bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of supply chain management practices on customer development and start-up performance
Authors: Amedofu Mawuli , Asamoah David , Agyei-Owusu Benjamin
Published: July 2019

Purpose

The number of entrepreneurial start-ups operating in developing countries has grown tremendously in recent years. However, research suggests that most start-ups in developing countries fail shortly after becoming operational. The purpose of this paper explores how supply chain management (SCM) practices may enhance the performance of start-ups in developing countries.

Design/methodology/approach

The study develops and empirically tests a research model which explores the effect of SCM practices on customer development and start-up performance. A survey of 300 start-ups operating in Ghana was conducted, with 72 usable responses obtained. The research model was analyzed using partial least squares structural equation modeling.

Findings

The results confirmed the positive impact of SCM practices on customer development and start-up performance. Customer development was also found to positively impact start-up performance. Additionally, a partial mediation role of customer development on relationship between SCM practices and start-up performance was observed.

Originality/value

To the best of the researchers’ knowledge, this is the first study that empirically explores the effects of SCM practices on the performance of start-ups. This is also the first study that examines the effect of SCM practices on customer development to the best of the researchers’ knowledge.
Top management characteristics and intellectual capital performance in small Italian companies
Authors: Ginesti Gianluca
Published: July 2019

Purpose

This study aims to explore the relationship between top management characteristics and intellectual capital (IC) performance of small companies.

Design/methodology/approach

This research offers an empirical investigation into a unique sample of 135 small Italian companies, which have been recognised as meeting legal values. This study uses a regression analysis to test whether CEO age, CEO connections and management team size affect IC performance.

Findings

Companies managed by CEOs with higher levels of connections and with a greater number of managers exhibit improved IC performance. In addition, this study provides evidence that companies with older CEOs demonstrate better IC efficiency.

Research limitations/implications

This study does not consider all top management-specific factors and incentives that may affect IC performance and uses a limited sample of companies.

Practical implications

This study suggests that increased network activity and larger management teams are beneficial for small companies to improve the efficiency of IC used.

Originality/value

The work offers novel empirical evidence to understand what governance and management-specific factors affect the efficiency in managing IC assets in small companies.
Competitive intelligence practice in liquor retailing: evidence from a longitudinal case analysis
Authors: Priporas Constantinos Vasilios
Published: July 2019

Purpose

Competitive intelligence (CI) is a vital tool for any company to survive and remain competitive in today’s hypercompetitive and uncertain business environment. The purpose of this paper is to investigate the use of CI in liquor retailing in the USA.

Design/methodology/approach

An exploratory single longitudinal case study was performed through observation and semi-structured interviews plus examining documents from secondary sources in two phases. Content analysis was used for the data analysis.

Findings

Regardless of the small size of the company, the owner has an active attitude toward monitoring competition by using various sources of information and converting it into intelligence for making sound decisions for both short-term and long-term competitiveness. Also, the central role of the owner in the CI process has been verified.

Originality/value

This study responds to calls for more case studies in the field and is the first one to explore CI in the liquor retailing ecosystem by using a longitudinal case study. In general, studies of CI in retailing are limited. It has clear value to CI practices for retailers in the USA and in general.
University students’ perceptions of their abilities relate to their entrepreneurial intent
Authors: Räty Hannu , Komulainen Katri , Hytti Ulla , Kasanen Kati , Siivonen Päivi , Kozlinska Inna
Published: July 2019

Purpose

The purpose of this paper is to examine to what extent Finnish university students endorse entrepreneurial intent and the ways in which they position themselves in relation to entrepreneurship according to their self-perceived abilities or “ability self”.

Design/methodology/approach

The study was conducted by means of an e-survey, and the participants comprised the sample of students (n=1,819) from two Finnish universities, representing diverse fields of study.

Findings

It was found that a great majority of the students showed a relatively low intent to become an entrepreneur. The perception of abilities, such as innovativeness and ambitiousness-competitiveness, was positively related with entrepreneurial intent, whereas the perception of academic abilities and “conventional” employee skills indicated inverse associations.

Social implications

The findings suggest that in terms of self-perceived abilities, entrepreneurship in an academic context is perceived as a rather restricted category to which only a few specific individuals have access. Accordingly, there is a certain tension between the tenets of entrepreneurship and corresponding abilities, and the ethos of universities and related high-valued abilities such as theoreticality and criticality.

Originality/value

Although employability and entrepreneur intent have been widely studied, little is known about students’ identification with entrepreneurship according to their ability perceptions. The present study contributes to the existing body of knowledge on university students’ “internal employability” that involves students’ self-assurance and views of work-related relevance with regard to supposed abilities.
The relational model of entrepreneurship and knowledge management toward innovation, strategy implementation and improving Islamic boarding school performance
Authors: Rofiaty Rofiaty
Published: July 2019

Purpose

The influence of entrepreneurial orientation and knowledge management on innovation, the influence of knowledge management on the implementation of strategies and the influence of entrepreneurial orientation, knowledge management, innovation, implementation of strategies to organizational performance, where the organization referred to is an Islamic boarding school.

