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CONSOLIDATING ORGANIZATIONAL CULTURE IN TIMES OF ADVERSITY: THE CASE OF TOTERS DELIVERY
No full textLebanon experienced an ongoing set of adversities, from the economic crisis, followed by the COVID-19 pandemic, to the Beirut port explosion, all in one year span. All these events represent grand challenges in which problems can be plausibly addressed through coordinated and collaborated efforts. As organizations felt the threat to their continuity, many start-ups failed to remain operative due to breakage in their organizational culture. This project investigates the role of the organizational culture of Lebanese-based start-ups in responding to these challenges. The project also tackles the strategies adopted by start-ups as a response to the encountered challenges. Such strategies are changes in the business model, whether innovation, adaptation or both. Following a review of the literature, the study follows Edgar Schein’s culture framework – the layers of culture. The research takes the case of Toters Delivery, a Lebanese high-tech start-up, with one office in Lebanon and one in Iraq. To write the case, I participated in a 1.5-year participatory observation where data such as meetings with the staff, stakeholders, company files, and an interview with the CEO were collected. The result is a teaching case study that defines Toters’ background in the social and economic context of Lebanon. The study concludes with an application of the literature to the case
Characteristics and Outcomes of Traumatic Cardiac Arrests in the Pan-Asian Resuscitation Outcomes Study*
Get PDFObjective: Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival. Methods: Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC). Results: There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39–73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99–4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25–5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71–2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27–7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80–21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39–97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99–5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05–10.53) relative to asystole. Conclusions: In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes. © 2022 National Association of EMS Physicians
Factors associated with survival in adult trauma patients undergoing angiography with and without embolization across trauma centers in the United States
Get PDFIntroduction: Interventional angiography is increasingly utilized in trauma management for various injuries. Despite published guidelines by the Eastern Association for the Surgery of Trauma on the use of angiography, limited data exist on factors associated with outcomes in angiography procedures. This study examines factors associated with survival to hospital discharge in trauma patients undergoing angiography with or without embolization across US trauma centers. Materials and methods: This retrospective observational study used the National Trauma Data Bank 2017 dataset and included adult trauma patients who underwent conventional angiography with or without embolization. A bivariate analysis was done to compare patients’ characteristics by outcome (survived/died), followed by a multivariable logistic regression analysis to determine factors associated with survival to hospital discharge after adjusting for important confounders. Results: In the included sample of 4242 patients, median age was 41 years and male gender was predominant (72.6%). Overall mean time to angiography was 263.77 ± 750.19 min. Factors positively associated with survival included treatment at large facilities with over 401 beds (OR = 2.170; 95% CI, [1.277–3.685]), helicopter ambulance/fixed-wing transport (OR = 1.736; 95% CI, [1.325–2.275]), mild Glasgow Coma Scale (OR = 7.621; 95% CI, [5.868–9.898]) and moderate Glasgow Coma Scale (OR = 3.127; 95% CI, [2.080–4.701]), SBP ≥ 90 (OR = 1.516; 95% CI [1.199–1.916]), and spleen as embolization site (OR = 1.647; 95% CI [1.119–2.423]). Conclusion: This nationwide study identified variables associated with survival in trauma patients who underwent angiography. These variables can serve in creating standardized risk stratification tools that could be incorporated into evidence-based guidelines for angiography candidates. © 2022, The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER)
Roundtable 2023
Get PDFThis brief was published following the first roundtable of AUB-NCC's 2023 series, titled “Navigating Climate Change and Environmental Activism in the MENA Region: Challenges and Opportunities.” Roundtable discussion organized on March 30th, 2023,
