Learning by exporting:lessons from high-technology SMEs

We investigate the learning by exporting hypothesis by examining the effect of exporting on the subsequent innovation performance of a sample of high-technology SMEs based in the UK. We find evidence of learning by exporting, but the pattern of this effect is complex. Exporting helps high-tech SMEs innovate subsequently, but does not make them more innovation intensive. There is evidence that consistent exposure to export markets helps firms overcome the innovation hurdle, but that there is a positive scale effect of exposure to export markets which allows innovative firms to sell more of their new-to-market products on entering export markets. Service sector firms are able to reap the benefits of exposure to export markets at an earlier (entry) stage of the internationalization process than are manufacturing firms. Innovation-intensive firms exhibit a different pattern of entry to and exit from export markets from low-intensity innovators, and this is reflected in different effects of exporting. © 2012 Elsevier Ltd.

Learning by exporting:lesson from high-technology SMEs

Theory points to the existence of a learning by exporting effect, in which exposure to export markets enhances performance through exposure to the knowledge stocks of trading partners. We investigate the learning by exporting hypothesis by examining the effect of exporting on the subsequent innovation performance of UK high-tech SMEs. We find evidence of learning by exporting, but the pattern of this effect is relatively complex. Exporting helps high-tech SMEs innovate subsequently, but does not make them more innovation intensive. There is also evidence that it is consistent exposure to export markets that helps firms overcome the innovation hurdle, but that there is a positive scale effect of exposure to export markets which allows innovative firms to sell more of their new-to-market products on entering export markets. Service sector firms are able to reap the benefits of exposure to export markets at an earlier (entry) stage of the internationalization process than are manufacturing firms. Firms producing a rapidly changing portfolio of innovative products exhibit higher churn in terms of entry to and exit from export markets than low-intensity innovators, and this is reflected in the effects of entry and exit into and out of such markets.

Blurred edges look faint, and faint edges look sharp:The effect of a gradient threshold in a multi-scale edge coding model

A multi-scale model of edge coding based on normalized Gaussian derivative filters successfully predicts perceived scale (blur) for a wide variety of edge profiles [Georgeson, M. A., May, K. A., Freeman, T. C. A., & Hesse, G. S. (in press). From filters to features: Scale-space analysis of edge and blur coding in human vision. Journal of Vision]. Our model spatially differentiates the luminance profile, half-wave rectifies the 1st derivative, and then differentiates twice more, to give the 3rd derivative of all regions with a positive gradient. This process is implemented by a set of Gaussian derivative filters with a range of scales. Peaks in the inverted normalized 3rd derivative across space and scale indicate the positions and scales of the edges. The edge contrast can be estimated from the height of the peak. The model provides a veridical estimate of the scale and contrast of edges that have a Gaussian integral profile. Therefore, since scale and contrast are independent stimulus parameters, the model predicts that the perceived value of either of these parameters should be unaffected by changes in the other. This prediction was found to be incorrect: reducing the contrast of an edge made it look sharper, and increasing its scale led to a decrease in the perceived contrast. Our model can account for these effects when the simple half-wave rectifier after the 1st derivative is replaced by a smoothed threshold function described by two parameters. For each subject, one pair of parameters provided a satisfactory fit to the data from all the experiments presented here and in the accompanying paper [May, K. A. & Georgeson, M. A. (2007). Added luminance ramp alters perceived edge blur and contrast: A critical test for derivative-based models of edge coding. Vision Research, 47, 1721-1731]. Thus, when we allow for the visual system's insensitivity to very shallow luminance gradients, our multi-scale model can be extended to edge coding over a wide range of contrasts and blurs. © 2007 Elsevier Ltd. All rights reserved.

A small scale Multi-effect Distillation (MED) unit for rural micro enterprises:part I-design and fabrication

Removal of dissolved salts and toxic chemicals in water, especially at a few parts per million (ppm) levels is one of the most difficult problems. There are several methods used for water purification. The choice of the method depends mainly on the level of feed water salinity, source of energy and type of contaminants present. Distillation is an age old method which can remove all types of dissolved impurities from contaminated water. In multiple effect distillation (MED) latent heat of steam is recycled several times to produce many units of distilled water with one unit of primary steam input. This is already being used in large capacity plants for treating sea water. But the challenge lies in designing a system for small scale operations that can treat a few cubic meters of water per day, especially suitable for rural communities where the available water is brackish. A small scale MED unit with an extendable number of effects has been designed and analyzed for optimum yield in terms of total distillate produced. © 2010 Elsevier B.V.

