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In today's competitive global economy, most managers are - or will be - global managers. They may work in their home country, but are influenced by global events and have to manage diverse workforces. As such, they need multicultural competence and global management skills to work successfully across cultures. This new edition pairs a richly illustrated text with management applications, key concepts, discussion questions, web-based cases and skill-building exercises aimed at current and aspiring managers. Each chapter is accompanied by a Manager's Notebook highlighting field strategies and encouraging students to develop multicultural competence that will be highly valued by future employers. Exploring the challenges and opportunities facing global managers, readers can examine cultural, organizational, and managerial environments before developing a range of skills from communication and leadership to negotiation and global team management. Suitable for students taking courses in international management, cross-cultural management or international HRM at advanced undergraduate, Masters and MBA levels.
Identifying risk factors of individuals in a clinical-high-risk state for psychosis are vital to prevention and early intervention efforts. Among prodromal abnormalities, cognitive functioning has shown intermediate levels of impairment in CHR relative to first-episode psychosis and healthy controls, highlighting a potential role as a risk factor for transition to psychosis and other negative clinical outcomes. The current study used the AX-CPT, a brief 15-min computerized task, to determine whether cognitive control impairments in CHR at baseline could predict clinical status at 12-month follow-up.
Baseline AX-CPT data were obtained from 117 CHR individuals participating in two studies, the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP) and the Understanding Early Psychosis Programs (EP) and used to predict clinical status at 12-month follow-up. At 12 months, 19 individuals converted to a first episode of psychosis (CHR-C), 52 remitted (CHR-R), and 46 had persistent sub-threshold symptoms (CHR-P). Binary logistic regression and multinomial logistic regression were used to test prediction models.
Baseline AX-CPT performance (d-prime context) was less impaired in CHR-R compared to CHR-P and CHR-C patient groups. AX-CPT predictive validity was robust (0.723) for discriminating converters v. non-converters, and even greater (0.771) when predicting CHR three subgroups.
These longitudinal outcome data indicate that cognitive control deficits as measured by AX-CPT d-prime context are a strong predictor of clinical outcome in CHR individuals. The AX-CPT is brief, easily implemented and cost-effective measure that may be valuable for large-scale prediction efforts.
Over 80% of CTSA programs have a community advisory board (CAB). Little is known about how research discussed with CABs aligns with community priorities (bidirectionality). This program evaluation assessed researcher presentations from 2014 to 2018 to the CABs linked to our CTSA at all three sites (Minnesota, Arizona, and Florida) for relevance to local community needs identified in 2013 and/or 2016. From content analysis, of 65 presentations total, 41 (63%) addressed ≥1 local health needs (47% Minnesota, 60% Florida, and 80% Arizona). Cross-cutting topics were cancer/cancer prevention (physical activity/obesity/nutrition) and mental health. Results could help to prioritize health outcomes of community-engaged research efforts.
To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.
Retrospective cohort study.
Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.
We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.
We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.
Common bean (Phaseolus vulgaris L.) is perhaps the most important grain legume in sub-Saharan Africa (SSA) smallholder systems for food security and household income. Although a wide choice of varieties is available, smallholder farmers in western Kenya realize yields that are low and variable since they operate in risky production environments. Significant seasonal variations exist in rainfall and severity of pests and diseases. This situation is worsened by the low and declining soil fertility, coupled with low capacity of farmers to purchase production inputs such as fertilizers, fungicides and insecticides, and land scarcity. The objective of this study was to investigate whether growing multiple-bean varieties instead of a single variety can enable farmers enhance yield stability over seasons and ensure food security. Five common bean varieties were evaluated in multiple farms for 11 seasons at Kapkerer in Nandi County, western Kenya. Data were collected on grain yield, days to 50% flowering and major diseases. In addition, daily rainfall was recorded throughout the growing seasons. The five varieties were combined in all possible ways to create 31 single- and multiple-bean production strategies. The strategies were evaluated for grain yield performance and yield stability over seasons to determine the risk of not attaining a particular yield target. Results indicated that cropping multiple-bean varieties can be an effective way for reducing production risks in heterogeneous smallholder systems. Yield stability can be greatly enhanced across diverse environments, leading to improved food security, especially for the resource-poor smallholder farmers operating in risk-prone environments. Although the results show that some of the single-bean variety strategies were high yielding, their yield stability was generally lower than those of multiple strategies. Resource-poor risk averse farmers can greatly increase the probability of exceeding their yield targets by cropping multiple-bean varieties with relatively low yields but high grain yield stability. Trading-off high grain yield for yield stability might be an important strategy for minimizing bean production risks.
