This article examines the impact of product, process and organisational innovations on two alternative dimensions of business performance: finance and operations. Two indicators capture financial ...performance: sales increase and production cost reduction. Operational firm performance is captured by two alternative indicators: productive capacity augmentation and quality improvement of product/service provided by the firm. Using a wide-ranging sample of Spanish small- and medium-sized enterprises (SMEs), our findings highlight the significant impact of innovation upon both these dimensions of business performance, although they differ regarding the type of innovation and the performance indicator considered. Furthermore, our results indicate that the relationship between innovation choices in SMEs and business performance should be analysed from a multi-dimensional approach. These findings reveal significant implications for innovation policies and strategies for SMEs.
Classical fiber dissection of post mortem human brains enables us to isolate a fiber tract by removing the cortex and overlying white matter. In the current work, a modification of the dissection ...methodology is presented that preserves the cortex and the relationships within the brain during all stages of dissection, i.e. ‘cortex‐sparing fiber dissection’. Thirty post mortem human hemispheres (15 right side and 15 left side) were dissected using cortex‐sparing fiber dissection. Magnetic resonance imaging study of a healthy brain was analyzed using diffusion tensor imaging (DTI)‐based tractography software. DTI fiber tract reconstructions were compared with cortex‐sparing fiber dissection results. The fibers of the superior longitudinal fasciculus (SLF), inferior fronto‐occipital fasciculus (IFOF), inferior longitudinal fasciculus (ILF) and uncinate fasciculus (UF) were isolated so as to enable identification of their cortical terminations. Two segments of the SLF were identified: first, an indirect and superficial component composed of a horizontal and vertical segment; and second, a direct and deep component or arcuate fasciculus. The IFOF runs within the insula, temporal stem and sagittal stratum, and connects the frontal operculum with the occipital, parietal and temporo‐basal cortex. The UF crosses the limen insulae and connects the orbito‐frontal gyri with the anterior temporal lobe. Finally, a portion of the ILF was isolated connecting the fusiform gyrus with the occipital gyri. These results indicate that cortex‐sparing fiber dissection facilitates study of the 3D anatomy of human brain tracts, enabling the tracing of fibers to their terminations in the cortex. Consequently, it is an important tool for neurosurgical training and neuroanatomical research.
Context:
Cushing's syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To ...decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed.
Objective:
To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test.
Design:
Observational, prospective, multicenter.
Setting:
Referral hospital.
Patients:
A cohort of 353 patients attending endocrinology units for outpatient visits.
Interventions:
All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS.
Main Outcome Measures:
Diagnosis or exclusion of CS.
Results:
Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%.
Conclusions:
We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.
A prediction model for Cushing's syndrome diagnosis in at-risk populations was developed based on clinical variables and late night salivary cortisol levels.
Black carbon (BC) from fossil fuel and biomass combustion darkens the snow and makes it melt sooner. The BC footprint of research activities and tourism in Antarctica has likely increased as human ...presence in the continent has surged in recent decades. Here, we report on measurements of the BC concentration in snow samples from 28 sites across a transect of about 2,000 km from the northern tip of Antarctica (62°S) to the southern Ellsworth Mountains (79°S). Our surveys show that BC content in snow surrounding research facilities and popular shore tourist-landing sites is considerably above background levels measured elsewhere in the continent. The resulting radiative forcing is accelerating snow melting and shrinking the snowpack on BC-impacted areas on the Antarctic Peninsula and associated archipelagos by up to 23 mm water equivalent (w.e.) every summer.
This paper analyses the role of gender of the chief executive officer (CEO) on the propensity to introduce innovations using a sample of 1405 Spanish small- and medium-sized enterprises (SMEs). We ...examine whether there are significant differences between female- and male-led businesses in terms of their propensity to innovate, and whether these differences may be explained by factors related to the attributes of the CEO concerning risk tolerance, self-confidence, education level and cooperative behaviour. In particular, this study tests if the linkages between these managerial attributes and the propensity to innovate are influenced by the gender of the CEO. Using a multivariate
probit
model (
triprobit
), we further investigate the role of gender on the CEO decision to simultaneously introduce product, process and organisational innovations. Our main results indicate that there are not significant differences in the propensity to introduce innovations between male- and female-run businesses when considering innovation at an aggregated level, that is, innovating in any of the three types of innovations considered. However, we obtain a higher propensity of male CEOs to introduce process innovations, as compared to their female counterparts. No significant differences by gender are found for product and organisational innovations. Additionally, results of the multivariate
probit
model indicate that the three innovation decisions are interdependent and should be jointly analysed. This study contributes to the scant literature regarding gender impact on firm’s innovativeness with novel empirical evidence for SMEs.