at the Basile Antoine Meguerdiche Conference Hall - IFIThe series is co-designed with: Nature Conservation Center, Issam Fares Institute for Public Policy and International Affairs, Asfari Institute for Civil Society & Citizenship, Heinrich-Böll-Stiftung, Arab Reform Initiative.Panel: Dr. Nasser Yassin, Lebanon’s Minister of the Environment; Dr. Salma Talhouk, Founder of AUB-NCC and Professor at the Department of Landscape Design and Ecosystem Management; Taina Christiansen, Head of UN Habitat Lebanon Country Programme; Rabih Chaar, CEO and Co-founder of Nadeera Technologies; Antoine Kallab, Associate Director of AUB-NCC (moderator).The first brief of the “Navigating Climate Change and environmental activism in the MENA region: Challenges and Opportunities" series. The panel composed of academics, UN agency representatives, social entrepreneurs and public officials, highlighted stories that succeeded in aligning developmental agendas and rallying communities around a shared vision
Assessing the accuracy and consistency of ChatGPT in clinical pharmacy management: A preliminary analysis with clinical pharmacy experts worldwide
Get PDFBackground: ChatGPT conversation system has ushered in a revolutionary new era of information retrieval and stands as one of the fastest-growing platforms. Clinical pharmacy, as a dynamic discipline, necessitates an advanced comprehension of drugs and diseases. The process of decision-making in clinical pharmacy demands accuracy and consistency in medical information, as it directly affects patient safety. Objective: The objective was to evaluate ChatGPT's accuracy and consistency in managing pharmacotherapy cases across multiple time points. Additionally, input was gathered from global clinical pharmacy experts, and the agreement between ChatGPT's responses and those of clinical pharmacy experts worldwide was assessed. Methods: A set of 20 cases of pharmacotherapy was entered into ChatGPT at three different time points. Reliability analysis was performed using inter-rater reliability to measure the accuracy of the output generated by ChatGPT at each time point. Test-retest reliability was performed to measure the consistency of the output generated by ChatGPT across the three time points. Pharmacy expert performance was evaluated, and the overall results were compared. Results: ChatGPT achieved a hit rate of 70.83% at week 1, 79.2% at week 3, and 75% at week 5. The percent agreement between weeks 1 and 3 was 79.2%, whereas it was 87.5% between weeks 3 and 5, and 83.3% between weeks 1 and 5. In contrast, accuracy rates among clinical pharmacy experts showed considerable variation according to their geographic location. The highest agreement between clinical pharmacist responses and ChatGPT responses was observed at the last time point examined. Conclusions: Overall, the analysis suggested that ChatGPT is capable of generating clinically relevant pharmaceutical information, albeit with some variation in accuracy and consistency. It should be noted that clinical pharmacy experts worldwide may provide varying degrees of accuracy depending on their expertise. This study highlights the potential of AI chatbots in clinical pharmacy. © 2023 Elsevier Inc
Specialized competency framework for pharmacists in managerial positions in sales and marketing (SCF-PMSM): development, validation, and correlates
Get PDFBackground: Pharmacists in sales and marketing roles need specific skills for managerial positions, and a framework for evaluating and developing these competencies is necessary. Currently, no such framework is known to exist. Objective: This study aimed to develop and validate a specialized competency framework for pharmacists in sales and marketing managerial positions and assess correlates related to the competency domains. Methods: This web-based study carried out between March and October 2022 enrolled a convenient sample of 60 pharmacists with managerial positions in sales and marketing, contacted by phone, working in the field of sales and marketing from the five governorates of Lebanon (Beirut, Beqaa, Mount Lebanon, South, and North). Results: The framework demonstrated good construct and structural validity in all domains except for emergency preparedness, which had a low correlation with other domains. Competencies were well correlated with respective domains, and behaviors had excellent loadings on corresponding competencies. As for the correlates of the competency domains, males were more confident than females (p <.05), and participants with more experience (or heavier workload) reported higher competency levels (p <.05), particularly for upper management skills, communication skills, and professional practice. Further, education level was not significantly correlated with declared competency, with experience being the most cited source of competence (68.25%), followed by postgraduate degrees (42.48%) and continuing education sessions (33.93%), while undergraduate education was the least reported (29.5%). Conclusion: This study could develop and validate the Specialized Competency Framework for Pharmacists in Managerial Positions in Sales and Marketing (SCF-PMSM) among a sample of Lebanese pharmacists. This framework demonstrated good reliability, content, construct, and structural validity in all the domains, with the competencies being well correlated with their respective domains and behaviors having excellent loadings on related competencies, except for emergency preparedness and response. It also revealed a mismatch between what is taught at undergraduate and postgraduate levels and the needs in practice. © 2023, The Author(s)
Effect of fluence levels on prophylactic corneal cross-linking for laser in situ keratomileusis and transepithelial photorefractive keratectomy