OBJECTIVES/SPECIFIC AIMS: Over 80% of CTSA programs have a community advisory board (CAB), an effective strategy to increase community engagement (CE) in research. Little is known about how the research discussed with CABs aligns with community priorities (i.e., bi-directionality). This program evaluation assessed the health topics presented by researchers to the CABs linked to our CE Program at all three Mayo Clinic sites (MN, AZ, and FL) for relevance to local community needs. METHODS/STUDY POPULATION: Two coders classified Mayo researcher presentations to our CABs from 2014-2018 for relevance to needs identified in the local 2013 and/or 2016 County Health Needs Assessments and specific topic(s); with high levels of agreement (Kappa=0.90). RESULTS/ANTICIPATED RESULTS: Overall, of the 65 presentations 41 (63%) addressed one or more local health needs (47% MN, 60% FL, 80% AZ). Cross-cutting health topics addressed at 2 sites were physical activity/obesity/nutrition and mental health. DISCUSSION/SIGNIFICANCE OF IMPACT: Findings were shared with our CABs to obtain input on future directions. The FL and AZ CABs are systematic in seeking out or initiating research projects that address local health needs, an approach the MN site is interested in adopting. Ultimately, it is important to demonstrate improved health outcomes with CTSA-based CE research strategies. Understanding community health needs and depth of researchers in those areas may help to focus priorities for demonstrating such outcomes.
The pipeline metaphor used to characterize dwindling interest in science and STEM-related careers has gradually been replaced by alternative models that convey complex pathways into, through and out of science by young men and women. In this chapter, we review literatures from educational psychology, cognitive development, and science education and present our own mixed methods approach to developing a model of the roles that children, parents and teachers play in launching, supporting, and sustaining pathways to science interest from early childhood to the transition to college. We use our longitudinal data to describe cases that illustrate these critical developmental inflection points. These rich cases illustrate the advantages of using qualitative methods, when possible, to augment developmental models derived from more quantitative approaches depicted through path diagrams, phase models, or Sankey diagrams. The cases discussed highlight critical roles that parents and teachers might play in nurturing science interests among males and females. Implications for future research and suggestions for practice are considered.
Development, in fact, may be viewed best as a set of multiple developmental trajectories, and our task as developmentalists is to discover how the interplay between different trajectories of children and adults accounts for outcomes.
The present study’s aim was to assess the impact of a nutrition-sensitive intervention on dietary diversity and home gardening among non-participants residing within intervention communities.
The study was a cross-sectional risk factor analysis using linear and logistic multivariate models.
In Tanzania, women and children often consume monotonous diets of poor nutritional value primarily because of physical or financial inaccessibility or low awareness of healthy foods.
Participants were women of reproductive age (18–49 years) in rural Tanzania.
Mean dietary diversity was low with women consuming three out of ten possible food groups. Only 23·4 % of respondents achieved the recommended minimum dietary diversity of five or more food groups out of ten per day. Compared with those who did not, respondents who had a neighbour who grew crops in their home garden were 2·71 times more likely to achieve minimum dietary diversity (95 % CI 1·60, 4·59; P=0·0004) and 1·91 times more likely to grow a home garden themselves (95 % CI 1·10, 3·33; P=0·02). Other significant predictors of higher dietary diversity were respondent age, education and wealth, and number of crops grown.
These results suggest that there are substantial positive externalities of home garden interventions beyond those attained by the people who own and grow the vegetables. Cost-effectiveness assessments of nutrition-sensitive agriculture, including home garden interventions, should factor in the effects on the community, and not just on the individual households receiving the intervention.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs.