Design/methodology/approach

This research applied quantitative causal design and was an explanatory research. It was conducted at an Islamic boarding school in Malang in the period of April to December 2017. The population of this study included the managers of the pesantren, teachers and employee representatives making strategic decisions. The unit of analysis in this study consisted of Pondok Pesantren Ar Rohmah Putra, Pondok Pesantren Ar Rohmah Putri, Pondok Pesantren Al Izzah, Tazkiyah IIBS, Pondok Pesantren Darul Maghfirroh, Pondok Pesantren An Nur Putra, Pondok Pesantren An Nur Putri, PSBB MAN 3 Malang, Pondok Pesantren Ar Rifa’i Putra and Pondok Pesantren Ar Rifa’i Putri.

Findings

First, entrepreneurial orientation and knowledge management have a significant and positive impact on the improvement of innovation. This means that the higher the entrepreneurial orientation and knowledge management by Islamic boarding schools, the better the innovation in business competitiveness. Second, knowledge management positively affects the strategy implementation. This means the better the knowledge management, the better the strategy implementation of within the framework of business competitiveness of Islamic boarding schools. Third, entrepreneurial orientation, knowledge management and strategy implementation have a significant effect on the improvement of performance of Islamic boarding schools. The higher the entrepreneurial orientation, knowledge management and strategy implementation, the better will be the performance of Islamic boarding schools.

Originality/value

This study is one of the few studies that examine the influence of entrepreneurial orientation, knowledge management on innovation, implementation of strategies and the impact on organizational performance.
Sensitivity and reliability evaluation for a thermal power plant subject to complex failures and human error
Authors: Kumar Amit
Published: July 2019

Purpose

The purpose of this paper is to analyze a thermal power plant (TPP) by taking into consideration its key components, namely, boiler, turbine, conveyor and generator, which are handled by a human operator. It is well known fact that the continuous power generation through a power plant depends on the reliability/availability of its components.

Design/methodology/approach

The various performance measures of a TPP are obtained by using mathematical modeling, Markov process and supplementary variable technique.

Findings

Reliability, i.e. mean time to failure with respect to different components of a TPP, has been obtained and demonstrated with the help of graphs. Critical components of the system are identified through sensitivity analysis.

Originality/value

In the present paper, a mathematical model based on the functioning of a TPP has been developed. Conclusions in this paper are good references for the design of a TPP.
Nest structure affects auditory and visual detectability, but not predation risk, in a tropical songbird community
Authors: Mouton James C. , Martin Thomas E.
Published: July 2019

Offspring mortality varies dramatically among species with critical demographic and evolutionary ramifications, yet the causes of this variation remain unclear. Nests are widely used for breeding across taxa and thought to influence offspring mortality risk. Traditionally, more complex, enclosed nest structures are thought to reduce offspring predation by reducing the visibility of nest contents and muffling offspring sounds compared to open nests. Direct tests of the functional bases for nest structure influence on predation risk are lacking.

We used experiments and 10 years of observational data to examine how nest structure influences nest predation risk in a diverse community of tropical songbirds. First, we examined how nest size was related to nest structure and nest predation rates across species. Second, we assessed how nest structure influences the detectability of nestling begging calls both in field and in laboratory settings. Finally, we examined how the acoustic properties of different nest structures influence nest predation risk. Specifically, we experimentally broadcast begging calls from open and enclosed nests to determine how auditory cues and nest structure interact to affect predation on plasticine and quail eggs. We also tested whether nest structure was associated with differences in nest predation rates between the incubation (no begging cues) and nestling (begging cues) stages.

We found that enclosed nests are larger than open nests after accounting for adult size, and larger nests had increased predation rates. Moreover, enclosed nests did not consistently alter nestling begging calls in ways that reduce the likelihood of predation compared to open nests. Indeed, begging cues increased predation rates for enclosed but not open‐cup nests in our playback experiment, and nest predation rates showed greater increases after hatching in enclosed than open‐cup nests.

Ultimately, enclosed nests do not necessarily provide greater predation benefits than open nests in contrast to long‐standing theory.

A free plain language summary can be found within the Supporting Information of this article.
Phenotypic plasticity or evolutionary change? An examination of the phenological response of an arctic seabird to climate change
Authors: Sauve Drew , Divoky George , Friesen Vicki L.
Published: July 2019

Phenological adjustments are an important aspect of a population's response to climate change. Changes in phenology can occur through either individual plasticity or evolutionary change within populations. Few studies have investigated both these processes in Arctic environments.