Comparison of the effect of pre-treatment and catalysts on liquid quality from fast pyrolysis of biomass

The overall objective of this work was to compare the effect of pre-treatment and catalysts on the quality of liquid products from fast pyrolysis of biomass. This study investigated the upgrading of bio-oil in terms of its quality as a bio-fuel and/or source of chemicals. Bio-oil used directly as a biofuel for heat or power needs to be improved particularly in terms of temperature sensitivity, oxygen content, chemical instability, solid content, and heating values. Chemicals produced from bio-oil need to be able to meet product specifications for market acceptability. There were two main objectives in this research. The first was to examine the influence of pre-treatment of biomass on the fast pyrolysis process and liquid quality. The relationship between the method of pre-treatment of biomass feedstock to fast pyrolysis oil quality was studied. The thermal decomposition behaviour of untreated and pretreated feedstocks was studied by using a TGA (thermogravimetric analysis) and a Py-GC/MS (pyroprobe-gas chromatography/mass spectrometry). Laboratory scale reactors (100g/h, 300g/h, 1kg/h) were used to process untreated and pretreated feedstocks by fast pyrolysis. The second objective was to study the influence of numerous catalysts on fast pyrolysis liquids from wheat straw. The first step applied analytical pyrolysis (Py-GC/MS) to determine which catalysts had an effect on fast pyrolysis liquid, in order to select catalysts for further laboratory fast pyrolysis. The effect of activation, temperature, and biomass pre-treatment on catalysts were also investigated. Laboratory experiments were also conducted using the existing 300g/h fluidised bed reactor system with a secondary catalytic fixed bed reactor. The screening of catalysts showed that CoMo was a highly active catalyst, which particularly reduced the higher molecular weight products of fast pyrolysis. From these screening tests, CoMo catalyst was selected for larger scale laboratory experiments. With reference to the effect of pre-treatment work on fast pyrolysis process, a significant effect occurred on the thermal decomposition of biomass, as well as the pyrolysis products composition, and the proportion of key components in bio-oil. Torrefaction proved to have a mild influence on pyrolysis products, when compared to aquathermolysis and steam pre-treatment.

Scale-up in emulsion polymerisation

The procedure for successful scale-up of batchwise emulsion polymerisation has been studied. The relevant literature on liquid-liquid dispersion on scale-up and on emulsion polymerisation has been crit1cally reviewed. Batchwise emulsion polymerisation of styrene in a specially built 3 litre, unbaffled, reactor confirmed that impeller speed had a direct effect on the latex particle size and on the reaction rate. This was noted to be more significant at low soap concentrations and the phenomenon was related to the depletion of micelle forming soap by soap adsorption onto the monomer emulsion surface. The scale-up procedure necessary to maintain constant monomer emulsion surface area in an unbaffled batch reactor was therefore investigated. Three geometrically similar 'vessels of 152, 229 and 305mm internal diameter, and a range of impeller speeds (190 to 960 r.p.m.) were employed. The droplet sizes were measured either through photomicroscopy or via a Coulter Counter. The power input to the impeller was also measured. A scale-up procedure was proposed based on the governing relationship between droplet diameter, impeller speed and impeller diameter. The relationships between impeller speed soap concentration, latex particle size and reaction rate were investigated in a series of polymerisations employing an amended commercial recipe for polystyrene. The particle size was determined via a light transmission technique. Two computer models, based on the Smith and Ewart approach but taking into account the adsorption/desorption of soap at the monomer surface, were successful 1n predicting the particle size and the progress of the reaction up to the end of stage II, i.e. to the end of the period of constant reaction rate.

