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Destructive Entrepreneurship in Emerging Markets:Causes and Consequences
No full textThe book investigates the intricate world of entrepreneurship, examining its dual nature as a force for constructive societal change as well as a potential source of destructive consequences. To examine these two facets in detail, the book scrutinizes the interplay between individual actions and institutional frameworks, showing how entrepreneurship can drive economic and social progress or hinder it through rent-seeking behaviors and exploitation of institutional gaps. By analyzing various settings, from capitalist to state-controlled economies, the book highlights the role of the 'rules of the game' in determining whether entrepreneurial activities contribute positively to society or perpetuate inequality and inefficiency. As such, in the context of emerging markets, this book addresses the question of when are entrepreneurial activities constructive and when are they destructive? Through a nuanced examination of diverse economic settings and institutional environments, the book illuminates how entrepreneurship can foster innovation and social value while also perpetuating corruption and inefficiency. By integrating theoretical frameworks with empirical evidence, it provides a comprehensive analysis of the factors influencing both productive and destructive entrepreneurial behaviors. The aim is to deepen readers' understanding of how entrepreneurship interacts with various contexts and to advocate for ethical and socially responsible practices, ultimately inviting contemplation on the challenges and opportunities that arise in the evolving landscape of entrepreneurship. As such, this book is a valuable resource for scholars studying these phenomena but also practitioners, and policymakers alike.</p
Highly Reliable Organisations and Sustainability Risk Management:Safety Cultures in the Nigerian Oil and Gas Supply Chain Sector
Get PDFThis study investigates the environmental consequences of pursuing profits in the oil and gas industry, focusing on Nigeria. It examines the role of top management commitment, safety culture and stakeholder risk prioritisation in the industry. By surveying 441 stakeholders, this study highlights the importance of extensive stakeholder engagement and a systemic supply chain approach in building resilience and shaping sustainable practices. The findings reveal that stakeholder risk perception influences sustainability risk management; however, variations in risk prioritisation between internal and external stakeholders remain a challenge. The study advocates for a paradigm shift and emphasises the crucial role of high-reliability management in guiding organisations towards effective risk mitigation strategies for the industry's immediate health, communities, environment and future.</p
Roux-en-Y gastric bypass, adjustable gastric banding, or sleeve gastrectomy for severe obesity (By-Band-Sleeve): a multicentre, open label, three-group, randomised controlled trial
Get PDFBackground: The health risks of severe obesity can be reduced with metabolic and bariatric surgery, but it is uncertain which operation is most effective or cost-effective. We aimed to compare Roux-en-Y gastric bypass, adjustable gastric banding, and sleeve gastrectomy in patients with severe obesity. Methods: By-Band-Sleeve is a pragmatic, multi-centre, open-label, randomised controlled trial conducted in 12 hospitals in the UK. Eligible participants were adults (aged ≥18 years) meeting national criteria for metabolic and bariatric surgery. Initially, a 2-group trial (Roux-en-Y gastric bypass versus adjustable gastric banding) became a 3-group trial to include sleeve gastrectomy at 2·6 years from study opening, when it became widely used in the UK. Co-primary endpoints were weight (proportion achieving ≥50% excess weight loss) and quality-of-life (EQ-5D utility score) at 3 years. If the proportion achieving at least 50% excess weight loss was non-inferior (<12% difference between groups) and quality-of-life was superior, sleeve gastrectomy and Roux-en-Y gastric bypass were considered more effective than adjustable gastric banding, and sleeve gastrectomy more effective than Roux-en-Y gastric bypass. Cost-effectiveness of the procedures was compared. This trial is registered with ClinicalTrials.gov, NCT02841527, and ISRCTN, 00786323. Results: Between Jan 16, 2013, and Sept 27, 2019, 1351 participants were randomly assigned; five withdrew consent and 1346 (mean age 47·3 [SD 10·6] years, 1020 [76%] women, 324 (24%) men, and two with missing data, mean weight of 129·7 kg [23·6] and mean BMI of 46·4 [6·9] kg/m 2) were included in this report. Of 1346 participants, 462 (34%) were in the Roux-en-Y gastric bypass group, 464 (34%) in the adjustable gastric banding group, and 420 (31%) in the sleeve gastrectomy group. 