Using 42 years of individual and pedigree data, we evaluated the contribution of plasticity and evolution to variation in breeding phenology at a colony of a high Arctic sea‐ice obligate seabird, Mandt's black guillemot (Cepphus grylle mandtii). Mean clutch initiation (first egg in a clutch) advanced 7.8 days, and both environmental (snowmelt) and demographic (years of breeding experience) factors varied among years.

Earlier phenology was associated with earlier snowmelt and experienced mothers. Females advanced phenology at different rates as they aged but at similar rates in response to variation in snowmelt. Heritability of clutch initiation was negligible, and there was no evidence of evolution contributing to phenological changes.

Earlier laying was associated with increased annual number of fledglings and annual adult survival at the individual level suggesting that the phenological changes are adaptive and are driven by phenotypic plasticity, but not genetic responses.

We propose that species with a constrained breeding season (like many Arctic species) may have a limited ability beyond existing plasticity to respond to changing environmental conditions.

A free Plain Language Summary can be found within the Supporting Information of this article.
Percutaneous vs surgical emergency cricothyroidotomy: An experimental randomized crossover study on an animal‐larynx model
Authors: Andresen Åke Erling L. , Kramer‐Johansen Jo , Kristiansen Thomas
Published: July 2019

Background

Airway management is a paramount clinical skill for the anaesthesiologist. The Emergency Cricothyroidotomy (EC) constitutes the final step in difficult airway algorithms securing a patent airway via a front‐of‐neck access. The main distinction among available techniques is whether the procedure is surgical and scalpel‐based or percutaneous and needle‐based.

Methods

In an experimental randomized crossover trial, using an animal larynx model, we compared two EC techniques; the Rapid Four Step Technique and the Melker Emergency Cricothyrotomy Kit®. We assessed time expenditure and success rates among 20 anaesthesiologists and related this to previous training, seniority and clinical experience with EC.

Results

All participants achieved successful airway access with both methods. Average time to successful airway access for scalpel‐based EC was 54 (±31) seconds and for percutaneous EC 89 (±38) seconds, with 35 (95% CI: 14‐57) seconds time difference, P = .003. Doctors with recent (<12 months) EC training performed better compared to the non‐training group (37 vs 61 seconds, P = .03 for scalpel‐based EC, and 65 vs 99 seconds, P = .02 for percutaneous EC). We found no differences according to clinical seniority or previous real‐life EC experience.

Conclusions

Our study demonstrated that anaesthesiologists achieved successful airway access on an animal experimental model with both EC methods within a reasonable time frame, but the scalpel‐based EC is performed more promptly. Recent EC training affected the time expenditure positively, while seniority and clinical EC experience did not. EC procedures should be regularly trained for.
Toward an Integrated Anthropology of Infant Sleep
Authors: Ball Helen L. , Tomori Cecilia , McKenna James J.
Published: July 2019

This article provides a novel synthesis of anthropological research on infant sleep, focusing on work in biological and sociocultural anthropology in the past decade. First, we briefly review early biological anthropological research into infant sleep from 1987 to 2007, which provided the evidence base for the argument that proximate parent–infant sleep combined with lactation represents a complex set of adaptations that constitute the human evolutionary norm. This work challenged the Western pediatric infant sleep research paradigm, which positioned formula‐ or bottle‐fed solitary sleeping infants as the basis for research and universal models about human infant sleep. Next, we address how recent research has built on these foundations and extended anthropological insights into new aspects of infant sleep. Biological anthropologists, who continue to lead this research, have advanced into the hormonal and behavioral ecology of parent–infant sleep and trade‐offs in nighttime care and parent–infant conflict. Moreover, they have made significant progress in translating anthropological research into policy and practice in clinical and health delivery settings. Until recently, sociocultural anthropology has primarily addressed infant sleep as part of broader endeavors, without an explicit focus on infant sleep. We highlight key ethnographic works that shed light on the cultural normalcy and interembodied experience of shared maternal–infant sleep with breastfeeding that help de‐center Western discourses of infant sleep. We conclude by discussing future research agendas to forward an integrated anthropology of human infant sleep that considers its full biological and sociocultural context. Integrated anthropological approaches to infant sleep not only present a path forward for novel cross‐subfield anthropological research but could help guide more effective and equitable approaches to maternal‐infant health. [nighttime care, parenting, infancy, sleep]
Effects of leukocyte‐ and platelet‐rich fibrin associated or not with bovine bone graft on the healing of bone defects in rats with osteoporosis induced by ovariectomy
Authors: Engler‐Pinto Ana , Siéssere Selma , Calefi Ana , Oliveira Luiz , Ervolino Edilson , de Souza Sérgio , Furlaneto Flávia , Messora Michel Reis
Published: July 2019

Objective

To evaluate the healing of critical size defects (CSDs) in calvaria of rats with osteoporosis induced by ovariectomy and treated with leukocyte‐ and platelet‐rich fibrin (L‐PRF) associated or not with bovine bone graft (XENO).

