Relatively little is understood about factors triggering entrepreneurial behaviour within organizations not driven by profit motives. Governance plays an important role in non‐profits, particularly ...boards of directors. Integrating resource‐based theory and entrepreneurial orientation research, we examine the influence of non‐profit boards as strategic resources shaping the organization's entrepreneurial orientation and performance. In particular, we focus on the non‐profit board's underlying behavioural orientations, or the extent to which the board is strategic, activist, conservative, and cohesive. Findings from a cross‐sectional survey on arts and culture organizations demonstrate that three of these behavioural orientations impact levels of entrepreneurship occurring within non‐profits. Higher levels of entrepreneurship affect social performance, but not financial performance.
In recent years the number of women-owned firms with employees has expanded at three times the rate of all employer firms. Yet women remain underrepresented in their proportion of high-growth firms. ...A number of plausible explanations exist. To develop richer insights, a two-stage research project was undertaken. A mail survey was sent to a sample of female entrepreneurs to assess motives, obstacles, goals and aspirations, needs, and business identity. Based on the survey results, follow-up, in-depth interviews were conducted with entrepreneurs, selecting equally from modest-growth and high-growth ventures. In terms of quantitative findings, growth orientation was associated with whether a woman was "pushed" or "pulled" into entrepreneurship, was motivated by wealth or achievement factors, had a strong women's identity in the venture, had equity partners, and believed women faced unique selling obstacles. The qualitative research made clear that modest- and high-growth entrepreneurs differ in how they view themselves, their families, their ventures, and the larger environment. The results of both stages suggest that growth is a deliberate choice and that women have a clear sense of the costs and benefits of growth and make careful trade-off decisions.
Background
This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes ...between benign and malignant disease.
Methods
Data on adrenalectomies were extracted from a national surgeon‐reported registry. Preoperative diagnosis, surgical technique, length of hospital stay, morbidity and in‐hospital mortality were examined.
Results
Some 3994 adrenalectomies were registered among patients with a median age of 54 (i.q.r. 43–65) years (55·9 per cent female). Surgery was performed for benign disease in 81·5 per cent. Tumour size was significantly greater in malignant disease: 60 (i.q.r. 34–100) versus 40 (24–55) mm (P < 0·001). A minimally invasive approach was employed in 90·2 per cent of operations for benign disease and 48·2 per cent for cancer (P < 0·001). The conversion rate was 3·5‐fold higher in malignant disease (17·3 versus 4·7 per cent; P < 0·001). The length of hospital stay was 3 (i.q.r. 2–5) days for benign disease and 5 (3–8) days for malignant disease (P < 0·050). In multivariable analysis, risk factors for morbidity were malignant disease (odds ratio (OR) 1·69, 1·22 to 2·36; P = 0·002), tumour size larger than 60 mm (OR 1·43, 1·04 to 1·98; P = 0·028) and conversion to open surgery (OR 3·48, 2·16 to 5·61; P < 0·001). The in‐hospital mortality rate was below 0·5 per cent overall, but significantly higher in the setting of malignant disease (1·2 versus 0·2 per cent; P < 0·001). Malignant disease (OR 4·88, 1·17 to 20·34; P = 0·029) and tumour size (OR 7·47, 1·52 to 39·61; P = 0·014) were independently associated with mortality in multivariable analysis.
Conclusion
Adrenalectomy is a safe procedure but the higher incidence of open surgery for malignant disease appears to influence postoperative outcomes.
Antecedentes
Este estudio investigó las indicaciones, procedimientos y resultados de la cirugía de la glándula suprarrenal a partir de la base de datos de la UKRETS desde 2005‐2017 y comparó los resultados entre enfermedad benigna y maligna.
Métodos
Se examinó un registro nacional con datos notificados por cirujanos que incluye 3.994 suprarrenalectomías; 57% mujeres, mediana de edad 53 (8‐88 años). Se evaluaron el diagnóstico preoperatorio, la técnica quirúrgica, la duración de la estancia hospitalaria, la morbilidad y la mortalidad hospitalaria.
