Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial

Objective To compare the pubovaginal sling and transurethral Macroplastique in the treatment of female stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD). Design A prospective randomised controlled trial comparing two surgical treatments for SUI and ISD. Setting Tertiary referral urogynaecology unit in Australia. Population Women with SUI and ISD who were suitable for either surgical technique. Methods Forty-five women with SUI and ISD were randomly allocated the pubovaginal sling (n = 22) or transurethral Macroplastique (n = 23). Subjective and objective success rates, patient satisfaction and cost measurements at six months and one year following surgery were the primary outcome measures. A telephone questionnaire survey was performed at a mean follow up period of 62 months (43-71). Main outcome measure Comparison of success rates, complications and costs. Results The symptomatic and patient satisfaction success rates were similar following the sling and Macroplastique with the objective success rate being significantly greater (P < 0.001) following the sling (81% vs 9%). Macroplastique had significantly lower morbidity but was more expensive than the sling (P < 0.001). Response rate at 62 months follow up was 60% in both groups with the sling group reporting better continence success (69% vs 21%) and satisfaction rates (69% vs 29%, P = 0.057). Conclusions The pubovaginal sling was more effective and economical than transurethral Macroplastique for the treatment of SUI and ISD. However, transurethral Macroplastique remains an appropriate treatment in selected cases of SUI and ISD.

Smoking status of Australian general practice patients and their attempts to quit

This paper seeks to report on smoking rates, quit attempt methods and success rates among adult patients attending Australian general practice. A cluster cross-sectional survey was used to survey adult patients (18+), who attended Australian GPs in during 2002 and 2003. Over a quarter of patients (27.3%; 95% CI: 26.0-28.7) were former smokers and one in five (21.5%; 95% CI: 20.1-22.9) were current smokers. Ninety-two percent of former and 80% of current smokers used only one method in their last quit attempt with cold turkey the most common method used by both former (88%) and current (62%) smokers. Overall, success rates varied from 77% for cold turkey to 23% for bupropion. Success rates were re-analysed to consider quit attempts post-bupropion listing, with success rate for cold turkey reduced to 40% while bupropion remained reasonably constant at 21%. By tailoring smoking cessation interventions to a smokers' preparedness to quit, scope exists to increase the pool of smokers offered strategies that are more effective in achieving abstinence and avoiding relapse rather than relying on less effective self-quitting behaviours such as cold turkey. (c) 2005 Elsevier Ltd. All rights reserved.

Measuring the benefits of a psychology placement year

Placement programmes are considered to provide students with an induction into the work environment and a valuable learning experience. Aston University maintains one of the highest success rates of any UK university for graduate employment and it is thought that the placement year plays a large role in this success. However, the benefits of placements in theoretical subjects like Psychology are often less obvious than those for practical subjects like Optometry or Engineering. Here we compared Psychology students on the 3-year vs. the 4-year sandwich course on a number of attributes using both quantitative and qualitative methodologies. Final year students who had taken a placement year achieved significantly higher marks in their final year (F 1,407=31.52, p<0.001) and were rated more favourably by academic staff on a measure of transferable skills (F1,43= 11.08, p<0.005). In addition, post-graduation, students who had taken a placement year reported a better idea of their career direction and could be argued to be further on in terms of their career progression and pay levels. Qualitatively, focus groups of placement and non-placement students suggested a number of benefits of taking a placement year, including better time management, confidence and responsibility. Whether the benefits of a sandwich placement in a psychology degree outweigh the costs to students and their families, and the need for further research to identify the scope and longevity of possible early career benefits are discussed. © 2006 Taylor & Francis.

Widening access to Higher Education:an evaluative case study of a foundation year alternative to access

Universities are encouraged to widen access to a broad range of applicants, including mature students taking Access qualifications. Admissions tutors can find it difficult to compare and choose between Access and A-level applications, and Access applicants for popular courses may be disadvantaged relative to students with good A-levels. In this evaluative case study a foundation year designed to avoid Access selection problems and widen participation in psychology, biology, optometry and pharmacy is reviewed. Progression and success rates are compared to national averages for Access courses and issues in Foundation Year management considered. The Foundation Year is rejected as unsatisfactory and it is concluded that widening participation for mature students can be achieved through Access courses. Difficulties in achieving this for high-demand courses in leading universities are discussed.

