Drugs for hypertension, angina and heart failure

12.1 Drugs for hypertension 12.1.1 Epidemiology and pathophysiology 12.1.2 Diuretics for hypertension 12.2.3 Vasodilators for hypertension 12.4.4 β-Adrenoceptor blockers for hypertension 12.2. Drugs for angina 12.2.1 Typical angina 12.2.2 Drugs to treat an attack of typical angina 12,2.3 Drugs to prevent an attack of typical angina 12.2.4 Atypical angina 12.3 Drugs for heart failure 12.3.1 The heart failure epidemic 12.3.2 Compensatory changes in heart failure 12.3.3 Diuretics for heart failure 12.3.4 ACE inhibitors and AT1-receptor antagonists 12.3.5 β-adrenoceptor antagonists 12.3.6 Digoxin

Risk factors for malnutrition in community-dwelling people with Parkinson’s disease

In the elderly, the risks for protein-energy malnutrition from older age, dementia, depression and living alone have been well-documented. Other risk factors including anorexia, gastrointestinal dysfunction, loss of olfactory and taste senses and early satiety have also been suggested to contribute to poor nutritional status. In Parkinson’s disease (PD), it has been suggested that the disease symptoms may predispose people with PD to malnutrition. However, the risks for malnutrition in this population are not well-understood. The current study’s aim was to determine malnutrition risk factors in community-dwelling adults with PD. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Data about age, time since diagnosis, medications and living situation were collected. Levodopa equivalent doses (LDED) and LDED per kg body weight (mg/kg) were calculated. Depression and anxiety were measured using the Beck’s Depression Inventory (BDI) and Spielberger Trait Anxiety questionnaire, respectively. Cognitive function was assessed using the Addenbrooke’s Cognitive Examination (ACE-R). Non-motor symptoms were assessed using the Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) and Modified Constipation Assessment Scale (MCAS). A total of 125 community-dwelling people with PD were included, average age of 70.2±9.3(35-92) years and average time since diagnosis of 7.3±5.9(0–31) years. Average body mass index (BMI) was 26.0±5.5kg/m2. Of these, 15% (n=19) were malnourished (SGA-B). Multivariate logistic regression analysis revealed that older age (OR=1.16, CI=1.02-1.31), more depressive symptoms (OR=1.26, CI=1.07-1.48), lower levels of anxiety (OR=.90, CI=.82-.99), and higher LDED per kg body weight (OR=1.57, CI=1.14-2.15) significantly increased malnutrition risk. Cognitive function, living situation, number of prescription medications, LDED, years since diagnosis and the severity of non-motor symptoms did not significantly influence malnutrition risk. Malnutrition results in poorer health outcomes. Proactively addressing the risk factors can help prevent declines in nutritional status. In the current study, older people with PD with depression and greater amounts of levodopa per body weight were at increased malnutrition risk.

Influencing innovation in SME’s : from designer to transitional engineer

The following paper presents insights found during an ongoing industry engagement with a family-owned manufacturing SME in Australia. The study seeks to unpack cultural, strategic, product opportunities and challenges available to the firm engaging in a design led approach to innovation. Design led innovation finds new market opportunities to innovate through a holistic perspective of both the internal business operations, focusing on the customer experience and external stakeholders. The action research based methodology consisted of 25 semi-structured interviews, a reflective journal and focus group, all of which were analysed thematically. This paper focuses on the resultant themes of the focus group data constituting a discussion around the best strategies to try and integrate design thinking as a fundamental skill across the company. The main thematic results included the participant’s limited views of themselves (in current roles) as being to create ‘buy-in’ to change initiatives, a preference to act as a group to gain traction in the firm, importance of better defining the problem before reaching a design solution and lastly the time required to implement versus the need for change. These findings are valuable in assisting other family owned firms in managing core growth activities with design and innovation initiatives, particularly in the area of new product development.

From entrepreneur to philanthropist : the “second half of the game”

This paper uses interviews with wealthy Australians to examine the progression from entrepreneurship to philanthropy in an Australian context. Understanding the characteristics, behaviours and motivations of this group of entrepreneurs turned philanthropists strengthens the links identified in international research between the entrepreneurship and philanthropic sectors. Three major themes emerging from the qualitative data are explored: first, the tipping points that move individuals (and their partners/families) between the two spheres of activity; and second, the strong motivations for giving that see entrepreneurs identified internationally as more generous than high net worth individuals whose wealth derives from other sources. The third major theme is the modes of giving that distinguish those with an entrepreneurship background from other philanthropists. The unique characteristics of a smaller sub-set of ultra high net worth donors are also explored, and areas for future study are highlighted.

