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In an attempt to respond to recent calls for better understanding the coexistence of multiple business models, we develop the concept of ‘multidexterity’ – the ability to develop, nurture, and execute several distinctive BM strategies simultaneously across different levels and functions of the MNC and its host markets. To illustrate this approach, we describe a European healthcare firm entering the rapidly transforming economy of China and facing regulatory constraints and ambiguities in the application of industry standards. This situation is a generic challenge for MNCs entering rapidly transforming economies, which they help in turn to substantially alter and develop. We argue multidextrous business models are effective entry strategies for MNCs. They also help resolve two conceptual limitations in the BMI literature: (1) the problem of environmental contingencies and (2) the interrelatedness of factors at the macro, meso, and micro levels. We address these problems from a practice approach. We provide some implications for the concept of multidexterity and business models and address managerial challenges and prospects in developing multidextrous organizations.
Dynamic imaging—acquiring images and simultaneously recording relevant sensor parameters—is a powerful way to extend the information and insight available over and above optical microscopy. It improves understanding and correlates how properties of materials alter with, for example, changing temperature, pressure, humidity, tensile forces, shear stress, or aging. The basics of an imaging setup are the microscope, a relevant stage, a camera of appropriate performance, and suitable software to acquire, synchronize, and analyze the images and data collected. However, many factors need to be considered and optimized to ensure reliable experiments. These include basic features of the microscope—objective resolution and magnification, for example, as well as the accuracy and reproducibility of the stage, the camera format, dynamic range, and resolution. In this tutorial, we discuss the components of a dynamic data and image capture system and present examples where researchers have used this approach to better understand their materials.
Beothukis mistakensis from the Ediacaran System of Newfoundland, Canada demonstrates complex fractal-like morphology through the development of primary-, secondary- and tertiary-order Rangea-like units. The primary-order rangeomorph units observed in B. mistakensis are tightly juxtaposed, show no evidence of being independent of one another and are made up of chamber-like secondary-order – probably mesoglea-filled – units. The growth of these rangeomorph units demonstrates that the frond developed from the tip towards the basal region through ontogeny. The tertiary-order units of Beothukis are considered to represent surface morphology on the secondary-order units. This is in contrast to palaeobiological reconstructions of Beothukis that invoke three-dimensional fractal-like branches with independent units, which has been used to infer an osmotrophic mode of life. It is considered here that the fractal-like morphology of the lower surface of B. mistakensis was an adaptation to increase surface area to volume ratio. The quilted morphology of Beothukis proposed here is consistent with a sessile, reclining, phagocytotic and/or chemosymbiotic mode of life similar to that invoked for the reclining rangeomorph Fractofusus.
SHEA endorses adhering to the recommendations by the CDC and ACIP for immunizations of all children and adults. All persons providing clinical care should be familiar with these recommendations and should routinely assess immunization compliance of their patients and strongly recommend all routine immunizations to patients. All healthcare personnel (HCP) should be immunized against vaccine-preventable diseases as recommended by the CDC/ACIP (unless immunity is demonstrated by another recommended method). SHEA endorses the policy that immunization should be a condition of employment or functioning (students, contract workers, volunteers, etc) at a healthcare facility. Only recognized medical contraindications should be accepted for not receiving recommended immunizations.
Several aspects of mother–child relationships are associated with children's internalizing problems. We examined longitudinal associations between mother–child conflict and children's internalizing problems in middle childhood. Specifically, we examined whether conflict and children's internalizing problems predict each other longitudinally in a sample of children from 3rd through 6th grade (N = 1,364) and their mothers using a cross-lagged panel model with random intercepts. In line with expectations, we found stable between-family differences in both mother–child conflict and children's internalizing problems. Contrary to expectations, we did not find that mother–child conflict and children's internalizing problems showed significant cross-lagged associations. However, mother–child conflict and children's internalizing problems had correlated errors at each wave, indicating that these two constructs covary with each other concurrently at multiple times across development, independent of stable between-family associations (i.e., as one increases, so does the other, and vice versa). The results of this study point to the importance of using statistical approaches that can disentangle between-family differences from within-family processes. In future studies, shorter time scales (e.g., weeks or months) may better capture dynamic associations between parent–child conflict and internalizing problems.
A bottom-up approach grounded in micro-level understanding of the thinking, feeling, behavioral, and social aspects of living with low income and associated low literacy can lead to greater understanding and improvement of interactions in the health arena. This paper draws on what we have learned about marketplace interactions in subsistence economies to inform innovations in medical education, design and delivery of healthcare for lowincome patients, outreach education, and future micro-level research at the human-healthcare interface.
Surgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.
To examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRS
American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011–2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.
Of 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.
The primary outcome of interest was 30-day SSI rate.
A total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23–2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09–1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06–2.53; P=.02), and longer duration of procedure were associated with development of SSI.