Surface properties of enterococcus faecalis in relation to infective endocarditis

The effect of growth conditions on both the appearance and the antigenic profile of cells of Enterococcus faecalis was investigated using electron micrographs of ruthenium red stained and sectioned cells and SDS-PAGE and blotting techniques respectively. Three specific antigens of molecular weights 73, 40 and 37 kdaltons were of particular interest being expressed most strongly after growth in serum. This medium was deemed to most closely mimic jn vjvo growth conditions reflecting an environment similar to that which the microorganisms would encounter during bacteraemia, preceding the colonisation of the endocardium and the development of infective endocarditis. The 40 and 37 kdalton antigens were shown by immunoqold labelling to be exposed on the surface of the cells although they did not appear to be connected with the fimbriae shown to exist on some of the E. faecalis cells examined by negative staining. The 73, 40 and 37 kdalton antigens were crudely purified using sarkosyl and ammonium sulphate precipitation, and used as the basis of a serodiagnostic test for E. faecalis endocarditis using an ELISA system. This was tested in a blind trial and the success rates were 94% for positives, 90% for negatives with endocarditis caused by other organisms and 80% for E. faecalis infections other than endocarditis. The binding of E.faecalis cells to the serum proteins fibronectin and albumin was investigated using 125I labelled proteins, followed by Scatchard analysis. This showed that· E.faecalis cells do loosely bind large amounts of both of these proteins, thus surely affecting the way in which the host's immune system perceives the cells. The E.faecalis receptor for fibronectin was partially characterised and appeared to involve protein and/or carbohydrate containing components. but did not involve LTA or the 40 and 37 kdalton species specific antigens.

Agent-orientated auction mechanism and strategy design

Agent-based technology is playing an increasingly important role in today’s economy. Usually a multi-agent system is needed to model an economic system such as a market system, in which heterogeneous trading agents interact with each other autonomously. Two questions often need to be answered regarding such systems: 1) How to design an interacting mechanism that facilitates efficient resource allocation among usually self-interested trading agents? 2) How to design an effective strategy in some specific market mechanisms for an agent to maximise its economic returns? For automated market systems, auction is the most popular mechanism to solve resource allocation problems among their participants. However, auction comes in hundreds of different formats, in which some are better than others in terms of not only the allocative efficiency but also other properties e.g., whether it generates high revenue for the auctioneer, whether it induces stable behaviour of the bidders. In addition, different strategies result in very different performance under the same auction rules. With this background, we are inevitably intrigued to investigate auction mechanism and strategy designs for agent-based economics. The international Trading Agent Competition (TAC) Ad Auction (AA) competition provides a very useful platform to develop and test agent strategies in Generalised Second Price auction (GSP). AstonTAC, the runner-up of TAC AA 2009, is a successful advertiser agent designed for GSP-based keyword auction. In particular, AstonTAC generates adaptive bid prices according to the Market-based Value Per Click and selects a set of keyword queries with highest expected profit to bid on to maximise its expected profit under the limit of conversion capacity. Through evaluation experiments, we show that AstonTAC performs well and stably not only in the competition but also across a broad range of environments. The TAC CAT tournament provides an environment for investigating the optimal design of mechanisms for double auction markets. AstonCAT-Plus is the post-tournament version of the specialist developed for CAT 2010. In our experiments, AstonCAT-Plus not only outperforms most specialist agents designed by other institutions but also achieves high allocative efficiencies, transaction success rates and average trader profits. Moreover, we reveal some insights of the CAT: 1) successful markets should maintain a stable and high market share of intra-marginal traders; 2) a specialist’s performance is dependent on the distribution of trading strategies. However, typical double auction models assume trading agents have a fixed trading direction of either buy or sell. With this limitation they cannot directly reflect the fact that traders in financial markets (the most popular application of double auction) decide their trading directions dynamically. To address this issue, we introduce the Bi-directional Double Auction (BDA) market which is populated by two-way traders. Experiments are conducted under both dynamic and static settings of the continuous BDA market. We find that the allocative efficiency of a continuous BDA market mainly comes from rational selection of trading directions. Furthermore, we introduce a high-performance Kernel trading strategy in the BDA market which uses kernel probability density estimator built on historical transaction data to decide optimal order prices. Kernel trading strategy outperforms some popular intelligent double auction trading strategies including ZIP, GD and RE in the continuous BDA market by making the highest profit in static games and obtaining the best wealth in dynamic games.