How difficult are exams? A framework for assessing the complexity of introductory programming exams

Student performance on examinations is influenced by the level of difficulty of the questions. It seems reasonable to propose therefore that assessment of the difficulty of exam questions could be used to gauge the level of skills and knowledge expected at the end of a course. This paper reports the results of a study investigating the difficulty of exam questions using a subjective assessment of difficulty and a purpose-built exam question complexity classification scheme. The scheme, devised for exams in introductory programming courses, assesses the complexity of each question using six measures: external domain references, explicitness, linguistic complexity, conceptual complexity, length of code involved in the question and/or answer, and intellectual complexity (Bloom level). We apply the scheme to 20 introductory programming exam papers from five countries, and find substantial variation across the exams for all measures. Most exams include a mix of questions of low, medium, and high difficulty, although seven of the 20 have no questions of high difficulty. All of the complexity measures correlate with assessment of difficulty, indicating that the difficulty of an exam question relates to each of these more specific measures. We discuss the implications of these findings for the development of measures to assess learning standards in programming courses.

A qualitative think aloud study of the early Neo-Piagetian stages of reasoning in novice programmers

Recent research indicates that some of the difficulties faced by novice programmers are manifested very early in their learning. In this paper, we present data from think aloud studies that demonstrate the nature of those difficulties. In the think alouds, novices were required to complete short programming tasks which involved either hand executing ("tracing") a short piece of code, or writing a single sentence describing the purpose of the code. We interpret our think aloud data within a neo-Piagetian framework, demonstrating that some novices reason at the sensorimotor and preoperational stages, not at the higher concrete operational stage at which most instruction is implicitly targeted.

A conceptual model for reflecting on expected learning vs. demonstrated student performance

Educators are faced with many challenging questions in designing an effective curriculum. What prerequisite knowledge do students have before commencing a new subject? At what level of mastery? What is the spread of capabilities between bare-passing students vs. the top performing group? How does the intended learning specification compare to student performance at the end of a subject? In this paper we present a conceptual model that helps in answering some of these questions. It has the following main capabilities: capturing the learning specification in terms of syllabus topics and outcomes; capturing mastery levels to model progression; capturing the minimal vs. aspirational learning design; capturing confidence and reliability metrics for each of these mappings; and finally, comparing and reflecting on the learning specification against actual student performance. We present a web-based implementation of the model, and validate it by mapping the final exams from four programming subjects against the ACM/IEEE CS2013 topics and outcomes, using Bloom's Taxonomy as the mastery scale. We then import the itemised exam grades from 632 students across the four subjects and compare the demonstrated student performance against the expected learning for each of these. Key contributions of this work are the validated conceptual model for capturing and comparing expected learning vs. demonstrated performance, and a web-based implementation of this model, which is made freely available online as a community resource.

Markers of disease severity are associated with malnutrition in Parkinson's disease

Objective In Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP). Methods Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease – Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA). Results Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight(mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score. Conclusions In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.

Emergent and deliberate entrepreneurial strategies in SMEs

Entrepreneurial strategies in large firms have been analysed in terms of antecedent conditions, elements and outcomes (Ireland, Covin & Kuratko, 2009), but to date less attention has been given to the strategies used by small and medium enterprises to remain competitive. The purpose of this paper is to increase our knowledge and understanding of the types of strategies and activities that existing small and medium enterprises (SMEs) are using to generate new economic activity to ensure the success of their business. This paper explores findings from a qualitative study of SMEs and identifies entrepreneurial management (Stevenson & Jarillo 1995) in different forms in different sized firms. Findings indicate that small and medium sized enterprises seeking to remain competitive, engage in proactive entrepreneurial strategies that develop and exploit capabilities.

Culture as a driver of entrepreneurship : contrasting independent entrepreneurship versus employee entrepreneurship

