42 resultados para Elective surgery of small-to-medium scope

em CentAUR: Central Archive University of Reading - UK


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Small and medium sized enterprises (SMEs) play an important role in the European economy. A critical challenge faced by SME leaders, as a consequence of the continuing digital technology revolution, is how to optimally align business strategy with digital technology to fully leverage the potential offered by these technologies in pursuit of longevity and growth. There is a paucity of empirical research examining how e-leadership in SMEs drives successful alignment between business strategy and digital technology fostering longevity and growth. To address this gap, in this paper we develop an empirically derived e-leadership model. Initially we develop a theoretical model of e-leadership drawing on strategic alignment theory. This provides a theoretical foundation on how SMEs can harness digital technology in support of their business strategy enabling sustainable growth. An in-depth empirical study was undertaken interviewing 42 successful European SME leaders to validate, advance and substantiate our theoretically driven model. The outcome of the two stage process – inductive development of a theoretically driven e-leadership model and deductive advancement to develop a complete model through in-depth interviews with successful European SME leaders – is an e-leadership model with specific constructs fostering effective strategic alignment. The resulting diagnostic model enables SME decision makers to exercise effective e-leadership by creating productive alignment between business strategy and digital technology improving longevity and growth prospects.

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This article examines an under-investigated area in relationship banking, i.e. the use of bank advice and support and its impacts on the financial conditions of small and medium-sized enterprises (SMEs). The findings indicate that the characteristics of businesses and entrepreneurs, among other factors, have determinant effects on the use of bank support by SMEs when they make financial decisions. SMEs can alleviate the severity of their financial problems significantly by using bank support more fully, through developing long-term relationships with banks as primary network partners. The article further recognises the value of advice from banks as a substitute for entrepreneurial human capital, especially when bankers use private information to determine the nature and level of financial and non-financial assistance that they are prepared to supply to their clients.

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Purpose – The construction industry is a very important part of the Malaysian economy. The government's aim is to make the industry more productive, efficient and safe. Small to medium-sized enterprises (SMEs) are at the core of the Malaysian construction industry and account for about 90 per cent of companies undertaking construction work. One of the main challenges faced by the Malaysian construction industry is the ability to absorb new knowledge and technology and to implement it in the construction phase. The purpose of this paper is to consider absorptive capacity in Malaysian construction SMEs in rural areas. Design/methodology/approach – The research was conducted in three stages: first, understanding the Malaysian construction industry; second, a literature review on the issues related to absorptive capacity and discussions with the Construction Industry Development Board (CIDB); and third, multiple case studies in five construction SMEs operating in a rural area to validate the factors influencing absorptive capacity. Findings – Nine key factors were identified influencing absorptive capacity in Malaysian construction SMEs operating in rural areas. These factors involved: cost and affordability; availability and supply; demand; infrastructure; policies and regulations; labour readiness; workforce attitude and motivation; communication and sources of new knowledge and; culture. Originality/value – The key factors influencing absorptive capacity presented in this paper are based on validation from the case studies in five construction SMEs in Malaysia. The research focuses on how they operate in rural areas; however, the research results have wider application than just Malaysia. The key factors identified as influencing absorptive capacity can serve as a basis for considering knowledge absorption in the wider context by SMEs in other developing countries.

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With the increase in e-commerce and the digitisation of design data and information,the construction sector has become reliant upon IT infrastructure and systems. The design and production process is more complex, more interconnected, and reliant upon greater information mobility, with seamless exchange of data and information in real time. Construction small and medium-sized enterprises (CSMEs), in particular,the speciality contractors, can effectively utilise cost-effective collaboration-enabling technologies, such as cloud computing, to help in the effective transfer of information and data to improve productivity. The system dynamics (SD) approach offers a perspective and tools to enable a better understanding of the dynamics of complex systems. This research focuses upon system dynamics methodology as a modelling and analysis tool in order to understand and identify the key drivers in the absorption of cloud computing for CSMEs. The aim of this paper is to determine how the use of system dynamics (SD) can improve the management of information flow through collaborative technologies leading to improved productivity. The data supporting the use of system dynamics was obtained through a pilot study consisting of questionnaires and interviews from five CSMEs in the UK house-building sector.