Potential causes of ethnic group disparities in infertility:a hospital database study

Introduction - Lower success rates of in vitro fertilisation (IVF) in South East Asian countries compared to Western countries in informal studies and surveys was considered a reflection of variations in methodology and expertise. However, recent studies on the effects of ethnicity on success rates of infertility procedures in western countries have suggested other inherent contributing factors to the ethnic disparity but the evidence evaluating these is lacking. In our study we aim to investigate some of the comorbidities that might cause ethnic disparity to infertility and related procedures from hospital admissions data. Methods - Anonymous hospital admissions data on patients of various ethnic groups with infertility, comorbidities and infertility procedures from multiple hospitals in Birmingham andManchester, UK between 2000 and 2013 were obtained from the local health authority computerised hospital activity analysis register using ICD-10 and OPCS coding systems. Statistical analysis was performed using SPSS version 20.Results Of 522 223 female patients aged 18 and over, there were44 758 (8.4%) patients from South Asian (SA) community. 1156(13.4%) of the 8653 patients coded for infertility were SA, whichis a considerably higher proportion of the background SA population. For IVF procedures, the percentage of SA increased to15.4% (233 of the total 1479 patients). The mean age of SA codedfor infertility (30.6 ± 4.7 SD years versus 32.8 ± 4.9 SD years)and IVF (30.4 ± 4.3 SD years versus 32.7 ± 4.4 SD years) was significantly lower than caucasian patien ts (P < 0.001). A multivariate logistic regression model looking at patients with infertility, accounting for variations in age, showed that SA have significantly higher prevalence of hypothyroidism, obesity andiron-deficiency anaemia compared to caucasians but lower prevalence of endometriosis. Interestingly, psychiatric and psychological conditions diagnoses were seldom registered in infertility patients. Conclusion - Other studies suggest that various cultural, lifestyles, psychosocial and socio-economic factors may explain the disparities in IVF success rates between South Asians and caucasians. The fact that SA infertility and IVF patients, in ou rstudy, were significantly younger than caucasians and that their proportion is considerably higher than the background South Asian population suggests the influence of these factors. A significant psychiatric disease burden in other conditions and low numbers in our data suggest under diagnosis in this group.Despite the limitations of the coding data, from our study, we propose that hypothyroidism, obesity and/or iron-deficiency anaemia should be considered for the ethnic disparity. Further research in this topic is essential to fully investigate the reasons for such ethnic disparities.

The Barriers to the Integration of the Uterine Balloon Tamponade into South Africa and Ghana's Health Systems for the Management of Postpartum Hemorrhage

Background

Postpartum hemorrhage is the most significant contributor to maternal mortality globally, claiming 140,000 lives annually. Postpartum hemorrhage is a leading cause of maternal death in South Africa, with the literature indicating that 80 percent of the postpartum hemorrhage deaths in South Africa are avoidable. Ghana, as of 2010, witnesses 2700 maternal deaths annually, primarily because of poor quality of care in health facilities and services being difficult to access. As per WHO recommendations, uterotonics are integral to treating postpartum hemorrhage as soon as it is diagnosed. In case of persistent bleeding or limited availability of uterotonics, the uterine balloon tamponade (UBT) can be used as a second line of defense. If both these measures are unable to counter the bleeding, providers must perform surgical interventions. Literature on the UBT, as one tool in the protocol to address postpartum hemorrhage, has shown it to have success rates ranging from 60 to 100 percent. Despite the potential to lower the number of postpartum hemorrhage deaths in South Africa and Ghana, the UBT has not been incorporated widely in South Africa and Ghana. The aim of this study is to describe the barriers involved with integrating the UBT into South Africa and Ghana’s health systems to address postpartum hemorrhage.

