METHODS FOR IMPLEMENTING STRATEGIC PLANNING

The process of turning strategies and plans into actions in order to achieve strategic objectives and goals is known as implementation. A strategic plan's critical steps transform it from a document on the shelf to action that propels business success. Unfortunately, the majority of businesses that have strategic plans fail to put them into action. However, this is only a plan; it does not guarantee that the desired performance will be achieved, any more than having a roadmap guarantees that the traveler will arrive at the target location. The truth is that both components are necessary for success. In fact, if done correctly, companies can acquire a competitive advantage through deployment. In the parts that follow, you'll learn how to receive help for your whole implementation strategy as well as how to prevent some frequent blunders. While defining a plan is an important initial step in implementing organisational change, the implementation process is equally important. If the implementation process is inefficient, even the best-laid plans may not come to fruition. The first step in the process is simple: you must determine the objectives that the new strategy should achieve. It can be tough to create a plan for getting there if you don't have a clear vision of what you want to achieve

Sub-threshold spinal cord stimulation facilitates spontaneous motor activity in spinal rats

BACKGROUND: Epidural stimulation of the spinal cord can be used to enable stepping on a treadmill (electrical enabling motor control, eEmc) after a complete mid-thoracic spinal cord transection in adult rats. Herein we have studied the effects of eEmc using a sub-threshold intensity of stimulation combined with spontaneous load-bearing proprioception to facilitate hindlimb stepping and standing during daily cage activity in paralyzed rats. METHODS: We hypothesized that eEmc combined with spontaneous cage activity would greatly increase the frequency and level of activation of the locomotor circuits in paralyzed rats. Spontaneous cage activity was recorded using a specially designed swivel connector to record EMG signals and an IR based camcorder to record video. RESULTS AND CONCLUSION: The spinal rats initially were very lethargic in their cages showing little movement. Without eEmc, the rats remained rather inactive with the torso rarely being elevated from the cage floor. When the rats used their forelimbs to move, the hindlimbs were extended and dragged behind with little or no flexion. In contrast, with eEmc the rats were highly active and the hindlimbs showed robust alternating flexion and extension resulting in step-like movements during forelimb-facilitated locomotion and often would stand using the sides of the cages as support. The mean and summed integrated EMG levels in both a hindlimb flexor and extensor muscle were higher with than without eEmc. These data suggest that eEmc, in combination with the associated proprioceptive input, can modulate the spinal networks to significantly amplify the amount and robustness of spontaneous motor activity in paralyzed rats

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Significance of customer experience in fast food industry

This piece of study is to understand the significance of customer experience in the fast food industry. In this study the researcher has developed on customer experience in general and in fast food business, various elements involved in fast food experiential delivery and indirect or influencing factors that affect the overall journey of customer experience. Later the study has the analysis of the collected survey data which is followed by an explanation, to what extent customer experience is significant. The participants were asked in questions in a survey regarding their references. The researcher finds answers to questions such as tangible and intangible aspects that are involved in customer experience, second is the pre and post dining factors that influencing the whole customer experiential journey and lastly, effects of customer experience in buying behavior. All these questions have been observed in order to the understand their value that is being held by the participants

Multi-site spinal stimulation strategies to enhance locomotion after paralysis

Los sentidos sobre los cuerpos se construyen social e históricamente. Los cuerpos humanos son cuerpos sexuados (De Lauretis, 1996; Butler, 2002), lugares de constantes apropiaciones y reapropiaciones, constitutivos de nuestra subjetividad. La relación de las mujeres con sus cuerpos ha sido de extrañamiento: los cuerpos, y las sexualidades, fueron definidos heterónomamente por el colectivo de varones, por el Estado y por la(s) iglesia(s), intentando transformar los cuerpos femeninos en "cuerpos dóciles" (Foucault, 2011) al servicio de los intereses patriarcales -y capitalistas- (Federici, 2010). Las decisiones sobre el propio cuerpo y el control de la propia sexualidad son de las demandas más fuertes de los distintos colectivos de mujeres y feministas desde los años setenta (Weeks, 2012; Bellucci, 2014; Lonzi, 2017; Gutiérrez, 2007). En el marco de una organización social patriarcal, esta posibilidad de decisión se les expropia a las mujeres, por ejemplo, a través de la prohibición del aborto que existe en la inmensa mayoría de los países latinoamericanos (Campagnoli, 2007; Silva y Llaja, 2017) y/o la extendida impunidad que existe ante casos de violencias contra las mujeres (RDM-CIDH, 2007), y particularmente ante casos de violencia sexual. El discurso jurídico, como producto del campo jurídico, trasciende los hechos lingüísticos para convertirse en un conjunto de prácticas (Costa, 2016) que legitiman, autorizan y resignifican otros discursos sociales, políticos y culturales. Las sentencias son tanto producto del discurso jurídico como productoras del mismo. En ese sentido, las sentencias judiciales en torno a los derechos sexuales, reproductivos y (no) reproductivos (Brown, 2014) constituyen a su vez un poderoso discurso social que crea y refuerza los mandatos de género (Hunter, McGlynn, Rackley, 2010), o que puede subvertirlos. En este marco, la investigación desarrollada para mi tesis doctoral, se propone analizar los sentidos sobre los cuerpos y sexualidades de las mujeres que son construidos en las sentencias judiciales que abordan casos relativos a los derechos sexuales, reproductivos y (no) reproductivos -especialmente sentencias sobre violación y aborto- en el periodo 2012-2017.Universidad Nacional de La Plat