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Siramesine (SRM) is a sigma-2 receptor agonist which has been recently shown to inhibit growth of cancer cells. Fluorescence spectroscopy experiments revealed two distinct binding sites for this drug in phospholipid membranes. More specifically, acidic phospholipids retain siramesine on the bilayer surface due to a high-affinity interaction, reaching saturation at an apparent 1:1 drug-acidic phospholipid stoichiometry, where after the drug penetrates into the hydrocarbon core of the membrane. This behavior was confirmed using Langmuir films. Of the anionic phospholipids, the highest affinity, comparable to the affinities for the binding of small molecule ligands to proteins, was measured for phosphatidic acid (PA, mole fraction Of X-PA = 0.2 in phosphatidylcholine vesicles), yielding a molecular partition coefficient of 240 +/- 80 x 10(6). An MD simulation on the siramesine:PA interaction was in agreement with the above data. Taking into account the key role of PA as a signaling molecule promoting cell growth our results suggest a new paradigm for the development of anticancer drugs, viz. design of small molecules specifically scavenging phospholipids involved in the signaling cascades controlling cell behavior.

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The question of linear sheared-disturbance evolution in constant-shear parallel flow is here reexamined with regard to the temporary-amplification phenomenon noted first by Orr in 1907. The results apply directly to Rossby waves on a beta-plane, and are also relevant to the Eady model of baroclinic instability. It is shown that an isotropic initial distribution of standing waves maintains a constant energy level throughout the shearing process, the amplification of some waves being precisely balanced by the decay of the others. An expression is obtained for the energy of a distribution of disturbances whose wavevectors lie within a given angular wedge and an upper bound derived. It is concluded that the case for ubiquitous amplification made in recent studies may have been somewhat overstated: while carefully-chosen individual Fourier components can amplify considerably before they decay. a general distribution will tend to exhibit little or no amplification.

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BACKGROUND AND PURPOSE: We have previously shown that a single 75-mg tablet of clopidogrel, taken before carotid endarterectomy, significantly reduces postoperative embolization, a marker of thromboembolic stroke. This study explores the antiplatelet effect of this submaximal dose. METHODS: Fifty-six patients on long-term aspirin (150 mg) were randomized to 75 mg clopidogrel or placebo before carotid endarterectomy. Blood samples were taken pre- and postdrug administration and at the end of surgery to measure platelet activation and adenosine diphosphate (ADP) response by flow cytometry and aggregometry. RESULTS: Surgery produced a significant rise in platelet activation in vivo as evidenced by a rise in the percentage of monocyte-platelet aggregates in patients given placebo, but this was not seen in patients receiving clopidogrel. Before surgery, clopidogrel produced a significant reduction in the platelet response to ADP; for example, with 10(-6)M ADP, 77.32+/-2.3% bound fibrinogen in placebo group compared with 67.16+/-3.1% after clopidogrel (P=0.01). This was accentuated after surgery when the percentage of platelets binding fibrinogen in response to ADP was 76.53+/-2.2% in patients given placebo and 62.84+/-3.3% in the clopidogrel group (P=0.002). Similar differences were seen over a range of ADP concentrations and by aggregometry. Platelet responsiveness before treatment was highly variable and was positively correlated with the inhibitory effect of clopidogrel; patients with the highest baseline response to ADP showed the greatest response to clopidogrel. A negative correlation was seen between the effect of clopidogrel and patients' weight (r=0.57; P=0.002). CONCLUSIONS: These results explain how a single 75-mg dose of clopidogrel produces a significant clinical impact on embolization.