Methods

The study took place in multiple sites in South Africa (Cape Town, Johannesburg, Durban and Mpumalanga) and in Accra, Ghana. South Africa and Ghana were selected because postpartum hemorrhage contributes greatly to their maternal mortality numbers and there is potential in both countries to lower those rates through greater use of the UBT. A total of 25 participants were interviewed through purposive sampling, snowball sampling and participant referrals, and included various categories of stakeholders integral to the integration process of a medical device. Individual in-depth interviews were used for data collection, with interview questions being tailored to each stakeholder category. The focus of the interviews was on the protocol used to counter postpartum hemorrhage, the frequency with which the UBT is used as part of the protocol, and the process of integrating it into the South Africa and Ghana’s health systems. The data collected were coded using NVivo and analyzed using content analysis.

Results

The barriers to integration of the uterine balloon tamponade to address postpartum hemorrhage in South Africa and Ghana were evident on the political, economic and health delivery levels. The results indicated that the barriers to integration in South Africa included the low recognition of postpartum hemorrhage as a problem, the lack of clarity surrounding the role of the Medicines Control Council as a regulatory body for medical devices, and low awareness of the UBT as an intervention to control postpartum hemorrhage. The barriers in Ghana were the cash constraints experienced by the Ghana Health Services to fund medical devices, a heavy reliance on donors for funding, and the lack of consistent knowledge on processes involving clinical trials for new medical devices in Ghana.

Conclusion

Existing literature on methods to counter postpartum hemorrhage to reduce maternal mortality has focused on and emphasized the efficacy of the UBT. Despite overwhelming evidence supporting the use of the UBT, many health systems across the world, particularly low-income countries, do not have access to the device owing to numerous barriers in integrating the device into obstetric care. This study illustrates the need to focus on incorporating the UBT into health systems for greater availability to health workers and its use as standard of care. Ultimately, this study can be used as a stepping-stone for more research on this subject, providing evidence to influence policymakers to integrate the UBT into their protocols for postpartum hemorrhage response.

Innovation in the pharmaceutical industry: New estimates of R&D costs.

The research and development costs of 106 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms. These data were used to estimate the average pre-tax cost of new drug and biologics development. The costs of compounds abandoned during testing were linked to the costs of compounds that obtained marketing approval. The estimated average out-of-pocket cost per approved new compound is $1395 million (2013 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 10.5% yields a total pre-approval cost estimate of $2558 million (2013 dollars). When compared to the results of the previous study in this series, total capitalized costs were shown to have increased at an annual rate of 8.5% above general price inflation. Adding an estimate of post-approval R&D costs increases the cost estimate to $2870 million (2013 dollars).

The Debate on First Nations Education Funding: Mind the Gap (Working Paper 49)

It is at long last becoming part of the public discourse that improving living conditions and opportunities for First Nations communities in Canada is a national imperative. It is also widely recognized that the education is critical to fostering a better future for First Nations people. Yet, for many First Nations youth, particularly those on reserve, completing even high school is well beyond reach. The graduation rate of First Nations people living on reserve was 35.3 per cent as recently as 2011 compared with 78 per cent for the population as a whole. At the same time, the First Nations population is young and growing fast - in First Nations communities 49 per cent of the population is under 24 years of age compared to 30 per cent of the general population. Despite some incremental improvements in education success rates for First Nations students in recent years, the education gap between First Nations and the rest of the country is increasing. The concerns expressed in the 2011 Auditor General report continue to hold weight: "In 2004, we noted that at existing rates, it would take 28 years for First Nations communities to reach the national average. More recent trends suggest that the time needed may still be longer.