1183 (88%) participants underwent surgery. 276 (68%) of 405 participants in the Roux-en-Y gastric bypass group, 97 (25%) of 383 participants in the adjustable gastric banding group and 141 (41%) of 342 participants in the sleeve gastrectomy group achieved at least 50% excess weight loss (adjusted risk difference: Roux-en-Y gastric bypass vs adjustable gastric banding 41% [98% CI 34 to 48]; sleeve gastrectomy vs adjustable gastric banding 15% [5 to 24]; sleeve gastrectomy vs Roux-en-Y gastric bypass, –26% [–36 to –16%]). Mean EQ-5D scores were 0·72 for Roux-en-Y gastric bypass, 0·62 for adjustable gastric banding, and 0·68 for sleeve gastrectomy (adjusted mean difference: Roux-en-Y gastric bypass vs adjustable gastric banding 0·08 [0·04 to 0·12], sleeve gastrectomy vs adjustable gastric banding 0·05 [0·01 to 0·09], and sleeve gastrectomy vs Roux-en-Y gastric bypass –0·03 [–0·07 to 0·01]). 1651 adverse events were reported following surgery (5·7 per year after sleeve gastrectomy, 6·0 per year after Roux-en-Y gastric bypass, and 4·6 per year after adjustable gastric banding). There were 11 deaths from randomisation to 3 years: one attributable to surgery (in the adjustable gastric bypass group, during the surgical admission) and ten not attributable to surgery (four each in the Roux-en-Y gastric bypass and adjustable gastric banding groups and two in the sleeve gastrectomy group). Roux-en-Y gastric bypass was most cost-effective. Interpretation: Roux-en-Y gastric bypass and sleeve gastrectomy are more effective than adjustable gastric banding. Sleeve gastrectomy has inferior weight loss and lower mean quality of life score compared with Roux-en-Y gastric bypass. Based on this evidence, it is recommended that patients electing to have metabolic and bariatric surgery are advised to have Roux-en-Y gastric bypass. Where contraindicated or unfeasible, sleeve gastrectomy should be offered. This evidence does not support adjustable gastric band as standard treatment for severe obesity. Funding: National Institute for Health and Care Research Health Technology Assessment Programme.</p
The use of nasopharyngeal and oropharyngeal suctioning in physiotherapy practice in the United Kingdom: a preliminary survey of current practice
Get PDFIntroduction: Nasopharyngeal (NP) and oropharyngeal (OP) suctioning are airway clearance techniques (ACTs) used to maintain airway patency and enhance gas exchange by removing secretions in an acutely unwell self-ventilating patient. Data on the current use of NP and OP suctioning by physiotherapists are scarce. Aim and objectives: To investigate the use of NP and OP suctioning by physiotherapists in the UK. Methods: An anonymous online questionnaire was developed in Microsoft Forms. UK-registered physiotherapists working in respiratory practice were invited to complete the survey via professional organisations and social media between May and June 2021. Data were analysed descriptively. Results: Respondents (N=134) mainly worked in the National Health Service (99%) in England (89%) across various clinical speciality levels. The median (IQR) frequency of treatment involving either NP or OP suctioning was 3 (1,5) in the preceding month. Suctioning was usually reported as being successful (92%) and most commonly administered following manual airway clearance techniques (78%), mechanical in/exsufflation (61%), and/or positioning and postural drainage (52%). The majority of respondents reported they performed suctioning with a lubricant (98%) and a nasal pharyngeal airway in situ (95%). Respondents reported experience of a number of adverse effects in relation to NP or OP suction, most notably bleeding (80%), hypoxaemia (63%), and tachycardia (58%). Conclusions: Although NP/OP suctioning is an important ACT in UK physiotherapy practice, it is highly invasive and carries the risk of adverse effects and negative patient experience. Further research and development of adaptations and less invasive alternatives to the technique are warranted. Contribution of the Paper: • This is the first study to identify how frequently and in what type of situations nasopharyngeal and oropharyngeal suctioning is used by physiotherapists in the UK. • The main modalities used prior to suctioning were manual techniques, mechanical insufflation-exsufflation, positioning, and the active cycle of breathing technique depending on patient's needs. • Suctioning was reported to be highly successful, although it carries a considerable risk of adverse effects such as bleeding, tachycardia and hypoxaemia.</p