Get PDFPurpose: The purpose of this study is to assess the effect of various fluence levels on prophylactic corneal cross-linking (CXL) combined with femtosecond laser in situ keratomileusis (FS-LASIK-Xtra) or transepithelial photorefractive keratectomy (TransPRK-Xtra) on biomechanics, demarcation line (DL), and stromal haze. Methods: Prospective analysis where two prophylactic CXL protocols (lower/higher fluence [LF/HF]: 30 mw/cm2, 60/80 s, 1.8/2.4 J/cm2) were performed as part of either an FS-LASIK-Xtra or TransPRK-Xtra procedure. Data were collected preoperatively and at 1 week and 1, 3, and 6 months postoperatively. Main outcome measures were (1) dynamic corneal response parameters and the stress–strain index (SSI) from Corvis, (2) actual DL depth (ADL), and (3) stromal haze on OCT images analysed by a machine learning algorithm. Results: Eighty-six eyes from 86 patients underwent FS-LASIK-Xtra-HF (21 eyes), FS-LASIK-Xtra-LF (21 eyes), TransPRK-Xtra-HF (23 eyes), and TransPRK-Xtra-LF (21 eyes). SSI increased similarly by around 15% in all groups 6 months postoperatively (p = 0.155). All other corneal biomechanical parameters were statistically significant worsening postoperatively, but the change was similar in all groups. At 1 month postoperatively, there was no statistical difference in mean ADL among four groups (p = 0.613), mean stromal haze was similar between the two FS-LASIK-Xtra groups, but higher in the TransPRK-Xtra-HF group compared with the TransPRK-Xtra-LF group. Conclusions: FS-LASIK-Xtra and TransPRK-Xtra lead to a similar ADL and improve SSI equally. Lower fluence prophylactic CXL might be recommended as it achieves similar mean ADL with potentially less induced stromal haze, especially in TransPRK. The clinical relevance and applicability of such protocols remains to be assessed. © 2022 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd
Establishment of a birth-to-education cohort of 1 million Palestinian refugees using electronic medical records and electronic education records
Get PDFBy linking datasets, electronic records can be used to build large birth-cohorts, enabling researchers to cost-effectively answer questions relevant to populations over the life-course. Currently, around 5.8 million Palestinian refugees live in five settings: Jordan, Lebanon, Syria, West Bank, and Gaza Strip. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides them with free primary health and elementary-school services. It maintains electronic records to do so. We aimed to establish a birth cohort of Palestinian refugees born between 1st January 2010 and 31st December 2020 living in five settings by linking mother obstetric records with child health and education records and to describe some of the cohort characteristics. In future, we plan to assess effects of size-at-birth on growth, health and educational attainment, among other questions. Methods We extracted all available data from 140 health centres and 702 schools across five settings, i.e. all UNRWA service users. Creating the cohort involved examining IDs and other data, preparing data, de-duplicating records, and identifying live-births, linking the mothers’ and children’s data using different deterministic linking algorithms, and understanding reasons for non-linkage. Results We established a birth cohort of Palestinian refugees using electronic records of 972,743 live births. We found high levels of linkage to health records overall (83%), which improved over time (from 73% to 86%), and variations in linkage rates by setting: these averaged 93% in Gaza, 89% in Lebanon, 75% in Jordan, 73% in West Bank and 68% in Syria. Of the 423,580 children age-eligible to go to school, 47% went to UNRWA schools and comprised of 197,479 children with both health and education records, and 2,447 children with only education records. In addition to year and setting, other factors associated with non-linkage included mortality and having a non-refugee mother. Misclassification errors were minimal. Conclusion This linked open birth-cohort is unique for refugees and the Arab region and forms the basis for many future studies, including to elucidate pathways for improved health and education in this vulnerable, understudied population. Our characterization of the cohort leads us to recommend using different sub-sets of the cohort depending on the research question and analytic purposes. © The Authors
SOMATO-DENDRITIC MECHANISMS REGULATE THE FIRING BEHAVIORS OF “STUTTERING” NEURONS: A TWO-COMPARTMENT MODELING STUDY ON PREMOTOR RA-PROJECTING HVC NEURONS