Sistemas auxiliares de desinfeção em Endodontia

Introdução: O objetivo da terapia endodôntica é eliminar a infeção presente nos canais radiculares e prevenir a reinfeção dos mesmos, criando assim as condições para a manutenção da peça dentária em função e livre de patologia pulpar ou peri-apical. A complexa anatomia dos canais faz com que seja impossível uma limpeza completa dos mesmos. Para se conseguir um bom resultado clínico é de extrema importância utilizarmos técnicas e procedimentos que visem uma utilização combinada de instrumentação mecânica e desinfeção com soluções de irrigação. Objetivo: Revisão bibliográfica sobre sistemas auxiliares de desinfeção em Endodontia, abordando as suas principais vantagens e limitações e apresentando estudos que provam a sua importância para o sucesso do tratamento endodôntico. Materiais e métodos: Realizou-se uma pesquisa eletrónica nos principais motores de busca online tais como PubMed, B-On, Scielo e Science Direct e em livros científicos sobre a temática, utilizando palavras-chave em inglês tais como “irrigation techniques”, “sonic irrigation”, “EndoVac”, “EDTA”, “hypoclorite sodium”, “passive ultrasonic irrigation”, “apical negative pressure irrigation”, “root canal irrigation”, “EndoAtivator”, e ainda alguns termos em português tais como “insucesso em endodontia”, “hipoclorito de sódio” “ácido cítrico” e “irrigação sónica e ultrasónica”. Da pesquisa efectuada entre Junho e Novembro de 2015 e cujo critério de inclusão foram artigos datados de 2001 a 2015, escolheu-se 65 artigos em inglês, 4 em português e 1 em espanhol, dos quais se utilizaram 44 artigos. Além dos artigos analisou-se 2 livros, dos quais se utilizou 1. Resultados: Os artigos analisados apresentam como principais resultados que a combinação de instrumentação mecânica e a irrigação reduz mas não elimina totalmente as bactérias. Até à data não existem soluções de irrigação ideais. Têm-se desenvolvido técnicas capazes de combater as dificuldades encontradas e aumentar as potencialidades da irrigação, cada uma apresentando suas vantagens e desvantagens. Dos resultados constatados, a literatura científica aparenta reconhecer o Sistema EndoVac como o melhor em termos de biossegurança e o sistema de irrigação ultrasónica passiva como o melhor em termos de desinfecção e limpeza. Conclusão: Uma combinação de soluções com uma sequência específica é aparentemente necessária para atingir o sucesso endodôntico, bem como uma escolha adequada da técnica. As novas técnicas desenvolvidas tais como a ativação dinâmica manual, irrigação ultrasónica passiva, ativação sónica e sistemas de pressão apical negativa apresentam melhores resultados quando associados a irrigantes adequados como o hipoclorito, EDTA, ácido cítrico, clorohexidina e álcool. No entanto, concluiu-se que mais investigação é necessária para melhorar o sucesso do tratamento endodôntico não-cirúrgico.