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Purpose – The development of marketing strategies optimally adjusted to export markets has been a vitally important topic for both managers and academics for about five decades. However, there is no agreement in the literature about which elements integrate marketing strategy and which components of domestic strategies should be adapted to export markets. The purpose of this paper is to develop a new scale – STRATADAPT. Design/methodology/approach – Results from a sample of small and medium-sized industrial exporting firms support a four-dimensional scale – product, promotion, price, and distribution strategies – of 30 items. The scale presents evidence of composite reliability as well as discriminant and nomological validity. Findings – Findings reveal that all four dimensions of marketing strategy adaptation are positively associated with the amount of the firm's financial resources allocated to export activity. Practical implications – The STRATADAPT scale may assist managers in developing better international marketing strategies as well as in planning more accurate and efficient marketing programs across markets. Originality/value – This study develops a new scale, the STRATADAPT scale, which is a broad measure of export marketing strategy adaptation.

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A survey is presented of hourly averages of observations of the interplanetary medium, made by satellites close to the Earth (i.e. at l a.u.) in the years 1963-1986. This survey therefore covers two complete solar cycles (numbers 20 and 21). The distributions and solar-cycle variations of IMF field strength, B, and its northward component (in GSM coordinates), B(z), and of the solar-wind density, n, speed, v, and dynamic pressure, P, are discussed. Because of their importance to the terrestrial magnetosphere/ionosphere, particular attention is given to B(z) and P. The solar-cycle variation in the magnitude and variability of B(z) previously reported for cycle 20, is also found for cycle 21. However, the solar-wind data show a number of differences between cycles 20 and 21. The average dynamic pressure is found to show a solar-cycle variation and a systematic increase over the period of the survey. The minimum of dynamic pressure at sunspot maximum is mainly due to reduced solar-wind densities in cycle 20, but lower solar-wind speed in cycle 21 is a more significant factor. The distribution of the duration of periods of stable polarity of the IMF B(z) component shows that the magnetosphere could achieve steady state for only a small fraction of the time and there is some evidence for a solar-cycle variation in this fraction. It is also found that the polarity changes in the IMF B(z) fall into two classes: one with an associated change in solar-wind dynamic pressure, the other without such a change. However, in only 20% of cases does the dynamic pressure change exceed 50%.

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This edited volume explores the origins of the term small wars and traces it to special operations. In the 17th century, such "guerrilla/petite guerre" special operations grew out of training and winter operations of the regular forces as practiced in the 16th century. In the 18th century, they fused with a tradition going back to Antiquity, of employing special ethnic groups (such as the Hungarian Hussars) for special operations. Side by side with these special operations, however, there was the even older genealogy of uprisings and insurgencies, which since the Spanish Guerrilla of 1808-1812 has been associated with this term. All three traditions have influenced each other.

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Existing literature has paid considerable attention to the effects of supporting programmes on the survival and performance of small and medium-sized enterprises (SMEs), but it lacks a deep understanding of the benefits of the use of such assistance and the factors influencing the evaluation of such services from the perspective of SMEs. We examine the factors affecting the propensity to use assistance when SMEs make financial decisions and the usefulness perceived by the users. We examine 2500 UK SMEs and find that the use of assistance and the usefulness of such services, as perceived by SMEs, are much related to: the characteristics of the entrepreneur, the nature of the business, and the financial products used by the business. These empirical results imply that support and advice on financial decision making, available for SMEs, are important for them to better manage and to access finance. Assistance and advice are also very valuable for SMEs and entrepreneurs to compensate for their lack of human capital and thus facilitate overcoming possible problems in managing their businesses.

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Analysis of the vertical velocity of ice crystals observed with a 1.5micron Doppler lidar from a continuous sample of stratiform ice clouds over 17 months show that the distribution of Doppler velocity varies strongly with temperature, with mean velocities of 0.2m/s at -40C, increasing to 0.6m/s at -10C due to particle growth and broadening of the size spectrum. We examine the likely influence of crystals smaller than 60microns by forward modelling their effect on the area-weighted fall speed, and comparing the results to the lidar observations. The comparison strongly suggests that the concentration of small crystals in most clouds is much lower than measured in-situ by some cloud droplet probes. We argue that the discrepancy is likely due to shattering of large crystals on the probe inlet, and that numerous small particles should not be included in numerical weather and climate model parameterizations.