Material and Methods

A total of 32 rats underwent a bilateral ovariectomy procedure. After 3 months, one 5 mm in diameter CSD was created in the middle of the calvaria of each animal. In group C, defect was filled with blood clot only. In PRF, XENO, and PRF‐XENO groups, defects were filled with 0.1 ml of L‐PRF, 0.1 ml of XENO, and a mixture of 0.1 ml of L‐PRF plus 0.1 ml of XENO, respectively. L‐PRF compressed clots were used to cover the defects in PRF and PRF‐XENO groups. Animals were submitted to euthanasia at 30 postoperative days. Histomorphometric, microtomographic, and immunohistochemical analyses were performed.

Results

PRF‐XENO group presented greater amount of neoformed bone (NB) when compared with XENO group, as well as higher expression of vascular endothelial growth factor (VEGF), osteocalcin (OCN), and bone morphogenetic protein (BMP‐2/4) (p < .05). PRF group presented increased amount of NB and higher expression of VEGF, OCN, BMP‐2/4, and Runt‐related transcription factor 2 (RUNX‐2) when compared with group C (p < .05).

Conclusions

(a) The isolated use of L‐PRF clot can improve bone neoformation in CSDs in rats with osteoporosis induced by ovariectomy, but seems to lead to decreased amount of bone neoformation when compared to the isolated use of XENO; (b) L‐PRF potentiates the healing of XENO in rats with osteoporosis induced by ovariectomy.
Local Political Consolidation in Bangladesh: Power, Informality and Patronage
Authors: Lewis David , Hossain Abul
Published: July 2019

During the past decade Bangladesh has shifted from a competitively clientelistic two‐party system towards a dominant‐party democracy. This article analyses how the ruling party has consolidated partisan political control at the local level. Using qualitative field data from 2004 and 2016, and drawing on a post‐structural analysis of the state, it shows how this extension of power has been achieved locally through interaction between formal and informal political initiatives. Four main types of informal activity are documented, through which the extent of local political competition has been reduced: circumvention, capture, brokerage and the creation of new organizations. These insights into the changing nature of Bangladesh's long‐standing partisan politics highlight how the state's capacity to deliver local services, allocate resources and maintain stability has been enhanced through the ruling party's control of local government structures, its elimination of political opposition, and its reshaping of local patronage arrangements.
Determination and prediction of the appropriate depth of right internal jugular vein catheterization via the middle approach in adults using transesophageal echocardiography
Authors: Ju Hui , Sun Xiaochen , Feng Yi
Published: July 2019

Purpose

The appropriate depth of right internal jugular venous (RIJV) catheterization is still under debated. In this study, transesophageal echocardiography (TEE) is used to develop a prediction formula for fixed RIJV catheter depth.

Methods

Eighty patients with indications for intraoperative TEE and central line placement were enrolled. After intubation, a RIJV catheter was inserted via the middle approach using the Seldinger technique. When the J‐tip of the guide wire appeared at the junction of the superior vena cava and the right atrium under TEE guidance, the guide wire was pulled back by approximately 2‐3 cm, until its tip was out of the pericardial fold. This depth was regarded as the insertion depth of the central venous catheter. Body landmark distance was measured, and the prediction formula was generated.

Results

The mean central line depth after TEE‐guided placement was 15.1 ± 1.7 cm. The prediction formula developed is as follows: Insertion depth = (Height ÷ 20) + (D ÷ 2), where D equals the distance from the insertion point to the sternal angle via the right sternoclavicular joint (r = 0.595, r2 = 0.354, P < 0.01).

Conclusions

TEE is an effective method for determining the appropriate insertion depth for an RIJV catheter. The prediction formula can be used as a reference for future RIJV catheterizations via the middle approach.
High‐affinity multivalent interactions between apolipoprotein E and the oligomers of amyloid‐β
Authors: Ghosh Shamasree , Sil Timir Baran , Dolai Subhrajyoti , Garai Kanchan
Published: July 2019