Principal Topic Counties in Northern Europe, such as Sweden, Finland and Denmark, have comparatively low per capita rates of entrepreneurship as measured by independent new venture start-up rates – as for example measured by the Global Entrepreneurship Monitor (GEM) Total entrepreneurial activity (TEA) rate. However, the latest 2011 GEM data reveals that these same countries have comparatively very high Employee Entrepreneurship Activity (EEA) rates – that is a high rate per capita of employees involved in new product development or new enterprise activities. This observation has prompted us to investigate the role of national culture in driving independent versus employee entrepreneurial activities. Prior research has established that national (and regional) culture plays an important role in forming an “entrepreneurial culture” that encourages (or discourages) independent business start-ups and TEA (e.g. Davidsson, 1995; Beugelsdijk, 2007). However, the relationship of culture and EEA has not received research attention. Moreover, empirical relationships between elements of national culture and independent entrepreneurship have revealed some surprising results. For example, Wildeman et al. (1999) report an unexpected higher share of individual business ownership in countries that have higher uncertainty avoidance, higher power distance and lower individualism according to Hofstede’s dimensions of culture. They speculate that dissatisfaction can be a source of entrepreneurship: in countries with a high power distance, a high uncertainty avoidance and low individualism, there may be relatively more business owners since enterprising individuals cannot satisfy their needs within existing organizations. Yet it remains a rather open question whether entrepreneurial behaviour in existing organisations provides a satisfactory explanation for these empirical findings. Methods We will conduct a cross sectional study of the influence of national culture according to the five / six dimensions of Hofstede (1980; 2001) on both TEA and EEA for the 54 countries that participated in GEM 2011. Since it is well established that the opportunities for entrepreneurship vary substantially with a country’s level of economic development, we intend to conduct separate analyses for the three categories of development – innovation driven economies, efficient driven economies and factor driven economies. We also intend to restrict our assessment of TEA to opportunity driven entrepreneurship, as necessity driven entrepreneurship has a different relationship to the “entrepreneurial culture” that is the focus of our study. We will control for a range of factors such as GDP growth, ease of doing business index and unemployment. Results and Implications Descriptive analyses of the GEM TEA and EEA data reveal clusters of countries that appear to be have similar national culture. We are yet to conduct regression analyses.

Intrapreneurial bricolage: a contradiction in terms or useful construct?

This paper addresses the ambiguous relationship of internal, organizationa social capital and external social capital with corporate entrepreneurship performance. Drawing on social construction theory we argue that bricolage can mitigate some of the negative effects associated with social capital by recombining and redefining the purpose of available resources. We investigated our hypotheses through a random sample of 206 corporate entrepreneurship projects. We found that both internal and external social capital have no direct effect on performance of corporate entrepreneurship projects. The results indicate that bricolage mediates the relationship between social capital and performance of corporate entrepreneurship projects. Bricolage thrives in particularly when there is wide availability of social capital internal and external to the organization. The implications are that bricolage is a critical behavior in allowing corporate entrepreneur projects to benefit from resources available through their network of social relations inside and outside the company.

Born unfinished : boundaries of bricolage effectiveness

In this paper, we present initial results of an inductive, longitudinal case study of four firms that applied bricolage behaviors during resource constraints in firm emergence. Building on these cases, we discuss and extend existing research in bricolage theories by investigating how bricolage enables or hinders progress within firm creation. We explore the factors that places limits on the use of bricolage effectiveness during emergence. Specifically, in this paper, we discuss the impact of commitment and attention on bricolage effectiveness and how these influences may shape attempts to further progress and continue despite the resource constraints entrepreneurs often face in venture creation processes.

How the environment affects opportunity recognition by entrepreneurs at the bottom of the pyramid

There is an army of bottom of the pyramid entrepreneurs (BOPE) who have the potential to transform developing economies, if they can identify and exploit business opportunities. BOPE could have unidentified resources that could lead to the recognition of radical new opportunities. This study paper asks how environmental factors and identification of resources affect Opportunity Recognition by BOP entrepreneurs in developing economies. To investigate this research question we conduct a literature review and plan semi-structured interviews of existing and nascent entrepreneurs in the largest and arguably the poorest country in Africa, the Democratic Republic of the Congo. In this paper we review the context of BOPE and describe the methodology we will use to gather and analyse data. Finally, we describe our access to suitable respondents for this study and how it will be conducted.

Alternative modes of entrepreneurial opportunity exploitation : the case on inter-organizational project

While entrepreneurship research has taken firm formation to be the predominant mode of opportunity exploitation, entrepreneurship can take place through many other types of organizational arrangements. In the present article, we consider one such alternative arrangement, namely the formation of inter-organizational projects (IOPs). We propose a multi-level contingency model that suggests that uncertainty both at the level of the firm and at the level of the environment makes the exploitation of opportunities through IOPs more likely. The model is tested by telephone survey data collected amongst a panel of 1725 SMEs and longitudinal industry data. Our findings provide strong support for the industry-level part of the model, but interestingly, only partial support for the firm level part of the model. This indicates that the effects of uncertainty need to be dissected into different levels of analysis to understand the conditions under which alternative modes of opportunity exploitation can be a prominent entrepreneurial alternative to new firm formation.