This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty.
Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18–65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million.
There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.
In 1949, the critic and controversialist Paul Blanshard launched a broadside attack on the Catholic hierarchy in the United States with the publication of American Freedom and Catholic Power, his harshly critical exploration of the Catholic church's involvement in American public life. An instant best-seller, American Freedom and Catholic Power went through eleven printings in its first year and continued to draw new readers throughout the 1950s. Blanshard's mission was to alert Americans to the movements of a Catholic hierarchy that was becoming, he charged, “more and more aggressive in extending the frontiers of Catholic authority into the fields of medicine, education, and foreign policy.” He reserved some of his most stinging commentary for the church's intrusion into the world of medicine.
Psychosocial and health-related risk factors for depressive symptoms are known. It is unclear if these are associated with depressive symptom patterns over time. We identified trajectories of depressive symptoms and their risk factors among midlife women followed over 15 years.
Participants were 3300 multiracial/ethnic women enrolled in a multisite longitudinal menopause and aging study, Study of Women's Health Across the Nation. Biological, psychosocial, and depressive symptom data were collected approximately annually. Group-based trajectory modeling identified women with similar longitudinal patterns of depressive symptoms. Trajectory groups were compared on time-invariant and varying characteristics using multivariable multinomial analyses and pairwise comparisons.
Five symptom trajectories were compared (50% very low; 29% low; 5% increasing; 11% decreasing; 5% high). Relative to whites, blacks were less likely to be in the increasing trajectory and more likely to be in the decreasing symptom trajectory and Hispanics were more likely to have a high symptom trajectory than an increasing trajectory. Psychosocial/health factors varied between groups. A rise in sleep problems was associated with higher odds of having an increasing trajectory and a rise in social support was associated with lower odds. Women with low role functioning for 50% or more visits had three times the odds of being in the increasing symptom group.
Changes in psychosocial and health characteristics were related to changing depressive symptom trajectories. Health care providers need to evaluate women's sleep quality, social support, life events, and role functioning repeatedly during midlife to monitor changes in these and depressive symptoms.
Variability in superovulatory responses remains one of the major factors preventing the more widespread utilisation of embryo transfer in sheep breed improvement. Previous work in our group has suggested that in sheep receiving a standard superovulatory treatment regime using oFSH (Ovagen, Immuno-chemical Products Ltd., Auckland, NZ) there is an identifiable pool of follicles at the start of oFSH treatment that eventually ovulate following treatment. If this is the case then research efforts to increase the consistency of superovulatory responses should be focused on increasing the supply of follicles in this category. This experiment therefore had two aims, i) to test the theory that variability in superovulatory responses is a function of variability in the number of potentially ovulatory follicles at the time of the first FSH injection, and ii) to identify the size category of follicles at the start of superovulatory treatment that forms this ovulatory pool.
The bright nearby binary α Centauri constitutes an excellent laboratory for testing stellar evolution models. The mass, radius, and luminosity of α Cen A and B are known to better than 1% accuracy thanks to recent interferometric and adaptive optical observations, and p-mode oscillations have been observed in both stars. We present new stellar models which fit simultaneously the classical and seismic observations, with particular emphasis on the convective mixing length parameter MLT – the adaptivity of which is necessary to fit the models to observations. The oscillation data provide an important constraint on the models, as the small frequency separation is sensitive to the composition gradient in the core of the stars, while the large frequency separation constrains the mean density of the stars, providing an independent check on the mass and radius.
