal with the inevitability of change and face the challenges that initiatives such as online education bring

    Information and Voting: the Wisdom of the Experts versus the Wisdom of the Masses

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    In a common-values election with continuously distributed information quality, the incentive to pool private information conflicts with the swing voters curse. In equilibrium, therefore, some citizens abstain despite clear private opinions, and others vote despite having arbitrarily many peers with superior information. The dichotomy between one's own and others' information quality can explain the otherwise puzzling empirical relationship between education and turnout, and suggests the importance of relative information variables in explaining turnout, which I verify for U.S. primary elections. Though voluntary elections fail to utilize nonvoters' information, mandatory elections actually do worse; e¤orts to motivate turnout may actually reduce welfare.

    Dementia-related adverse events in PARADIGM-HF and other trials in heart failure with reduced ejection fraction.

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    Aims: Inhibition of neprilysin, an enzyme degrading natriuretic and other vasoactive peptides, is beneficial in heart failure with reduced ejection fraction (HFrEF), as shown in PARADIGM-HF which compared the angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan with enalapril. As neprilysin is also one of many enzymes clearing amyloid-β peptides from the brain, there is a theoretical concern about the long-term effects of sacubitril/valsartan on cognition. Therefore, we have examined dementia-related adverse effects (AEs) in PARADIGM-HF and placed these findings in the context of other recently conducted HFrEF trials. Methods and results: In PARADIGM-HF, patients with symptomatic HFrEF were randomized to sacubitril/valsartan 97/103 mg b.i.d. or enalapril 10 mg b.i.d. in a 1:1 ratio. We systematically searched AE reports, coded using the Medical Dictionary for Regulatory Activities (MedDRA), using Standardized MedDRA Queries (SMQs) with ‘broad’ and ‘narrow’ preferred terms related to dementia. In PARADIGM-HF, 8399 patients aged 18–96 years were randomized and followed for a median of 2.25 years (up to 4.3 years). The narrow SMQ search identified 27 dementia-related AEs: 15 (0.36%) on enalapril and 12 (0.29%) on sacubitril/valsartan [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.33–1.59]. The broad search identified 97 (2.30%) and 104 (2.48%) AEs (HR 1.01, 95% CI 0.75–1.37), respectively. The rates of dementia-related AEs in both treatment groups in PARADIGM-HF were similar to those in three other recent trials in HFrEF. Conclusion: We found no evidence that sacubitril/valsartan, compared with enalapril, increased dementia-related AEs, although longer follow-up may be necessary to detect such a signal and more sensitive tools are needed to detect lesser degrees of cognitive impairment. Further studies to address this question are warranted
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