Get PDFThe high vocal center (HVC) is the avian analogue of the premotor cortex in the songbird brain. It represents a central component of an interconnected circuit of brain nuclei known as ‘the song system’ and constitutes a critical neural site for song learning and production. HVC contains at least three neural populations: neurons that project to the RA (robust nucleus of arcopallium, or HVCRA), neurons that project to Area X (basal ganglia), and interneurons. Recent intracellular whole-cell patch clamp recordings accompanied by neuropharmacological and histological manipulations have shown that HVCRA neurons display a significant variability in their intrinsic firing patterns (Daou et al, in preparation). In particular, Daou et al showed that there exist three classes of HVCRA neurons that are distinguished by their electrophysiological and morphological properties, a diversity that is orchestrated by a cocktail of ion channels that are expressed in these neurons. Despite the fundamental importance of this class of projecting premotor neurons during song learning and production, little is known about the ion channels orchestrating their intrinsic firing properties and their distribution inside the cells (i.e., soma and dendrites). In this work, we developed two-compartment HVCRA conductance-based neuronal models that consist of somatic and dendritic compartments and fit the models to the electrophysiological data we collected in brain slices. Initially, the distribution of ion channels inside the cell membranes of HVCRA followed a similar mammalian distribution of ion channels from neurons that exhibit the same ion channels and similar firing patterns. In the first part of the study, we reproduced the voltage traces exhibited by the three classes of HVCRA neurons in brain slices in response to various current stimuli. Next, we focused on Class III HVCRA neurons, a class of neurons that exhibit a stuttering or pausing firing behavior, reminiscent of the discharges that some classes of neurons in the somatosensory cortex, basolateral amygdala, dentate gyrus, visual cortex, and other areas of the brain exhibit. While some pharmacological manipulations have previously shed light on some of the ionic currents that govern these neurons’ dynamics (not in the HVC), computationally there is yet no coherent mathematical model that provides a clear explanation and analysis of the parameters that orchestrate their intrinsic properties. The models we designed highlighted the importance of low-threshold voltage-gated D-type (ID) and M-type (IM) potassium currents in regulating the firing patterns of class I and class II HVCRA neurons. The models as well highlighted a crucial interplay between somatic IM (M-type) and ISK (calcium-dependent) potassium currents with dendritic ID (D-type) and IA (A-type) potassium currents in shaping the stuttering or pausing behaviors of class III HVCRA neurons. In particular, somatic IM was responsible for dampening their excitability, somatic ISK regulates the number of bursts, while dendritic ID and IA control the inter-burst duration of the “stutters” in spike trains, the number of spikes in the corresponding epochs, and the delay to the onset of spiking in these neurons. Our models provide insight on the distribution and interactions between the distinct ion channels located on the surface membranes of the somatic and dendritic compartments of HVCRA neurons, which we will be testing and verifying histologically. They also provide a solid mathematical framework that could be used to model other neurons in the brain that exhibit this distinctive firing pattern
CONTRIBUTION OF ECOSYSTEM SERVICES TO REDUCING POVERTY VULNERABILITY: A CASE STUDY OF ONDO STATE, NIGERIA
Get PDFEcosystem services have gained attention as a potential tool for promoting sustainable development and natural resource management. Despite this, development agencies often overlook ecosystem services in their policies and plans. This study investigates the potential of ecosystem services to reduce poverty vulnerability in Ondo State, Nigeria. The study found that the study area is rich in multiple ecosystem services, including provisioning services such as crop production and water, regulating services such as carbon storage and crop pollination, supporting services such as habitat quality, and cultural services such as aesthetic quality and recreation & tourism. The mapping of these services provides a useful tool for decision-makers to incorporate ecosystem services into poverty vulnerability reduction plans. However, the study also identified hindrances such as oil spillage and lack of infrastructure to maximize the potential of ecosystem services to reduce poverty vulnerability in areas with high poverty especially in the coastal regions.
The study suggests that the success of the strategy to use ecosystem services to reduce poverty vulnerability depends on several factors, including governance, economic opportunities, and infrastructure. Therefore, there is a need for a comprehensive approach that considers multiple factors to reduce poverty vulnerability effectively. The findings have implications for sustainable development planning in Ondo State and other regions with similar ecosystems. It highlights opportunities that might not have been explored by development agencies and underscores the need for integrated approaches to natural resource management, considering the value of ecosystem services for sustainable development. It also provides valuable insights into how ecosystem services can be harnessed to promote sustainable development in Ondo State and beyond.
However, the study has some limitations, including model-based oversimplifications, the use of secondary data sources that may introduce errors and inaccuracies, and the lack of consideration of economic issues. Future research could address these limitations using more accurate and detailed data, incorporating economic considerations, and considering broader regional and national contexts