Resultados
En el 82% de los casos la cirugía se realizó por enfermedad benigna. El tamaño del tumor fue significativamente mayor en la enfermedad maligna: 60 mm (34‐100 mm) versus 40 mm (24‐55 mm), P < 0,001. Se utilizó un abordaje mínimamente invasivo en el 90% de los casos de enfermedad benigna y en el 48% de las operaciones por cáncer (P < 0,001). La tasa de conversión fue 3,5 veces más alta en la enfermedad maligna (17% versus 4,9%, P < 0,001). La duración de la estancia fue 3 días (rango intercuartílico, interquartile range, IQR 2‐5) para la enfermedad benigna y 5 (IQR 3‐8) días para la enfermedad maligna (P < 0,05). En el análisis multivariable, los factores de riesgo para la morbilidad fueron: enfermedad maligna (razón de oportunidades, odds ratio, OR 1,64, 1,217‐2,359; P = 0,002), tamaño del tumor (OR 1,433, 1.040‐1,967; P = 0,028) y conversión a cirugía abierta (OR 3,483, 2,160‐5,612; P < 0,0001). La mortalidad hospitalaria global fue baja (< 0,5%) pero significativamente mayor en el escenario de la enfermedad maligna (1,2% versus 0,2%, P < 0,001). La enfermedad maligna (OR 4,881, 1,171‐20,343; P = 0,029) y el tamaño del tumor (OR 7,474, 1,515‐39,610; P = 0,014) se asociaron de forma independiente con la mortalidad en el análisis multivariable.
Conclusión
La suprarrenalectomía es un procedimiento seguro, pero la mayor incidencia de cirugía abierta para la enfermedad maligna parece tener un impacto sobre los resultados postoperatorios.
This article examined the incidence of recorded benign and malignant adrenal surgery per year.
Low rate of complications
Osterix (Osx) is an osteoblast‐specific transcription factor required for osteoblast differentiation and bone formation. Osx null mice develop a normal cartilage skeleton but fail to form bone and to ...express osteoblast‐specific marker genes. To better understand the control of transcriptional regulation by Osx, we identified Osx‐interacting proteins using proteomics approaches. Here, we report that a Jumonji C (JmjC)‐domain containing protein, called NO66, directly interacts with Osx and inhibits Osx‐mediated promoter activation. The knockdown of NO66 in preosteoblast cells triggered accelerated osteoblast differentiation and mineralization, and markedly stimulated the expression of Osx target genes. A JmjC‐dependent histone demethylase activity was exhibited by NO66, which was specific for both H3K4me and H3K36me in vitro and in vivo, and this activity was needed for the regulation of osteoblast‐specific promoters. During BMP‐2‐induced differentiation of preosteoblasts, decreased NO66 occupancy correlates with increased Osx occupancy at Osx‐target promoters. Our results indicate that interactions between NO66 and Osx regulate Osx‐target genes in osteoblasts by modulating histone methylation states.
Background
Parathyroid hormone (PTH) has a short half-life and is cleared by the liver and kidneys. This study examined whether declining estimated glomerular filtration rate (eGFR) affects ...application of the Miami criterion for intraoperative PTH (ioPTH) decline during parathyroidectomy for primary hyperparathyroidism (pHPT).
Methods
A retrospective review of consecutive patients undergoes parathyroidectomy for pHPT. Patients with multi-gland disease, without ioPTH, failure-to-cure and those <18 years were excluded. Baseline demographics, pre-operative PTH, ioPTH and 6-month follow-up data were available. Patients were categorised into normal or chronic kidney disease (CKD stage 2–5) based on pre-operative eGFR. Nonparametric data were compared using Mann–Whitney U test/Kruskal–Wallis test. The primary outcome measure was to assess whether CKD-affected ioPTH decline in parathyroidectomy for pHPT.