Alveolite

A etiologia da alveolite é desconhecida. Considera-se não haver uma causa específica, mas sim uma associação de factores inerentes ao seu aparecimento. O diagnóstico é realizado, geralmente, entre o 2º e 5º dia após exodontia, sendo bastante claro. Manifesta-se por uma dor aguda e pulsátil, mal controlada com analgésicos, e de apresentação clínica uma inflamação da mucosa em torno do alvéolo, com parcial ou total perda do coágulo, apresentando-se este vazio ou com tecido necrótico e/ou restos alimentares. Pode ainda haver uma exposição óssea. Diversas são as taxas de incidência, variando consoante os factores de risco predisponentes da doença. São estes a idade, género, ciclo menstrual e toma de contraceptivos orais (nas mulheres), trauma cirúrgico e experiência do médico, a indicação da extração, bem como características do dente a ser extraído, ainda as técnicas e anestesia usadas, bem como remanescentes ósseos e/ou radiculares, uso de retalhos e suturas, patologias sistémicas, medicação e cuidados pós-operatórios do doente. Todos estes podem ter impacto no desenvolvimento desta condição, devendo o médico dentista eliminá-los e reduzi-los ao máximo. A prevenção aplica-se a medidas não farmacológicas, como redução de factores de risco, em combinação a terapia farmacológica, de modo a favorecer uma correta cicatrização. Recurso a soluções antissépticas, medicação tópica (intra-alveolar) e prescrição sistémica de antibióticos e anti-inflamatórios não esteroides são algumas dessas medidas. Ao nível do tratamento, vários métodos e materiais estão disponíveis no mercado. Por ser uma condição que o próprio organismo “combate”, o objectivo terapêutico passa basicamente pela redução dos sintomas debilitantes do paciente e controlo bacteriano. A opção é individual, uma vez que não existe nenhum tratamento com características ideais, sendo os resultados na literatura bastante discrepantes. Limpeza do alvéolo, medicação intra-alveolar (tópica) e/ou sistémica, bem como terapia com laser de baixa intensidade, são algumas opções. A administração antibiótica deve ser reservada para casos especiais, não devendo ser abordada como método de rotina. Analgésicos são uma opção, podendo ser aconselhada consoante o quadro clínico doloroso. Também o reforço para uma higiene oral rigorosa, com irrigação do alvéolo para evitar detritos e impactação alimentar (no caso de não existirem obtundantes intra-alveolares) devem ser preocupação do médico dentista. Deve haver um seguimento regular do paciente, especialmente se aplicados medicamentos tópicos, para avaliação e renovação (se necessário) do curativo até recuperação. O médico dentista deve saber identificar um caso de alveolite, encontrando-se informado e consciente das várias opções preventivas e terapêuticas. Estudos mais claros e objectivos são necessários na procura de critérios de diagnóstico genéricos da doença, bem como terapêuticas preventivas e de tratamentos com taxas de sucesso altas e suportadas por evidência científica. Para que, desta forma, seja elaborado um protocolo universal a seguir na prática clínica.

Cárie secundária e propriedades antibacterianas dos materiais restauradores

Grande parte do tempo clínico do Médico Dentista é, atualmente, gasto a substituir restaurações dentárias realizadas no passado devido a fraturas ou fenómenos de cárie secundária. Pesquisou-se, assim, para a realização desta monografia em diferentes bases de pesquisa acerca dos fenómenos de cárie e cárie secundária. Um dos objetivos desta revisão bibliográfica estudar a microbiologia associada á cárie secundária, a histopatologia da lesão, o diagnóstico e os problemas associados ao diagnóstico. pretende-se, também, nesta monografia devido á sua pertinência investigar o potencial bacteriostático e bactericida dos diversos materiais disponíveis e em que situações esse efeito é potenciado, de modo a auxiliar o clinico na sua decisão no momento de restauração dentária, procurando prevenir ou adiar a necessidade de efetuar uma nova restauração. Para a realização desta monografia foram realizadas pesquisas nos motores de busca PubMed, B-on, Science Direct e Sci-elo. Depois de selecionados os artigos com interesse e com a utilização de seguintes palavras-chave e combinações de palavras sendo que no final foram selecionados 58 Artigos, dentro dos últimos 10 anos na língua portuguesa e na língua inglesa. Apesar da microbiologia e dos fenómenos histopatológicos de desenvolvimento da lesão estarem bem documentados, não existe consenso no que toca ao diagnóstico e tratamento das lesões. Existem diversos métodos de diagnóstico ao alcance da prescrição do Médico Dentista, sendo que, no entanto, nem todos estão indicados para o diagnóstico de lesões de cárie. Face á grande variedade de materiais restauradores e sistemas adesivos existentes no mercado torna-se imperativo que o Médico Dentista tenha os conhecimentos necessários sobre o potencial antibacteriano desses mesmos materiais. Sendo, assim, capaz de concluir mediante a situação apresentada: as vantagens, desvantagens e potencialidades dos diversos materiais á sua disposição na prevenção de lesões de cárie inicial e cárie secundária, aumentando a sobrevivência das peças dentárias. Conclui-se que a cárie secundária não é um fenómeno exclusivo a nenhum tipo de material forrador, ou restaurador não existindo também nenhum material capaz de efetuar com elevadas taxas de sucesso a sua prevenção. Contudo, atualmente, vem-se procurando a utilização de materiais que proporcionem um maior selamento da estrutura dentária, diminuindo a microinfiltração e consequentemente diminuindo os fenómenos de cárie secundária.

