The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Revolution in sales:The impact of social media and related technology on the selling environment

Over the years several articles have tracked the impact of technology on various aspects of the sales domain. However, the advent of social media and technologies related to social media has gone largely unnoticed in the literature. This article first provides brief attention to changing aspects of technology within the sales environment, leading to the identification of social media as a dominant new selling tool. A qualitative approach (focus groups) is employed to explore the breadth of current technology usage by sales managers and salespeople. Analysis of the data, collected in the United States and the United Kingdom, reveals six major themes: connectivity, relationships, selling tools, generational, global, and sales/marketing interface. Results provide evidence of a revolution in the buyer-seller relationship that includes some unanticipated consequences both for sales organization performance and needed future research contributions.

Immigration, asylum and citizenship in Germany: the impact of unification and the Berlin Republic

In recent years, there has been much debate over whether post-unification Germany, often termed the 'Berlin Republic', represents a substantive change from the 'Bonn Republic ', that is, West Germany. This article analyses Germany's immigration and citizenship policy against this background by examining various dimensions of immigration before and after unification. The article argues that both unification itself and Germany's changed international environment have resulted in far-reaching changes in policy, which have forced a reappraisal of Germany's traditional self-image as a 'non-immigration country'.

Performance of small and medium enterprises and the impact of environmental variables: evidence from Vietnam

thesis is developed from a real life application of performance evaluation of small and medium-sized enterprises (SMEs) in Vietnam. The thesis presents two main methodological developments on evaluation of dichotomous environment variable impacts on technical efficiency. Taking into account the selection bias the thesis proposes a revised frontier separation approach for the seminal Data Envelopment Analysis (DEA) model which was developed by Charnes, Cooper, and Rhodes (1981). The revised frontier separation approach is based on a nearest neighbour propensity score matching pairing treated SMEs with their counterfactuals on the propensity score. The thesis develops order-m frontier conditioning on propensity score from the conditional order-m approach proposed by Cazals, Florens, and Simar (2002), advocated by Daraio and Simar (2005). By this development, the thesis allows the application of the conditional order-m approach with a dichotomous environment variable taking into account the existence of the self-selection problem of impact evaluation. Monte Carlo style simulations have been built to examine the effectiveness of the aforementioned developments. Methodological developments of the thesis are applied in empirical studies to evaluate the impact of training programmes on the performance of food processing SMEs and the impact of exporting on technical efficiency of textile and garment SMEs of Vietnam. The analysis shows that training programmes have no significant impact on the technical efficiency of food processing SMEs. Moreover, the analysis confirms the conclusion of the export literature that exporters are self selected into the sector. The thesis finds no significant impact from exporting activities on technical efficiency of textile and garment SMEs. However, large bias has been eliminated by the proposed approach. Results of empirical studies contribute to the understanding of the impact of different environmental variables on the performance of SMEs. It helps policy makers to design proper policy supporting the development of Vietnamese SMEs.

An assessment of the learning benefits of using a web-based learning environment when teaching accounting

The impact and use of information and communication technology on learning outcomes for accounting students is not well understood. This study investigates the impact of design features of Blackboard 1 used as aWeb-based Learning Environment (WBLE) in teaching undergraduate accounting students. Specifically, this investigation reports on a number of Blackboard design features (e.g. delivery of lecture notes, announcements, online assessment and model answers) used to deliver learning materials regarded as necessary to enhance learning outcomes. Responses from 369 on-campus students provided data to develop a regression model that seeks to explain enhanced participation and mental effort. The final regression shows that student satisfaction with the use of a WBLE is associated with five design features or variables. These include usefulness and availability of lecture notes, online assessment, model answers, and online chat.

Women in management in the new economic environment:the case of India

Liberalization of the Indian economy has created considerable employment opportunities for those, including women, who possess marketable skills and talent. Historically, women in India have not enjoyed a good status in workplace settings whether in managerial or operative roles. This traditional positioning of women has restricted the intensity of their efforts towards realizing the benefits of the globalisation process. An attempt has been made in this contribution to highlight the important issues relating to women in management in the Indian context. The messages from a review of the literature are analysed. Research evidence from various sources is presented to highlight the dynamics of developments in the status of Indian women managers. The contribution discusses the main aspects of the historical, socio-cultural and economic factors influencing women managers: issues concerning gender-based stereotypes; the main barriers to women's movement to top managerial positions; the impact of developments in information technology (IT) on women managers; and the way forward. Results from two research projects are also presented. The analysis has important messages for practitioners and contributes to women's studies and management in the Indian context. © 2005 Taylor & Francis Ltd.