Results
A total of 476 patients were included 75.4% women; median age 63.8 years (18–92). CKD was present in 362 (76%) (CKD2:289; CKD3:66; CKD4/5:7). Increasing CKD stage was associated with advancing age normal 53 years (41–61); CKD2 65 (57–73); CKD3 73.5 (66–78); CKD4/5 74(63–81);
p
< 0.001 and higher pre-operative PTH 16.6 pmol/L (11.1–22.9); 13.1 (10.4–17.7); 22.6 (13.8–33.7); 33.8(12.4–41.7);
p
< 0.001. Baseline and post-excision ioPTH were significantly higher in those with CKD4/5 (
p
< 0.05). The Miami criterion was met in all patients, but median fall in ioPTH at 10-min varied between groups normal:0.78 (0.71–0.82); CKD2:0.76 (0.69–0.83); CKD3:0.75 (0.69–0.82); CKD4/5:0.69 (0.61–0.70);
p
= 0.048). It was significantly lower in those with CKD4/5 compared with the remainder of patients 0.69 (0.61–0.70) vs. 0.76 (0.70–0.82);
p
= 0.008.
Conclusions
Although the reduction in ioPTH after successful parathyroidectomy is lower in severe CKD, the Miami criterion remains predictive of cure. Differences in absolute levels of PTH and tumour weight suggest that renal HPT may be a confounding factor.
Introduction
Ultrasound and Tc99mMIBI scans are used to localise parathyroid tumours in sporadic primary hyperparathyroidism (pHPT). Intra-operative PTH (ioPTH) assay facilitates unilateral neck ...exploration (UNE). When both ultrasound and MIBI are negative, it is our policy to explore the left side of the neck and only proceed to bilateral neck exploration (BNE) when either a tumour is not found or when ioPTH does not fall to >50% of the highest pre-excision value. The aim of this study was to investigate the outcome of our approach to ‘double negative’ patients.
Methods
A retrospective analysis of patients undergoing primary parathyroidectomy for pHPT. Data were obtained from a prospective surgical database and the hospital electronic patient record.
Results
Between January 2004 and November 2014, 746 patients underwent a parathyroidectomy for pHPT. Those who did not have both pre-operative scans, ioPTH or a minimum of 6-month follow-up were excluded. Of 552 patients, 111 (20%) had double negative scans (group A), and in 441, either one or both scans were positive (group B). Median age was 61.5 years (range 10–88). Pre-operative PTH level was significantly lower in group A: 11.8 pmol/l (range 3.1–38.8) versus 14.9 pmol/l (range 2.8–101.6;
P
< 0.01). Median tumour weight was significantly lower in group A: 280 mg (range 50–3710) versus 573 mg (range 10–12,000;
P
< 0.01). Overall rate of multiple gland disease (MGD) was 11%; 24% in group A and 7% in group B (
P
< 0.01). Overall rate of UNE in Group A was 28% and converse to the rate in Group B (76%;
P
< 0.01). Sensitivity and specificity of ioPTH to detect MGD were 98 and 98% in Group A versus 98 and 100% in Group B. First-time cure rate was 92.7% in group A and 96.8% in group B (
P
< 0.05).
Conclusion
A double negative scan is associated with small tumours and higher rates of MGD. Despite these challenges, surgery is successful in this group of patients reinforcing the message that negative localisation is not a contraindication for parathyroidectomy. We demonstrated that it is feasible to offer unilateral neck surgery to 28% of patients with double negative scans. A randomised trial is needed to compare BNE with ioPTH/UNE in this select population.
Purpose
This study aims to evaluate the outcomes of first-time parathyroidectomy for primary hyperparathyroidism using intraoperative PTH (IOPTH) assay in the light of the UK National Institute for ...Health and Care Excellence (NICE) guidelines for the management of primary hyperparathyroidism.
Method
This is a retrospective cohort analysis of a prospectively maintained database of endocrine surgery in a tertiary centre. Preoperative radiological localisation (concordance and accuracy), intraoperative PTH parameters and adjusted serum calcium at minimum 6-month follow-up were analysed. The accuracy of IOPTH to predict post-operative normocalcaemia and the number needed to treat (NNT) within the cohort when IOPTH was utilised were determined. Differences between groups were evaluated with Chi-squared and Fisher’s exact test.