Although the interaction of apoE isoforms with amyloid‐β (Aβ) peptides plays a critical role in the progression of Alzheimer's disease, how they interact with each other remains poorly understood. Here, we investigate the molecular mechanism of apoE‐Aβ interactions by comparing the effects of the different domains of apoE on Aβ. The kinetics of aggregation of Aβ1‐42 are delayed dramatically in the presence of substoichiometric, nanomolar concentrations of N‐terminal fragment (NTF), C‐terminal fragment (CTF) and full‐length apoE both in lipid‐free and in lipidated forms. However, interactions between apoE and Aβ as measured by intermolecular Förster resonance energy transfer (FRET) analysis were found to be minimal at t = 0 but to increase in a time‐dependent manner. Thus, apoE must interact with one or more ‘intermediates’ rather than the monomers of Aβ. Kinetics of FRET between full‐length apoE4 labelled with EDANS at position 62 or 139 or 210 or 247 or 276, and tetramethylrhodamine‐labelled Aβ (TMR‐Aβ), further support an involvement of all the three domains of apoE in the interactions. However, the above‐mentioned residues do not appear to form a single pocket in the 3‐dimensional structure of apoE. A competitive binding assay examining the effects of unlabelled fragments or full‐length apoE on the FRET between EDANS‐apoE and TMR‐Aβ show that binding affinity of the full‐length apoE to Aβ is much higher than that of the fragments. Furthermore, apoE4 is found to interact more strongly than apoE3. We hypothesize that high affinity of the apoE‐Aβ interaction is attained due to multivalent binding mediated by multiple interactions between oligomeric Aβ and full‐length apoE.
Interaction of N‐acetyl‐l‐glutamate kinase with the PII signal transducer in the non‐photosynthetic alga Polytomella parva: Co‐evolution towards a hetero‐oligomeric enzyme
Authors: Selim Khaled A. , Lapina Tatyana , Forchhammer Karl , Ermilova Elena
Published: July 2019

During evolution, several algae and plants became heterotrophic and lost photosynthesis; however, in most cases, a nonphotosynthetic plastid was maintained. Among these organisms, the colourless alga Polytomella parva is a special case, as its plastid is devoid of any DNA, but is maintained for specific metabolic tasks carried out by nuclear encoded enzymes. This makes P. parva attractive to study molecular events underlying the transition from autotrophic to heterotrophic lifestyle. Here we characterize metabolic adaptation strategies of P. parva in comparison to the closely related photosynthetic alga Chlamydomonas reinhardtii with a focus on the role of plastid‐localized PII signalling protein. Polytomella parva accumulates significantly higher amounts of most TCA cycle intermediates as well as glutamate, aspartate and arginine, the latter being specific for the colourless plastid. Correlating with the altered metabolite status, the carbon/nitrogen sensory PII signalling protein and its regulatory target N‐acetyl‐l‐glutamate‐kinase (NAGK; the controlling enzyme of arginine biosynthesis) show unique features: They have co‐evolved into a stable hetero‐oligomeric complex, irrespective of effector molecules. The PII signalling protein, so far known as a transiently interacting signalling protein, appears as a permanent subunit of the enzyme NAGK. NAGK requires PII to properly sense the feedback inhibitor arginine, and moreover, PII tunes arginine‐inhibition in response to glutamine. No other PII effector molecules interfere, indicating that the PII‐NAGK system in P. parva has lost the ability to estimate the cellular energy and carbon status but has specialized to provide an entirely glutamine‐dependent arginine feedback control, highlighting the evolutionary plasticity of PII signalling system.
Biophysical characterization and single‐chain Fv construction of a neutralizing antibody to measles virus
Authors: Tadokoro Takashi , Jahan Mst Lubna , Ito Yuri , Tahara Maino , Chen Surui , Imai Atsutoshi , Sugimura Natsumi , Yoshida Koki , Saito Mizuki , Ose Toyoyuki , Hashiguchi Takao , Takeda Makoto , Fukuhara Hideo , Maenaka Katsumi
Published: July 2019

The measles virus (MV) is a major cause of childhood morbidity and mortality worldwide. We previously established a mouse monoclonal antibody, 2F4, which shows high neutralizing titers against eight different genotypes of MV. However, the molecular basis for the neutralizing activity of the 2F4 antibody remains incompletely understood. Here, we have evaluated the binding characteristics of a Fab fragment of the 2F4 antibody. Using the MV infectious assay, we demonstrated that 2F4 Fab inhibits viral entry via either of two cellular receptors, SLAM and Nectin4. Surface plasmon resonance (SPR) analysis of recombinant proteins indicated that 2F4 Fab interacts with MV hemagglutinin (MV‐H) with a KD value at the nm level. Furthermore, we designed a single‐chain Fv fragment of 2F4 antibody as another potential biopharmaceutical to target measles. The stable 2F4 scFv was successfully prepared by the refolding method and shown to interact with MV‐H at the μm level. Like 2F4 Fab, scFv inhibited receptor binding and viral entry. This indicates that 2F4 mAb uses the receptor‐binding site and/or a neighboring region as an epitope with high affinity. These results provide insight into the neutralizing activity and potential therapeutic use of antibody fragments for MV infection.
A practical method for fatigue limit prediction in ductile cast irons
Authors: Endo Masahiro , Matsuo Takashi
Published: July 2019