Social impact assessment:A case study of a sewerage project in Barbados

The purpose of this paper is to investigate the reasons of social impacts of projects in developing countries despite of thorough impact assessment in appraisal phase of projects. A case study approach on a sewerage project in Barbados was undertaken using primary and secondary information. The study reveals that although the impact assessment report suggested appropriate mitigation measures, but they were not implemented by the contractors. The study suggests fostering an interconnected and symbiotic relationship between appraisal and implementation phases of a project in order to manage project environment. Additionally, a more vigilant and proactive supervisory role should be instituted and strengthened over time and adapted within the dictates of environmental needs. Copyright © 2005 Inderscience Enterprises Ltd.

Managing the quality, value and impact of academic libraries: the role of external standards

Purpose – The purpose of this paper is to explore the role and relevance of external standards in demonstrating the value and impact of academic library services to their stakeholders. Design/methodology/approach – Two UK standards, Charter Mark and Customer Service Excellence, are evaluated via an exploratory case study, employing multiple data collection techniques. Methods and results of phases 1-2 of a three phase research project are outlined. Findings – Despite some limitations, standards may assist the manager in demonstrating the value, impact and quality of academic libraries in a recessional environment. Active engagement and partnership with customers is imperative if academic libraries are to be viewed as vital to their parent organisations and thus survive. Originality/value – This paper provides a systematic evaluation of the role of external accreditation standards in measuring academic library service value and impact.

Does business environment matter to the development of a market orientation?

Developing a market orientation is one of the key issues in market-orientation research. In this study, based on a survey of top managers from 143 Chinese hotels and 72 travel services—two tourism sectors with distinctly different business environments—we explore the effects of environmental conditions on the development of market orientation. In particular we examine whether environmental conditions have a direct impact on the level of market orientation or whether they moderate the relationship between market orientation and its antecedents. We find that the effectiveness of top management emphasis varies under different environmental conditions but that the impact of other antecedents is not influenced by environmental conditions.

The development of a market orientation in a turbulent, transitional environment:the case of Ukraine

This research is concerned with the case of Ukraine where there has been a fundamental change in the economic environment engendered by the transition from a centrally planned to a market economy and the resulting conditions of economic crisis. The way that Ukrainian marketers and consumers are reacting to this environmental change is the principal concern of the research together with the basic linkages between critical environmental elements and strategic marketing decisions. This research analyses the way in which marketing evolves in a turbulent, transitional environment. The study is based on eight case analyses within the retail sector of the Ukrainian market. The process of transition to a free market economy leads a researcher to question the validity of existing theories that have been based on empirical data that has been collected in the stable marketing environment of the West. For this reason an in-depth, theory building methodology is preferred. A number of broad research objectives were set. Firstly, to establish whether the sales - production - marketing stages model of marketing evolution, derived from empirical data collected in stable Western environments, is relevant in the context of the turbulent, transitional environment of Ukraine. Secondly, to establish if, in this turbulent, transitional environment, idiosyncratic approaches to marketing are emerging and thirdly to assess the development of attitudes to marketing, organisation for marketing and the development of marketing strategy in Ukraine. The main conclusions of this thesis are firstly, that the stages model of marketing orientation is not relevant in the context of Ukraine, secondly that there are idiosyncratic approaches to marketing emerging in the turbulent, transitional environment of Ukraine and finally that the above developments have a profound impact on the development of attitudes to marketing, organisation for marketing and the development of marketing strategy in Ukraine.

The impact of the introduction of visual display terminals on the job characteristics, job satisfaction and well-being of users in government offices

The proliferation of visual display terminals (VDTs) in offices is an international phenomenon. Numerous studies have investigated the health implications which can be categorised into visual problems, symptoms of musculo-skelctal discomfort, or psychosocial effects. The psychosocial effects are broader and there is mixed evidence in this area. The inconsistent results from the studies of VDT work so far undertaken may reflect several methodological shortcomings. In an attempt to overcome these deficiencies and to broaden the model of inter-relationships a model was developed to investigate their interactions and Ihc outputs of job satisfaction, stress and ill health. The study was a two-stage, long-term investigation with measures taken before the VDTs were introduced and the same measures taken 12 months after the 'go-live' date. The research was conducted in four offices of the Department of Social Security. The data were analysed for each individual site and in addition the total data were used in a path analysis model. Significant positive relationships were found at the pre-implementation stage between the musculo-skeletal discomfort, psychosomatic ailments, visual complaints and stress. Job satisfaction was negatively related to visual complaints and musculo-skeletal discomfort. Direct paths were found for age and job level with variety found in the job and age with job satisfaction and a negative relationship with the office environment. The only job characteristic which had a direct path to stress was 'dealing with others'. Similar inter-relationships were found in the post-implementation data. However, in addition attributes of the computer system, such as screen brightness and glare, were related positively with stress and negatively with job satisfaction. The comparison of the data at the two stages found that there had been no significant changes in the users' perceptions of their job characteristics and job satisfaction but there was a small and significant reduction in the stress measure.