Results
Between January 2004 and September 2018, 849 patients (75.4% women), median age 64 years (IQR 54–72), were analysed. The median preoperative adjusted serum calcium was 2.80mmol/l (IQR 2.78–2.90), and the median preoperative PTH was 14.20pmol/l (IQR 10.70–20.25). The overall first-time cure (normocalcaemia) rate was 96.4%. The sensitivity, specificity, positive predictive value and negative predictive values of IOPTH were 96.8%, 83.2%, 97.6% and 78.8%, respectively, with an accuracy of 95.1%. For patients with concordant scans (48.3%), a targeted approach without IOPTH would have achieved a cure rate of 94.1% compared with 98.0% using IOPTH (
p
<0.01)
Conclusion
The use of IOPTH assay significantly improved the rate of normocalcaemia at 6 months. The low NNT to benefit from IOPTH, particularly those patients with a single positive scan, and the inevitable reduction in the potential costs incurred from failure and reoperation justify its utilisation.
Predictors of Nonadherence to Screening Colonoscopy Denberg, Thomas D.; Melhado, Trisha V.; Coombes, John M. ...
Journal of general internal medicine : JGIM,
November 2005, Letnik:
20, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Background: Colonoscopy has become a preferred colorectal cancer (CRC) screening modality. Little is known about why patients who are referred for colonoscopy do not complete the recommended ...procedures. Prior adherence studies have evaluated colonoscopy only in combination with flexible sigmoidoscopy, failed to differentiate between screening and diagnostic procedures, and have examined cancellations/no‐shows, but not nonscheduling, as mechanisms of nonadherence.
Methods: Sociodemographic predictors of screening completion were assessed in a retrospective cohort of 647 patients referred for colonoscopy at a major university hospital. Then, using a qualitative study design, a convenience sample of patients who never completed screening after referral (n=52) was interviewed by telephone, and comparisons in reported reasons for nonadherence were made by gender.
Results: Half of all patients referred for colonoscopy failed to complete the procedure, overwhelmingly because of nonscheduling. In multivariable analysis, female sex, younger age, and insurance type predicted poorer adherence. Patient‐reported barriers to screening completion included cognitive‐emotional factors (e.g., lack of perceived risk for CRC, fear of pain, and concerns about modesty and the bowel preparation), logistic obstacles (e.g., cost, other health problems, and competing demands), and health system barriers (e.g., scheduling challenges, long waiting times). Women reported more concerns about modesty and other aspects of the procedure than men. Only 40% of patients were aware of alternative screening options.
Conclusions: Adherence to screening colonoscopy referrals is sub‐optimal and may be improved by better communication with patients, counseling to help resolve logistic barriers, and improvements in colonoscopy referral and scheduling mechanisms.
In 2013, the UK Government announced that seven of the nation’s largest banks had agreed to publish their lending data at the local level across Great Britain. The release of such area based lending ...data has been welcomed by advocacy groups and policy makers keen to better understand and remedy geographies of financial exclusion. This paper makes three contributions to debates about financial exclusion. First, it provides the first exploratory spatial analysis of the personal lending data made available; it scrutinises the parameters and robustness of the dataset and evaluates the extent to which the data increase transparency in UK personal lending markets. Second, it uses the data to provide a geographical overview of patterns of personal lending across Great Britain. Third, it uses this analysis to revisit the analytical and political limitations of ‘open data’ in addressing the relationship between access to finance and economic marginalisation. Although a binary policy imaginary of ‘inclusion-exclusion’ has historically driven advocacy for data disclosure, recent literatures on financial exclusion generate the need for more complex and variegated understandings of economic marginalisation. The paper questions the relationship between transparency and data disclosure, the policy push for financial inclusion, and patterns of indebtedness and economic marginalisation in a world where ‘fringe finance’ has become mainstream. Drawing on these literatures, this analysis suggests that data disclosure, and the transparency it affords, is a necessary but not sufficient tool in understanding the distributional implications of variegated access to credit.
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