A simple, reasonably accurate method was proposed for fatigue limit prediction in ductile cast irons (DCIs) containing small defects, employing an easy‐to‐use prediction equation. A technique was also presented for the estimation of the statistical effects of complex structural discontinuities, as characterized by graphite and casting defects. The validity of these approaches was confirmed by the experimental results obtained via rotating‐bending fatigue tests on six DCIs, with varying distributions of graphite nodule size and different matrix structures.
Conservation of spawning time between years in lumpfish Cyclopterus lumpus and potential impacts from the temporal distribution of fishing effort
Authors: Kennedy James , Ólafsson Halldór G.
Published: July 2019

Lumpfish, Cyclopterus lumpus L., has an extended ovary development period and a relatively long spawning season. It therefore seems unlikely that individuals spawning later in the season would be able to recover from spawning and develop their gonads in time to spawn during the early part of the season the following year. The hypothesis that individuals spawning early or late in a spawning season would spawn early or late the following year was tested using fish tagged in Iceland between 2008 and 2017. The tagging date and recapture date the following year were positively correlated with an average of 356 days at large (DAL). Fish sampled from the fishery indicate that tagging/recapture date gives an indication of spawning time. From this, it was concluded that spawning time in the current year can be used to predict spawning time the following year. As fishing effort was greatest at the end of April/beginning of May, it seems likely that fish that come to spawn at this time will be subject to a higher fishing mortality. Therefore, they will be less likely to spawn successfully than fish spawning earlier or later in the year. If spawning time is under genetic control, then this could have consequences for the spawning phenology of lumpfish.
“I Desire to Suffer, Lord, because Thou didst Suffer”: Teresa of Avila on Suffering
Authors: Bueno‐Gómez Noelia
Published: July 2019

Teresa of Avila's desire for suffering cannot be interpreted as the mere passive assumption of a feminine sacrificial role. On the contrary, Teresa was able to transform her suffering into the incarnated performance of her relationship with God: By desiring suffering and by understanding it and her ability to confront it as proof of divine love, she was able to reinforce her self‐confidence and strength. This article discusses Teresa of Avila's experience and interpretation of suffering in the context of the female ascetic‐mystic Christian tradition. It criticizes Teresa's positive conceptualization of suffering but examines in depth the potential of her ability to actively manage and control it. Although Teresa was able to affirm her personality through ascetic practices such as self‐humiliation and mortification, the general applicability of such practices to the management of suffering is fraught since they leave the suffering individual in a vulnerable position. Although Teresa of Avila finds fulfillment and, paradoxically, self‐actualization through self‐denial and the surrender of her will, such practices entail the substantial risk of total self‐annihilation.
Barriers to pharmacist prescribing: a scoping review comparing the UK, New Zealand, Canadian and Australian experiences
Authors: Zhou Mingming , Desborough Jane , Parkinson Anne , Douglas Kirsty , McDonald David , Boom Katja
Published: July 2019

Objectives

Non-medical prescribers, including pharmacists, have been found to achieve comparable clinical outcomes with doctors for certain health conditions. Legislation supporting pharmacist prescribing (PP) has been implemented in the United Kingdom (UK), Canada and New Zealand (NZ); however, to date, Australian pharmacists have not been extended prescribing rights. The purpose of this review was to describe the barriers to PP found in the literature from the UK, Canada, NZ and Australia, and examine the implications of these for the development of PP in Australia.

Methods

We conducted a scoping review, which included peer-reviewed and grey literature, and consultation with stakeholders. Sources – Scopus, PubMed and CINAHL; Google Scholar, OpenGrey and organisational websites from January 2003 to March 2018 in the UK, Canada, NZ and Australia. Inclusion criteria – articles published in English, related to implementation of PP and articulated barriers to PP.

Key findings

Of 863 unique records, 120 were reviewed and 64 articles were eligible for inclusion. Three key themes emerged: (1) Socio-political context, (2) Resourcing issues and (3) Prescriber competence. The most common barriers were inadequate training regarding diagnostic knowledge and skills, inadequate support from authorities and stakeholders, and insufficient funding/reimbursement.

Conclusions

If implementation of PP is to occur, attention needs to be focused on addressing identified barriers to PP implementation, including fostering a favourable socio-political context and prescriber competence. As such, a concerted effort is required to develop clear policy pathways, including targeted training courses, raising stakeholder recognition of PP and identifying specific funding, infrastructure and resourcing needs to ensure the smooth integration of pharmacist prescribers within interprofessional clinical teams.
Evaluating recruitment methods of patients with advanced cancer: a pragmatic opportunistic comparison
Authors: Edwards Zoe , Bennett Michael I , Petty Duncan , Blenkinsopp Alison
Published: July 2019

Background

Recruitment of patients with advanced cancer into studies is challenging.