The effect of antifoams upon recombinant protein production in yeast

Foaming during fermentation reduces the efficiency of the process leading to increased costs and reduced productivity. Foaming can be overcome by the use of chemical antifoaming agents, however their influence upon the growth of organisms and protein yield is poorly understood. The objective of this work was to evaluate the effects of different antifoams on recombinant protein production. Antifoam A, Antifoam C, J673A, P2000 and SB2121 were tested at different concentrations for their effect on the growth characteristics of Pichia pastoris producing GFP, EPO and A2aR and the yield of protein in shake flasks over 48 h. All antifoams tested increased the total GFP in the shake flasks compared to controls, at higher concentrations than would normally be used for defoaming purposes. The highest yield was achieved by adding 1 % P2000 which nearly doubled the total yield followed by 1 % SB2121, 1 % J673A, 0.6 % Antifoam A and lastly 0.8 % Antifoam C. The antifoams had a detrimental effect upon the production of EPO and A2aR in shake flasks, suggesting that their effects may be protein specific. The mechanisms of action of the antifoams was investigated and suggested that although the volumetric mass oxygen transfer coefficient (kLa) was influenced by the agents, their effect upon the concentration of dissolved oxygen did not contribute to the changes in growth or recombinant protein yield. Findings in small scale also suggested that antifoams of different compositions such as silicone polymers and alcoxylated fatty acid esters may influence growth characteristics of host organisms and the ability of the cells to secrete recombinant protein, indirectly affecting the protein yield. Upon scale-up, the concentration effects of the antifoams upon GFP yield in bioreactors was reversed, with lower concentrations producing a higher yield. These data suggest that antifoam can affect cells in a multifactorial manner and highlights the importance of screening for optimum antifoam types and concentrations for each bioprocesses.

The effect of ward design on the well-being of post-operative patients

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

Effect of liquid flow patterns on distillation trays

The thesis describes experimental work on sieve trays in an air-water simulator, 2.44 m in diameter. The liquid flow pattern, for flowrates similar to those used in commercial scale distillation, was observed experimentally by water cooling experiments, in which the temperature of the water is measured at over 100 positions over the tray area. The water is cooled by the rising air which is forced through the tray. A heat and mass transfer analogy is drawn whereby the water temperature is mapped to liquid concentration in mass transfer, and the water temperature profiles reveal how liquid channelling may reduce the tray efficiency. The first experiment was to observe the flow of water only over an unperforated tray. With the exception of very low weir loads, the flow separated at the ends of the inlet downcomer. This caused liquid to flow straight across the tray between the downcomers and large circulating regions to be formed in the side regions of the tray. The effect of the air crossflow on the flow pattern was then observed on a sieve tray of 10% free area with 1 mm diameter holes (such as is used in cryogenic distillation). The flow patterns developed on the tray were similar to those produced with water only on the unperforated tray, but at low weir loads the air crossflow prevented separation of the water flow and the associated circulating regions. At higher weir loads, liquid channelling down the centre of the tray and circulation in the side regions occurred. The percentage of the tray occupied by circulating liquid depended upon the velocity of the liquid entering the tray, which was set by the weir load and size of the gap under the inlet downcomer. The water cooling experiments showed that the temperature of the water in a circulating region is much lower than in other parts of the tray, indicating that the driving force for heat transfer is reduced. In a column section where trays (and circulating areas) are mounted on top of each other, the circulating regions will cause air (or vapour) passing through them to have a reduced change in temperature or concentration leading a loss in tray efficiency.

Flow patterns, performance and scale-up of distillation trays

This work is concerned with the nature of liquid flow across industrial sieve trays operating in the spray, mixed, and the emulsified flow regimes. In order to overcome the practical difficulties of removing many samples from a commercial tray, the mass transfer process was investigated in an air water simulator column by heat transfer analogy. The temperature of the warm water was measured by many thermocouples as the water flowed across the single pass 1.2 m diameter sieve tray. The thermocouples were linked to a mini computer for the storage of the data. The temperature data were then transferred to a main frame computer to generate temperature profiles - analogous to concentration profiles. A comprehensive study of the existing tray efficiency models was carried out using computerised numerical solutions. The calculated results were compared with experimental results published by the Fractionation Research Incorporation (FRl) and the existing models did not show any agreement with the experimental results. Only the Porter and Lockett model showed a reasonable agreement with the experimental results for cenain tray efficiency values. A rectangular active section tray was constructed and tested to establish the channelling effect and the result of its effect on circular tray designs. The developed flow patterns showed predominantly flat profiles and some indication of significant liquid flow through the central region of the tray. This comfirms that the rectangular tray configuration might not be a satisfactory solution for liquid maldistribution on sieve trays. For a typical industrial tray the flow of liquid as it crosses the tray from the inlet to the outlet weir could be affected by the mixing of liquid by the eddy, momentum and the weir shape in the axial or the transverse direction or both. Conventional U-shape profiles were developed when the operating conditions were such that the froth dispersion was in the mixed regime, with good liquid temperature distribution while in the spray regime. For the 12.5 mm hole diameter tray the constant temperature profiles were found to be in the axial direction while in the spray regime and in the transverse direction for the 4.5 mm hole tray. It was observed that the extent of the liquid stagnant zones at the sides of the tray depended on the tray hole diameter and was larger for the 4.5 mm hole tray. The liquid hold-up results show a high liquid hold-up at the areas of the tray with low liquid temperatures, this supports the doubts about the assumptions of constant point efficiency across an operating tray. Liquid flow over the outlet weir showed more liquid flow at the centre of the tray at high liquid loading with low liquid flow at both ends of the weir. The calculated results of the point and tray efficiency model showed a general increase in the calculated point and tray efficiencies with an increase in the weir loading, as the flow regime changed from the spray to the mixed regime the point and the tray efficiencies increased from approximately 30 to 80%.Through the mixed flow regime the efficiencies were found to remain fairly constant, and as the operating conditions were changed to maintain an emulsified flow regime there was a decrease in the resulting efficiencies. The results of the estimated coefficient of mixing for the small and large hole diameter trays show that the extent of liquid mixing on an operating tray generally increased with increasing capacity factor, but decreased with increasing weir loads. This demonstrates that above certain weir loads, the effect of eddy diffusion mechanism on the process of liquid mixing on an operating tray to be negligible.