Transcranial Direct Current Stimulation (tDCS) Used at Home for People with a Diagnosis of Depression: Sleep Quality Outcomes
Get PDFBackground: There is a high prevalence of sleep quality problems and insomnia in people with depression. Insomnia is a common, distressing, and impairing sleep disorder and is linked to poor mental and physical health. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of insomnia and improve sleep quality. Flow FL-100 is a tDCS device self-administered at home. Purpose/aim: To investigate the impact of up to 10 weeks of Flow Neuroscience AB FL-100 tDCS use on sleep quality in people with depression, using the Montgomery-Åsberg Depression Rating Scale Self (MADRS-S) sleep quality question. Methods: A retrospective analysis of MADRS-S self-report data collected between 2020 and 2024. Results: 6229 datasets of people who received tDCS and who self-reported insomnia were analysed. The MADRS-S sleep quality remission rates in people who adhered to the tDCS protocol were 36.1% at one week, 43.1% at two weeks, 50.2% at three weeks, 59.3% at six weeks and 63.2% at ten weeks. Conclusion: The results show that tDCS may improve sleep quality in those with depression and insomnia. Due to problems with existing insomnia treatment options, it is important to be able to offer additional evidence-based insomnia treatments. Appropriately designed and powered randomised controlled trials (RCTs) and testing of feasibility in healthcare settings are warrante
Orwell, Afrofuturism, and Queer Speculative Fiction
No full textThis chapter examines the legacy of George Orwell’s Nineteen Eighty-Four in a selection of queer speculative and Afrofuturist novels by British, Japanese, Ghanaian-American, Nigerian, and American writers published between the late 1970s and early 2020s. Kay Dick’s They (1977, reprinted 2022), Yoko Ogawa’s The Memory Police (1994; translated 2019), Nana Kwame Adjei-Brenyah’s ‘Zimmer Land’ (2018), Namwali Serpell’s The Old Drift (2019), and Marisa Crane’s I Keep My Exoskeletons to Myself (2023), I argue, dismantle the white supremacist, patriarchal, heteronormative, and western imperialist principles undergirding Orwell’s text and its most famous descendants, the majority of which are by white Anglo-American male writers. By replacing the individual narrative with a collective one, centring the stories of the oppressed, and sidelining the structures and systems that render their worlds oppressive to focus, instead, on the everyday and, very often, the home, Dick, Ogawa, Serpell, and Crane problematize the Orwellian tradition and reconceptualize the genre of dystopian fiction. I contextualize these texts both within the respective histories to which they allude and within the history of queer speculative and Afrofuturist fiction more generally
Seeping into the Land
No full textIn the rain on the sand, a simple practice begins. It is a practice that dissolves in and through the body; a soluble body being known. It is also a counter-practice, a corporeal balm that resists the machinations of the default digital logic. In this practice we live as creatures not machines
Effect of brief ambient cooling on serum stress biomarkers in older adults during a daylong heat exposure:a laboratory-based heat wave simulation
Get PDFVisiting an air-conditioned location during heat exposure reduces physiological strain; however, the effects on gastrointestinal barrier dysfunction and renal ischemia remain unexplored. We compared serum protein responses during a 9 h heat exposure (40.3 °C, 9.3% relative humidity) in 17 older adults without cooling (control) and 19 older adults with a cooling break (∼23 °C) during hours 5 and 6 (cooling). IFABP and sCD14 increased similarly across groups. NGAL was 3.2 pg/mL [1.9, 6.1] lower in the cooling group during heat exposure. A 2 h cooling centre exposure did not ameliorate gastrointestinal barrier dysfunction, but did a reduce a surrogate marker of renal ischemia. ClinicalTrials.gov identifier: NCT04353076.</p
Protocol for an eDelphi study to identify consensus on policy metrics which should be included in future assessments of the England Rare Diseases Action Plans