Patients with disseminated cancer are at a higher risk for developing SSI. ASA score >3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
The materiality of ritual performance is a growing focus for archaeologists. In Europe, collective ritual performance is expected to be highly structured and to leave behind a loud archaeological signature. In Australia and Papua New Guinea, ritual is highly structured; however, material signatures for performance are not always apparent, with ritual frequently bound up in the surrounding natural and cultural landscape. One way of assessing long-term ritual in this context is by using archaeology to historicize ethno-historical and ethnographic accounts. Examples of this in the Torres Strait region, islands between Papua New Guinea and mainland Australia, suggest that ritual activities were materially inscribed at kod sites (ceremonial men's meeting places) through distribution of clan fireplaces, mounds of stone/bone and shell. This paper examines the structure of Torres Strait ritual for a site ethnographically reputed to be the ancestral kod of the Mabuyag Islanders. Intra-site partitioning of ritual performance is interpreted using ethnography, rock art and the divergent distribution of surface and sub-surface materials (including microscopic analysis of dugong bone and lithic material) across the site. Finally, it discusses the materiality of ritual at a boundary zone between mainland Australia and Papua New Guinea and the extent to which archaeology provides evidence for Islander negotiation through ceremony of external incursions.
The integration of behavioral health services into primary care has led to enhanced use of brief screening measures to identify mental health problems. Although useful, such instruments are largely symptom based and diagnosis specific. This narrow focus can potentially limit the identification of broader social or relational distress in patients that affect medical outcomes, as well as present feasibility challenges using a multi-measure approach in identifying mental health comorbidities.
This exploratory study of adult primary care patients compared an ultra-brief, and widely used measure of global distress across life functioning, the Outcome Rating Scale (ORS), with the Patient Health Questionnaire (PHQ-9 and PHQ-2).
Correlations between the ORS and the PHQ-9 and PHQ-2 indicated agreement between the measures in classifying patients, and the ORS identified significantly more patients in the clinical range.
Although results are preliminary, the ORS may cast a wider net in identifying patients with significant distress in primary care.
A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.
Radiometric ages for undated parts of the volcanic succession and intrusions in West Greenland were obtained by the 40Ar–39Ar incremental heating method. Acceptable crystallization ages were obtained for 27 samples. Combined with published results the new data provide a volcanic stratigraphy correlatable throughout the Nuussuaq Basin. The thick onshore volcanic pile consists of four widespread formations: 62.5–61 Ma picrites (Vaigat Formation), 61–60 Ma depleted basalts (Maligât Formation and the Hellefisk-1 well), 60–58 Ma less-depleted basalts (Svartenhuk Formation) and 56–54 Ma enriched basalts (Naqerloq Formation). Two local successions comprise 53.5 Ma alkali basalts (Erqua Formation) and 38.7 Ma transitional basalts (Talerua Member). A central volcano developed on Ubekendt Ejland, leading to the Sarqâta qáqâ gabbro-granophyre intrusion at 57–55 Ma. Pre-break-up volcanism took place further south as early as 64–63 Ma. The offshore volcanic succession most probably comprises the known onshore succession plus some younger lavas. The change in spreading direction near the Paleocene–Eocene boundary took place west of the Nuussuaq Basin c. 56.2 Ma. Some tectonomagmatic events are correlatable across the entire North Atlantic Igneous Province. A quiescent 58–56 Ma period correlates with similar periods in East Greenland and the Faroes, and the Naqerloq Formation is coeval with the Eocene basalts in East Greenland. The Paleocene and Eocene tholeiitic basalts are distinguishable chemically; in early Eocene time, mantle typical of the Iceland plume seems to have extended beneath the whole West Greenland margin as well as the central East Greenland margin.
For over 100 years, the genetics of human anthropometric traits has attracted scientific interest. In particular, height and body mass index (BMI, calculated as kg/m2) have been under intensive genetic research. However, it is still largely unknown whether and how heritability estimates vary between human populations. Opportunities to address this question have increased recently because of the establishment of many new twin cohorts and the increasing accumulation of data in established twin cohorts. We started a new research project to analyze systematically (1) the variation of heritability estimates of height, BMI and their trajectories over the life course between birth cohorts, ethnicities and countries, and (2) to study the effects of birth-related factors, education and smoking on these anthropometric traits and whether these effects vary between twin cohorts. We identified 67 twin projects, including both monozygotic (MZ) and dizygotic (DZ) twins, using various sources. We asked for individual level data on height and weight including repeated measurements, birth related traits, background variables, education and smoking. By the end of 2014, 48 projects participated. Together, we have 893,458 height and weight measures (52% females) from 434,723 twin individuals, including 201,192 complete twin pairs (40% monozygotic, 40% same-sex dizygotic and 20% opposite-sex dizygotic) representing 22 countries. This project demonstrates that large-scale international twin studies are feasible and can promote the use of existing data for novel research purposes.
Satellite altimetric time series allow high-precision monitoring of ice-sheet mass balance. Understanding elevation changes in these regions is important because outlet glaciers along ice-sheet margins are critical in controlling flow of inland ice. Here we discuss a new airborne altimetry dataset collected as part of the ICECAP (International Collaborative Exploration of the Cryosphere by Airborne Profiling) project over East Antarctica. Using the ALAMO (Airborne Laser Altimeter with Mapping Optics) system of a scanning photon-counting lidar combined with a laser altimeter, we extend the 2003–09 surface elevation record of NASA’s ICESat satellite, by determining cross-track slope and thus independently correcting for ICESat’s cross-track pointing errors. In areas of high slope, cross-track errors result in measured elevation change that combines surface slope and the actual Δz/Δt signal. Slope corrections are particularly important in coastal ice streams, which often exhibit both rapidly changing elevations and high surface slopes. As a test case (assuming that surface slopes do not change significantly) we observe a lack of ice dynamic change at Cook Ice Shelf, while significant thinning occurred at Totten and Denman Glaciers during 2003–09.