The effect of antifoam addition on protein production yields

Pichia pastoris is a widely used host for recombinant protein production. The foaming associated with culturing it on a large scale is commonly prevented by the addition of chemical antifoaming agents or "antifoams." Unexpectedly, the addition of a range of antifoams to both shake flask and bioreactor cultures of P. pastoris has been shown to alter the total yield of the recombinant protein being produced. Possible explanations for this are that the presence of the antifoam increases the total amount of protein being produced and secreted per cell or that it increases the density of the culture. Antifoaming agents may therefore have specific effects on the growth and yield characteristics of recombinant cultures, in addition to their primary action as de-foamers.

Effect of fatigue on consumers' advertising processing

Huge advertising budgets are invested by firms to reach and convince potential consumers to buy their products. To optimize these investments, it is fundamental not only to ensure that appropriate consumers will be reached, but also that they will be in appropriate reception conditions. Marketing research has focused on the way consumers react to advertising, as well as on some individual and contextual factors that could mediate or moderate the ad impact on consumers (e.g. motivation and ability to process information or attitudes toward advertising). Nevertheless, a factor that potentially influences consumers’ advertising reactions has not yet been studied in marketing research: fatigue. Fatigue can yet impact key variables of advertising processing, such as cognitive resources availability (Lieury 2004). Fatigue is felt when the body warns to stop an activity (or inactivity) to have some rest, allowing the individual to compensate for fatigue effects. Dittner et al. (2004) defines it as “the state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli.’’ It signals that resources will lack if we continue with the ongoing activity. According to Schmidtke (1969), fatigue leads to troubles in information reception, in perception, in coordination, in attention getting, in concentration and in thinking. In addition, for Markle (1984) fatigue generates a decrease in memory, and in communication ability, whereas it increases time reaction, and number of errors. Thus, fatigue may have large effects on advertising processing. We suggest that fatigue determines the level of available resources. Some research about consumer responses to advertising claim that complexity is a fundamental element to take into consideration. Complexity determines the cognitive efforts the consumer must provide to understand the message (Putrevu et al. 2004). Thus, we suggest that complexity determines the level of required resources. To study this complex question about need and provision of cognitive resources, we draw upon Resource Matching Theory. Anand and Sternthal (1989, 1990) are the first to state the Resource Matching principle, saying that an ad is most persuasive when the resources required to process it match the resources the viewer is willing and able to provide. They show that when the required resources exceed those available, the message is not entirely processed by the consumer. And when there are too many available resources comparing to those required, the viewer elaborates critical or unrelated thoughts. According to the Resource Matching theory, the level of resource demanded by an ad can be high or low, and is mostly determined by the ad’s layout (Peracchio and Myers-Levy, 1997). We manipulate the level of required resources using three levels of ad complexity (low – high – extremely high). On the other side, the resource availability of an ad viewer is determined by lots of contextual and individual variables. We manipulate the level of available resources using two levels of fatigue (low – high). Tired viewers want to limit the processing effort to minimal resource requirements by making heuristics, forming overall impression at first glance. It will be easier for them to decode the message when ads are very simple. On the contrary, the most effective ads for viewers who are not tired are complex enough to draw their attention and fully use their resources. They will use more analytical strategies, looking at the details of the ad. However, if ads are too complex, they will be too difficult to understand. The viewer will be discouraged to process information and will overlook the ad. The objective of our research is to study fatigue as a moderating variable of advertising information processing. We run two experimental studies to assess the effect of fatigue on visual strategies, comprehension, persuasion and memorization. In study 1, thirty-five undergraduate students enrolled in a marketing research course participated in the experiment. The experimental design is 2 (tiredness level: between subjects) x 3 (ad complexity level: within subjects). Participants were randomly assigned a schedule time (morning: 8-10 am or evening: 10-12 pm) to perform the experiment. We chose to test subjects at various moments of the day to obtain maximum variance in their fatigue level. We use Morningness / Eveningness tendency of participants (Horne & Ostberg, 1976) as a control variable. We assess fatigue level using subjective measures - questionnaire with fatigue scales - and objective measures - reaction time and number of errors. Regarding complexity levels, we have designed our own ads in order to keep aspects other than complexity equal. We ran a pretest using the Resource Demands scale (Keller and Bloch 1997) and by rating them on complexity like Morrison and Dainoff (1972) to check for our complexity manipulation. We found three significantly different levels. After having completed the fatigue scales, participants are asked to view the ads on a screen, while their eye movements are recorded by the eye-tracker. Eye-tracking allows us to find out patterns of visual attention (Pieters and Warlop 1999). We are then able to infer specific respondents’ visual strategies according to their level of fatigue. Comprehension is assessed with a comprehension test. We collect measures of attitude change for persuasion and measures of recall and recognition at various points of time for memorization. Once the effect of fatigue will be determined across the student population, it is interesting to account for individual differences in fatigue severity and perception. Therefore, we run study 2, which is similar to the previous one except for the design: time of day is now within-subjects and complexity becomes between-subjects