No full textIntroduction: Governments create policies to address societal needs and then assess their effectiveness through policy metrics. The UK Rare Diseases Framework and its England Rare Diseases Action Plans aim to improve the lives of people with lived experience of rare diseases and their carers. Reaching these goals requires more effective engagement with those least likely to interact with NHS services. This paper outlines a protocol to identify relevant high-level policy metrics while engaging underserved and underrepresented groups. Methods and Analysis: A long list of candidate metrics for the 36 Actions linked to the four Priority Areas of the Framework was compiled from government logic models. The list was discussed in three workshops, and irrelevant, ambiguous, or time-irrelevant metrics were removed. Additional metrics were identified through an evidence review and expert opinion. In the first round of a two-round eDelphi study, shortlisted metrics will be grouped into the four Priority Areas: Faster Diagnosis, Increased Healthcare Professional Awareness, Better Care Coordination, and Improved Access to Specialist Care, Treatment, and drugs. An eDelphi panel of 50 people living with rare disease or their carers, as well as 50 professional stakeholders, will rate each metric on a 1-9 scale. The sample size allows for 20% attrition. Consensus for inclusion or exclusion will be based on 70% agreement (7-9 for 'very valuable', 1-3 for 'not valuable'), with fewer than 15% rating the metric at the opposite end of the scale. Metrics will be included or excluded if consensus is reached in both groups; otherwise, they will remain under consideration in Round 2. In Round 1, eDelphi participants may propose additional metrics, which will be included in Round 2. After two rounds, a final set of policy metrics will be selected. Any discrepancies in Round 2 ratings will be explored through further research. Ethics and Dissemination: The Coventry University Group Research Ethics Committee has approved the study (P183377). The results will be disseminated to people with lived experience of rare disease and professional stakeholders through conferences, events, and newsletters and submitted to a peer-reviewed journal. If adopted, the identified metrics will inform decision-making on rare disease policies in England and beyond. Registration Details: ISRCTN41639707Competing Interest StatementAll authors have completed the ICMJE Uniform Disclosure Form. They declare funding from the National Institute for Health and Care Research and no support from any commercial organisation for the submitted work. Coventry University has provided in-kind support for PAW and AS in relation to their contributions to this study. JG and LB, through Realise Advocacy Ltd, have received financial support from patient advocacy groups and industry stakeholders for consultancy services related to patient involvement in drug development and Health Technology Assessment. JG leads JG Zebra Consulting, which provides international and national strategic consultancy services specialising in rare diseases and novel therapies, focusing on market access, public policy, and stakeholder engagement. LB chairs the Board of Trustees at Medics 4 Rare Diseases. LB and RL are members of the Rare Diseases Advisory Group (RDAG), which advises NHS England and the devolved administrations on the development, implementation, and national commissioning of highly specialised services for rare diseases. PG is a co-inventor on five filed patents in rare disease therapeutics and has received support for meeting attendance and medical writing.Clinical Protocolshttps://www.isrctn.com/ISRCTN41639707Funding StatementThis work is independent research funded by the National Institute for Health and Care Research (NIHR) [RareCare, NIHR205983]. The views expressed in this publication are those of the author(s) and not necessarily those of NIHR or The Department of Health and Social Care.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB nd/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Coventry University Group Research Ethics Committee has approved the study (P183377).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesGiven the small field of rare diseases, we will report findings for larger stakeholder groups (minimum of five people) to minimise the risk of indirect identification. Anonymised group-level data will be stored in an open-access repository and assigned a DOI to ensure long-term accessibility and ease of citation