There is no proven specific pharmacological treatment for patients with the acute respiratory distress syndrome (ARDS). The efficacy of corticosteroids in ARDS remains controversial. We aimed to ...assess the effects of dexamethasone in ARDS, which might change pulmonary and systemic inflammation and result in a decrease in duration of mechanical ventilation and mortality.
We did a multicentre, randomised controlled trial in a network of 17 intensive care units (ICUs) in teaching hospitals across Spain in patients with established moderate-to-severe ARDS (defined by a ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 mm Hg or less assessed with a positive end-expiratory pressure of 10 cm H
O or more and FiO
of 0·5 or more at 24 h after ARDS onset). Patients with brain death, terminal-stage disease, or receiving corticosteroids or immunosuppressive drugs were excluded. Eligible patients were randomly assigned based on balanced treatment assignments with a computerised randomisation allocation sequence using blocks of 10 opaque, sealed envelopes to receive immediate treatment with dexamethasone or continued routine intensive care (control group). Patients in the dexamethasone group received an intravenous dose of 20 mg once daily from day 1 to day 5, which was reduced to 10 mg once daily from day 6 to day 10. Patients in both groups were ventilated with lung-protective mechanical ventilation. Allocation concealment was maintained at all sites during the trial. Primary outcome was the number of ventilator-free days at 28 days, defined as the number of days alive and free from mechanical ventilation from day of randomisation to day 28. Secondary outcome was all-cause mortality 60 days after randomisation. All analyses were done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, NCT01731795.
Between March 28, 2013, and Dec 31, 2018, we enrolled 277 patients and randomly assigned 139 patients to the dexamethasone group and 138 to the control group. The trial was stopped by the data safety monitoring board due to low enrolment rate after enrolling more than 88% (277/314) of the planned sample size. The mean number of ventilator-free days was higher in the dexamethasone group than in the control group (between-group difference 4·8 days 95% CI 2·57 to 7·03; p<0·0001). At 60 days, 29 (21%) patients in the dexamethasone group and 50 (36%) patients in the control group had died (between-group difference -15·3% -25·9 to -4·9; p=0·0047). The proportion of adverse events did not differ significantly between the dexamethasone group and control group. The most common adverse events were hyperglycaemia in the ICU (105 76% patients in the dexamethasone group vs 97 70% patients in the control group), new infections in the ICU (eg, pneumonia or sepsis; 33 24% vs 35 25%), and barotrauma (14 10% vs 10 7%).
Early administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS.
Fundación Mutua Madrileña, Instituto de Salud Carlos III, The European Regional Development's Funds, Asociación Científica Pulmón y Ventilación Mecánica.
This paper analyses the involvement of small firms in international trade activities by identifying the comprehensive impact of innovation. Specifically, we study how innovation introduced by these ...firms determines the entrepreneurial decision-making process regarding whether to engage in exporting and/or importing. Our results confirm the interrelation of firms’ exporting and importing decisions and consequently, these two decisions should be jointly estimated when analysing the influence incurred by the introduction of alternative types of innovation (product, process, and organizational/managerial innovation) on said decisions. Furthermore, findings show complementarity between types of innovation to be relevant in explaining export and import decisions made by SMEs. Specifically, cumulative effects as a result of combining product and process innovation, as well as of product, process and organizational innovation, are highly significant in explaining export decisions, while in the case of imports, the combination of product and organizational innovation is shown to be significant. These findings lead to major policy and managerial implications regarding the promotion of SMEs’ participation in international trade flows through alternative innovation strategies.