Variation of cutting rooting ability in cultivated and wild species of Macadamia

In Australia, macadamia trees are commonly propagated by germinating rootstock seed and grafting when seedlings reach a suitable size. The production of grafted trees is a protracted and complex process, however, propagation of macadamia via cuttings represents a simpler and faster method of multiplication. Macadamias have traditionally proven difficult to propagate from cuttings, and while recent developments in the process have improved success rates, substantial variation in rooting ability between cultivars and species has been reported. The cultivar 'Beaumont' (Macadamia integrifolia × M. tetraphylla) is commonly propagated by cutting for use as a rootstock, and is relatively easy to strike while other cultivars are more difficult. There is speculation that Hawaiian cultivars are more difficult to strike from cuttings than Australian cultivars due to species and genetic composition. In this experiment, cuttings of 32 genotypes were evaluated for rooting ability. Each genotype's species profile was estimated using historical data, and used to determine species effects on survival (percentage) and rooting ability (rating 0-2). M. jansenii (100%), M. tetraphylla (84%) and M. integrifolia/tetraphylla hybrids (79%) had the highest success rates while M. integrifolia (54%) and M. ternifolia (43%) had the lowest survival. Rooting ability of M. jansenii (1.75) was significantly higher than M. ternifolia (0.49) but not significantly higher than M. tetraphylla × M. integrifolia with (1.09), M. tetraphylla (1.03) or M. integrifolia (0.88).

Business model evolution and firm performance of entrepreneurial companies

This research explores the business model (BM) evolution process of entrepreneurial companies and investigates the relationship between BM evolution and firm performance. Recently, it has been increasingly recognised that the innovative design (and re-design) of BMs is crucial to the performance of entrepreneurial firms, as BM can be associated with superior value creation and competitive advantage. However, there has been limited theoretical and empirical evidence in relation to the micro-mechanisms behind the BM evolution process and the entrepreneurial outcomes of BM evolution. This research seeks to fill this gap by opening up the ‘black box’ of the BM evolution process, exploring the micro-patterns that facilitate the continuous shaping, changing, and renewing of BMs and examining how BM evolutions create and capture value in a dynamic manner. Drawing together the BM and strategic entrepreneurship literature, this research seeks to understand: (1) how and why companies introduce BM innovations and imitations; (2) how BM innovations and imitations interplay as patterns in the BM evolution process; and (3) how BM evolution patterns affect firm performances. This research adopts a longitudinal multiple case study design that focuses on the emerging phenomenon of BM evolution. Twelve entrepreneurial firms in the Chinese Online Group Buying (OGB) industry were selected for their continuous and intensive developments of BMs and their varying success rates in this highly competitive market. Two rounds of data collection were carried out between 2013 and 2014, which generates 31 interviews with founders/co-founders and in total 5,034 pages of data. Following a three-stage research framework, the data analysis begins by mapping the BM evolution process of the twelve companies and classifying the changes in the BMs into innovations and imitations. The second stage focuses down to the BM level, which addresses the BM evolution as a dynamic process by exploring how BM innovations and imitations unfold and interplay over time. The final stage focuses on the firm level, providing theoretical explanations as to the effects of BM evolution patterns on firm performance. This research provides new insights into the nature of BM evolution by elaborating on the missing link between BM dynamics and firm performance. The findings identify four patterns of BM evolution that have different effects on a firm’s short- and long-term performance. This research contributes to the BM literature by presenting what the BM evolution process actually looks like. Moreover, it takes a step towards the process theory of the interplay between BM innovations and imitations, which addresses the role of companies’ actions, and more importantly, reactions to the competitors. Insights are also given into how entrepreneurial companies achieve and sustain value creation and capture by successfully combining the BM evolution patterns. Finally, the findings on BM evolution contributes to the strategic entrepreneurship literature by increasing the understanding of how companies compete in a more dynamic and complex environment. It reveals that, the achievement of superior firm performance is more than a simple question of whether to innovate or imitate, but rather an integration of innovation and imitation strategies over time. This study concludes with a discussion of the findings and their implications for theory and practice.