Using organoclay to promote morphology refinement and co-continuity in high-density polyethylene/polyamide 6 blends - Effect of filler content and polymer matrix composition

We investigate the gradual changes of the microstructure of two blends of high-density polyethylene (HDPE) and polyamide 6 (PA6) at opposite composition filled with increasing amounts of an organomodified clay. The filler locates preferentially inside the polyamide phase, bringing about radical alterations in the micron-scale arrangement of the polymer phases. When the host polyamide represents the major constituent, a sudden reduction of the average sizes of the polyethylene droplets was observed upon addition of even low amounts of organoclay. A morphology refinement was also noticed at low filler contents when the particles distributes inside the minor phase. In this case, however, keep increasing the organoclay content eventually results in a high degree of PA6 phase continuity. Rheological analyses reveal that the filler loading at which the polyamide assembles in a continuous network corresponds to the critical threshold for its rheological transition from a liquid- to a gel-like behaviour, which is indicative of the structuring of the filler inside the host PA6. On the basis of this finding, a schematic mechanism is proposed in which the role of the filler in driving the space arrangement of the polymer phases is discussed. Finally, we show that the synergism between the reinforcing action of the filler and its ability to affect the blend microstructure can be exploited in order to enhance relevant technological properties of the materials, such as their high temperature structural integrity.

Formation and characterization of ultra-sensitive surface plasmon resonance sensor based upon a nano-scale corrugated multi-layered coated D-shaped optical fiber

We present experimental results on the performance of a series of coated, D-shaped optical fiber sensors that display high spectral sensitivities to external refractive index. Sensitivity to the chosen index regime and coupling of the fiber core mode to the surface plasmon resonance (SPR) is enhanced by using specific materials as part of a multi-layered coating. We present strong evidence that this effect is enhanced by post ultraviolet radiation of the lamellar coating that results in the formation of a nano-scale surface relief corrugation structure, which generates an index perturbation within the fiber core that in turn enhances the coupling. We have found reasonable agreement when we modeling the fiber device. It was found that the SPR devices operate in air with high coupling efficiency in excess of 40 dB with spectral sensitivities that outperform a typical long period grating, with one device yielding a wavelength spectral sensitivity of 12000 nm/RIU in the important aqueous index regime. The devices generate SPRs over a very large wavelength range, (visible to 2 mu m) by alternating the polarization state of the illuminating light.

Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.