The interannual variations in atmospheric transport patterns to Summit, Greenland, are studied using twice-daily, three-dimensional, 10 day backward trajectory data corresponding to the summers (1 June–31 August) of 1989–98. While previous trajectory climatology studies have been prepared for Summit, the present work considers both the horizontal and vertical components of transport. A three-dimensional residence-time methodology is employed to account for both horizontal and vertical components of transport. the vertical transport component is quantified by passing all trajectories through a three-dimensional grid and tracking the time spent (i.e. the residence time) in each gridcell. This method also allows inspection of trajectory altitude distributions corresponding to transport from upwind regions of interest. the three-dimensional residence-time methodology is shown to be a valuable tool for diagnosing the details of long-range atmospheric transport to remote locations. for Summit, we find that the frequent transport from North America tends to occur at low altitudes, whereas transport from Europe is highly variable. Mean summertime flow patterns are described, as are anomalous patterns during 1990,1996 and 1998.
We introduce the conditional frailty model, an event history model that separates and accounts for both event dependence and heterogeneity in repeated events processes. Event dependence and heterogeneity create within-subject correlation in event times thereby violating the assumptions of standard event history models. Simulations show the advantage of the conditional frailty model. Specifically they demonstrate the model's ability to disentangle the sources of within-subject correlation as well as the gains in both efficiency and bias of the model when compared to the widely used alternatives, which often produce conflicting conclusions. Two substantive political science problems illustrate the usefulness and interpretation of the model: state policy adoption and terrorist attacks.
To evaluate the nutritional situation of the victims of the 2010 landslide disaster in Uganda, food varieties consumed and coping strategies were assessed.
Cross-sectional. Food variety scores (FVS) were obtained as the total of food items eaten over the last week while an index was based on severity weighting of household food insecurity coping strategies. We included 545 affected and 533 control households.
Victims in the affected Bududa district in Eastern Uganda and those victims resettled in the Kiryandongo district, Western Uganda.
Adjusted for covariates, in Bududa significantly higher mean FVS were observed among: affected than controls; farmers than others; and relief food recipients. Control households scored higher means (se) on severity of coping: 28·6 (1·3) v. 19·2 (1·2; P<0·01). In Kiryandongo, significantly higher FVS were observed among: control households; household heads educated above primary school; those with assets that complement food source; and recipients of relief food. Severity of coping was significantly higher among affected households and non-recipients of relief food. Affected households had a higher likelihood to skip a day without eating a household meal in Bududa (OR=2·31; 95 % CI 1·62, 3·29; P<0·01) and Kiryandongo (OR=1·77; 95 % CI 1·23, 2·57; P<0·01).
Whereas FVS and severity of coping showed opposite trends in the two districts, resettlement into Kiryandongo led to severe coping experiences. Administrative measures that provide a combination of relief food, social protection and resettlement integration may offset undesirable coping strategies affecting diet.
Introduction: Trauma is the leading cause of death among people under 40. With more than 7 million Canadians living over one hour’s travel from a level 1 or 2 trauma center, access to quality trauma care in Canada is a major concern. We recently reported that more than 40% of rural EDs across Canada were more than 300 km from levels 1 and 2 trauma centers. Direct transportation to trauma centers is therefore unusual and most trauma cases are initially managed in rural EDs. Assistance from trauma centers via telemedicine could thus be valuable in optimizing initial stabilization and inter-facility transfers. Objective: Is telemedicine a potentially effective intervention for improving rural trauma care? Methods: We conducted a literature review to examine the potential impact (number of transfers, transfer times, length of hospital stays and mortality) of telemedicine on rural trauma care. Two reviewers independently searched PubMed, Embase and Cochrane databases with key words / concept combinations: telemedicine, trauma and rural. Articles included in the final review had to address the question with specific methodologies. After duplicate removal, 312 articles were found relevant. After independent review of titles and abstracts, only 25 articles pertained to the specific question. Only three studies met inclusion criteria. Results: These studies reported 187 successful teleconsultations in the context of rural trauma care, 29 of which involved significant interventions (8 interventions potentially lifesaving). Some unnecessary inter-facility transfers were avoided. However, transfer times to trauma centers and length of hospital stays appeared slightly longer with telemedicine. Conclusion: The literature on the efficacy of telemedicine in trauma care is scarce, with only three studies addressing the question. Conclusions generally favor telemedicine, but additional research must should determine its impact and better understand the barriers/facilitators to the implementation of telemedicine for rural trauma care.