The impact of NC machinery upon manufacturing industry

The changing face of industry due to the adoption of `New Technology' is briefly discussed, as are the corresponding structural changes in the workforce. The adoption of NC machinery is identified as one of the major innovations affecting the structure of industry. The development of NC machinery, and of relevant programming techniques are reviewed, and the problems arising from its initial sponsorship by the aerospace industry are highlighted. The process of its subsequent diffusion into industry is reviewed. Skill levels adopted for NC use in Britain and Germany are discussed, and analysed to create a structural pattern. These classifications of skill levels are then used to examine the organisational structures adopted by companies utilising NC machines. The greater use made of higher level shop floor skills by German companies is discussed. The results of two surveys of the use made of NC by companies in the North East of England are presented. Effective company organisation for NC use is described, and lack of foresight is shown to lead to vulnerability problems where skills can become concentrated in a few key people. This led to closure of a company in one instance. It is shown that small sub-contract companies have adopted a highly skilled shop floor workforce, and that they have survived in the present hostile economic environment, whilst companies who have used NC to de-skill the shop floor contracted dramatically in the same period. The lack of awareness of the potential for reviewing the product design in relation to the flexibility of NC, so leading to reductions in work in progress levels, is highlighted. Recommendations for skill structures appropriate to various sized companies and suitable training programs are presented to ensure that the full potential of NC machinery is achieved.

A study of personality and leadership in a technical environment

l, This report presents the findings of a study of individual personalities of Naval Officers, Chief Petty Officers and Petty Officers serving in different environments within the Ministry of Defence and the Fleet. This sample was used to establish norms for the Cattell 16 PF Questionnaire, and these are compared with other occupational norms discussed in the literature. 2. The results obtained on psychometric measures were related to other data collected about the work and the formal organisation. This was in its turn related to problems facing the Navy because of changes in technology which have occurred or which are now taking place and are expected to make an impact in the future. 3. A need is recognised for a way of simulating the effects of proposed changes within the manpower field of the Royal Navy and a simulation model is put forward and discussed. 4. The use of psychometric measures in selection for entry and for special tasks is examined, Particular reference is made to problems of group formation in the context of leadership in a technical environment. 5. The control of the introduction of change is discussed in the recognition that people represent an increasingly important resource which is critical to the continuing life of the total organisation. 6. Conclusions are drawn from the various strands of the research and recommendations are made both for line management and for subsequent research programmes.

Evaluating the impact of design decisions on the financial performance of manufacturing companies

Product design decisions can have a significant impact on the financial and operation performance of manufacturing companies. Therefore good analysis of the financial impact of design decisions is required if the profitability of the business is to be maximised. The product design process can be viewed as a chain of decisions which links decisions about the concept to decisions about the detail. The idea of decision chains can be extended to include the design and operation of the 'downstream' business processes which manufacture and support the product. These chains of decisions are not independent but are interrelated in a complex manner. To deal with the interdependencies requires a modelling approach which represents all the chains of decisions, to a level of detail not normally considered in the analysis of product design. The operational, control and financial elements of a manufacturing business constitute a dynamic system. These elements interact with each other and with external elements (i.e. customers and suppliers). Analysing the chain of decisions for such an environment requires the application of simulation techniques, not just to any one area of interest, but to the whole business i.e. an enterprise simulation. To investigate the capability and viability of enterprise simulation an experimental 'Whole Business Simulation' system has been developed. This system combines specialist simulation elements and standard operational applications software packages, to create a model that incorporates all the key elements of a manufacturing business, including its customers and suppliers. By means of a series of experiments, the performance of this system was compared with a range of existing analysis tools (i.e. DFX, capacity calculation, shop floor simulator, and business planner driven by a shop floor simulator).

Fibre optic sensors for high speed hypervelocity impact studies and low velocity drop tests

The initial aim of this project was to develop a non-contact fibre optic based displacement sensor to operate in the harsh environment of a 'Light Gas Gun' (LGG), which can 'fire' small particles at velocities ranging from 1-8.4 km/s. The LGG is used extensively for research in aerospace to analyze the effects of high speed impacts on materials. Ideally the measurement should be made close to the centre of the impact to minimise corruption of the data from edge effects and survive the impact. A further requirement is that it should operate at a stand-off distance of ~ 8cm. For these reasons we chose to develop a pseudo con-focal intensity sensor, which demonstrated resolution comparable with conventional PVDF sensors combined with high survivability and low cost. A second sensor was developed based on 'Fibre Bragg Gratings' (FBG) which although requiring contact with the target the low weight and very small contact area had minimal effect on the dynamics of the target. The FBG was mounted either on the surface of the target or tangentially between a fixed location. The output signals from the FBG were interrogated in time by a new method. Measurements were made on composite and aluminium plates in the LGG and on low speed drop tests. The particle momentum for the drop tests was chosen to be similar to that of the particles used in the LGG.