Objective

To evaluate recruitment methods in a study of pharmacist-led cancer pain medicine consultations and produce recommendations for future studies.

Method

Two methods of recruitment were employed: (1) community-based (general practitioner computer search, identification by general practitioner, community pharmacist or district nurse and hospital outpatient list search) and (2) hospice-based (in and outpatient list search). Patients identified in method 1 were invited by post and in method 2 were invited face-to-face. Information was designed in collaboration with patients and carers.

Results

A total of 128 patients were identified (85 from the community and 43 from the hospice), and 47 met the inclusion criteria. Twenty-three agreed to take part and 19 completed the study, 17 of whom were already under specialist palliative care. Recruitment rates were 7% for community-based methods and 40% for hospice. The recruitment methods differed in intensity of resource use. Recruitment via letter and a lack of engagement by healthcare professionals were found to be barriers. Facilitators included the researcher having personal involvement in recruitment.

Conclusion

The overall recruitment rate was in line with other studies for this patient cohort. Attempts to identify and engage patients through community-based postal contact were less effective than where personal contact with patients was both possible and occurred. Methods were less successful at recruiting patients who were not already engaged with hospice services.
Inequality of opportunity and (unequal) opportunities in the youth labour market: How is the Arab world different?
Authors: DIMOVA Ralitza , STEPHAN Karim
Published: July 2019

The Middle East and North Africa (MENA) labour market is emblematic of widespread youth unemployment and high discouragement rates, experiencing disproportionately high levels of unemployment among educated young people. Using ILO School‐to‐Work Transition Surveys for Egypt, Jordan and Tunisia, the authors explore whether this is related to inequality of opportunity or to deeper structural characteristics that create a mismatch between skill demand and supply on the labour market. The low availability of high‐skilled jobs and the low value placed on skills gained through the system of vocational training are found to have high explanatory power.
Risk of malignancy in patients with psoriasis: a 15‐year nationwide population‐based prospective cohort study in Korea
Authors: Lee J.W. , Jung K.J. , Kim T.G. , Lee M. , Oh J. , Jee S.H. , Lee M.G.
Published: July 2019

Background

The association between psoriasis and risk of malignancy has not been thoroughly evaluated in a large longitudinal cohort of Asian population.

Objective

To determine the long‐term risk of malignancy in Korean adult patients with psoriasis.

Methods

We conducted a nationwide population‐based prospective cohort study with a 15‐year observational period. During the baseline period (1997–2000), total 1 773 786 Korean subjects who received health insurance from the National Health Insurance System were enrolled and 5788 subjects were defined as a psoriasis group. The number of new‐onset malignancy was collected during the observational period (2001–2015).

Results

Patients with psoriasis had a higher adjusted hazard ratio (aHR) for development of overall malignancy [aHR 1.08, 95% confidence interval (CI) 1.00–1.18] and gastric cancer (aHR 1.31, 95% CI 1.08–1.58) compared to controls. The risks of non‐Hodgkin lymphoma and non‐melanoma skin cancer were significantly increased only in patients with psoriasis who received systemic treatments (aHR 2.86, 95% CI 1.07–7.61 and aHR 3.93, 95% CI 1.47–10.47, respectively).

Conclusion

Psoriasis is associated with long‐term risk for overall malignancy in Koreans, which was primarily driven by the increased risk of gastric cancer.
Cost analysis of using Magee scores as a surrogate of Oncotype DX for adjuvant treatment decisions in women with early breast cancer
Authors: de Lima Mariana A.G. , Clemons Mark , Van Katwyk Sasha , Stober Carol , Robertson Susan J. , Vandermeer Lisa , Fergusson Dean , Thavorn Kednapa
Published: July 2019

Breast cancer is the most common cancer in women worldwide. Most current guidelines recommend using multigene profiling assays to aid the decision on the addition of chemotherapy to adjuvant hormone therapy for women who present with early‐stage, hormone receptor‐positive, HER2‐negative disease. One of these assays is the Oncotype DX, which predicts the disease recurrence risk and adjuvant chemotherapy benefits. Given its high cost, there is an economic incentive to evaluate its surrogates, such as the Magee equations. We assessed health system costs associated with the use of the Magee scores. A probabilistic decision tree was used to calculate the difference in mean health system costs based on data obtained from a randomized trial and the published literature. Costs were calculated from a perspective of Canada's publicly funded health care system. A series of sensitivity analysis was conducted to assess the robustness of the study findings. The Magee equations were associated with a total cost savings of C$100 per patient (95% CI, −C$3068 to C$5022) compared with standard of care. The difference in costs was highly sensitive to the extent that the Magee scores could reduce the frequency of adjuvant chemotherapy and Oncotype DX requests.
Difficulty of the decision‐making process in emergency departments for end‐of‐life patients
Authors: Douplat Marion , Berthiller Julien , Schott Anne‐Marie , Potinet Véronique , Le Coz Pierre , Tazarourte Karim , Jacquin Laurent
Published: July 2019

Background

In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life‐sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision‐making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients.