Atmospheric methane is both a potent greenhouse gas and photochemically active, with approximately equal anthropogenic and natural sources. The addition of chlorine to the atmosphere has been ...proposed to mitigate global warming through methane reduction by increasing its chemical loss. However, the potential environmental impacts of such climate mitigation remain unexplored. Here, sensitivity studies are conducted to evaluate the possible effects of increasing reactive chlorine emissions on the methane budget, atmospheric composition and radiative forcing. Because of non-linear chemistry, in order to achieve a reduction in methane burden (instead of an increase), the chlorine atom burden needs to be a minimum of three times the estimated present-day burden. If the methane removal target is set to 20%, 45%, or 70% less global methane by 2050 compared to the levels in the Representative Concentration Pathway 8.5 scenario (RCP8.5), our modeling results suggest that additional chlorine fluxes of 630, 1250, and 1880 Tg Cl/year, respectively, are needed. The results show that increasing chlorine emissions also induces significant changes in other important climate forcers. Remarkably, the tropospheric ozone decrease is large enough that the magnitude of radiative forcing decrease is similar to that of methane. Adding 630, 1250, and 1880 Tg Cl/year to the RCP8.5 scenario, chosen to have the most consistent current-day trends of methane, will decrease the surface temperature by 0.2, 0.4, and 0.6 °C by 2050, respectively. The quantity and method in which the chlorine is added, its interactions with climate pathways, and the potential environmental impacts on air quality and ocean acidity, must be carefully considered before any action is taken.
Background: Early prediction of students' learning performance using data mining techniques is an important topic these days. The purpose of this literature review is to provide an overview of the ...current state of research in that area. Method: We conducted a literature review following a two-step procedure, looking for papers using the major search engines and selection based on certain criteria. Results: The document search process yielded 133 results, 82 of which were selected in order to answer some essential research questions in the area. The selected papers were grouped and described by the type of educational systems, the data mining techniques applied, the variables or features used, and how early accurate prediction was possible. Conclusions: Most of the papers analyzed were about online learning systems and traditional face-to-face learning in secondary and tertiary education; the most commonly-used predictive algorithms were J48, Random Forest, SVM, and Naive Bayes (classification), and logistic and linear regression (regression). The most important factors in early prediction were related to student assessment and data obtained from student interaction with Learning Management Systems. Finally, how early it was possible to make predictions depended on the type of educational system. Keywords: Educational Data Mining; Learning Analytics; Early prediction of academic performance; Early Warning Systems; Detection of students at-risk of Dropping-out. Prediccion Temprana del Rendimiento Academico con Mineria de Datos: una Revision Sistematica. Antecedentes: la prediccion temprana del rendimiento academico mediante tecnicas de mineria de datos es un campo de estudio emergente, que se pretende analizar por medio de este articulo de revision. Metodo: se ha revisado la literatura existente por medio de un proceso de busqueda de articulos en los principales motores de busqueda, y de seleccion de los mismos de acuerdo con ciertos criterios. Resultados: el proceso de busqueda reporto 133 resultados, de los cuales 82 fueron seleccionados para dar respuesta a las preguntas de investigacion planteadas. Se han agrupado los trabajos encontrados para poder dar respuesta a las preguntas por tipo de sistema educativo, tecnicas de mineria de datos aplicadas, variables empleadas y grado de anticipacion con el que se puede predecir. Conclusiones: la mayor parte de los trabajos publicados corresponden a sistemas de aprendizaje en linea y presenciales-tradicionales en educacion secundaria y terciaria; los algoritmos mas utilizados el J48, Random Forest, SVM, Naive Bayes (cl a sificacion), y la regresion logistica y lineal (regresion); los datos de evaluacion y los obtenidos de la interaccion del estudiante con el entorno de aprendizaje son las variables mas relevantes; finalmente, la anticipacion en la prediccion varia segun el tipo de sistema educativo. Palabras clave: Data Mining Educativo; Analitica de Aprendizaje; prediccion temprana del rendimiento academico; sistemas de deteccion temprana; estudiantes en riesgo de abandono.
This paper examines the impact of different types of innovation on the business performance of small and medium-sized enterprises (SMEs) using a multi-dimensional analytical approach. Based on a wide ...sample of Spanish SMEs, our results highlight the existence of positive impacts of innovation on financial and operational dimensions of business performance, and the significant differences in these impacts depending on the type of innovation and the performance indicator considered. Our findings are relevant for managers and innovation decision-makers when designing innovation strategies to foster the business performance of SMEs. Additionally, the multi-faceted nature of the link between innovation and business outcomes in SMEs reveals that making the right innovation decision is crucial in securing the desired performance outcomes in a context of limited resources for innovation.
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