Aim

The purpose of this study is to describe the decision‐making process of withholding and withdrawing life‐sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients.

Design

We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017.

Results

We included 109 patients in the study. Fifty‐eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life‐sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision‐making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died.

Conclusion

There is little anticipation in end‐of‐life decisions. Discussion with patients concerning their end‐of‐life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.
Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population
Authors: Bynum Julie , Passow Honor , Austin Andrea , Carmichael Donald , Grodstein Francine
Published: July 2019

OBJECTIVES

As key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end‐of‐life (EOL) care differs from the general population as was shown for physicians.

DESIGN

Observational propensity‐matched cohort study.

SETTING

Fee‐for‐service Medicare.

PARTICIPANTS

Nurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital.

MEASUREMENTS

Characteristics of care during the first year after diagnosis and the last 6 months of life (EOL).

RESULTS

Among 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life‐prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar.

CONCLUSIONS

Nurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582–1589, 2019
Creating the Next Generation of Translational Geroscientists
Authors: Newman John C. , Sokoloski Julie L. , Robbins Paul D. , Niedernhofer Laura J. , Reed May J. , Wei Jeanne , Austad Steven N. , Barzilai Nir , Cohen Harvey Jay , Kuchel George A. , Kirkland James L. , Pignolo Robert J.
Published: July 2019

Advances in understanding fundamental processes of aging have led to a variety of investigational therapies to delay or prevent age‐related diseases and conditions. These geroscience therapeutics hold the promise of revolutionizing medical care of older adults by treating the complex syndromes of aging and preserving health and independence. A crucial bottleneck is the study of geroscience therapeutics in early‐stage, first‐in‐human, or proof‐of‐concept clinical trials. There is a limited pool of clinical investigators with the combination of knowledge and skills at the interface of clinical research, care of older adults, and aging biology needed to successfully design, fund, and implement geroscience trials. Current training pipelines are insufficient to meet the need. The sixth retreat of the National Institute on Aging R24 Geroscience Network brought together basic scientists, gerontologists, clinicians, and clinical researchers from the United States and Europe to discuss how to identify, recruit, and train investigators who can perform early‐stage clinical trials in geroscience. We present herein the group's consensus on necessary subject domains and competencies, identification of candidate learners, credentialing learners, and the efficient and rapid implementation of training programs. Foundations and funding agencies have crucial roles to play in catalyzing the development of these programs. Geriatrician investigators are indispensable but cannot meet the need alone. Translational geroscience training programs can create a cadre of groundbreaking investigators from a variety of backgrounds and foster institutional cultures supportive of multidisciplinary translational aging research to turn innovative ideas into transformative therapeutics that can improve the health and independence of older adults. J Am Geriatr Soc 67:1934–1939, 2019
Focusing on the hospital stay or everyday life with cancer: Parents’ experiences of choosing a central access device for their child with cancer
Authors: Bergviken Hanna , Nilsson Stefan
Published: July 2019

Purpose

The aim of this study was to gain insights into the experiences of parents of children with cancer in conjunction with their decisions on the type of central access device that their child would have.

Design and Methods

The qualitative study design was chosen to maximize the likelihood of capturing the full range of the phenomenon, that is the parents’ experiences from decision‐making. Open interviews were conducted between December 2015 and January 2016 with 17 parents of children who had been diagnosed with cancer in 2014–2015. The interviews were analyzed using inductive qualitative content analysis.

Results

The analysis of the decision‐making process data yielded four subcategories: (a) Feeling overwhelmed owing to limited information and alienation within the healthcare system, (b) the burden of making a quick medical decision without having the big picture, (c) receiving conflicting views and approaches from the healthcare professionals, and (d) including the child's perspective. Those four subcategories were condensed into the following main category: focusing on the hospital stay and treatment or on everyday life with cancer.

Practice Implications

Healthcare professionals need to be aware that they may influence the parents’ decision, and they should consider that parents are often naïve in their situation. To optimize the decision, its timing should be carefully chosen. Parents often take the child's perspective and interpret the child's reactions as reflecting a wish to avoid needle jabs or to live an unhindered everyday life. Healthcare professionals informing families about central access devices need to address both hospital stays and everyday life with cancer, and they need to adopt a child‐centered approach.