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Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357

Background There is increasing evidence demonstrating the importance of the neighbourhood built environment in supporting physical activity. Physical activity provides numerous health benefits including improvements in health-related fitness (i.e., muscular, cardiorespiratory, motor, and morphological fitness). Emerging evidence also suggests that the neighbourhood built environment is associated with health-related fitness. Our aim was to summarize evidence on the associations between the neighbourhood built environment and components of health-related fitness in adults. Methods We undertook a systematic review following PRISMA guidelines. Our data sources included electronic searches in MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, Environment Complete, ProQuest Dissertations and Theses, and Transport Research International Documentation from inception to March 2021. Our eligibility criteria consisted of observational and experimental studies estimating associations between the neighbourhood built environment and health-related fitness among healthy adults (age ≥ 18 years). Eligible studies included objective or self-reported measures of the neighbourhood built environment and included either objective or self-reported measures of health-related fitness. Data extraction included study design, sample characteristics, measured neighbourhood built environment characteristics, and measured components of health-related fitness. We used individual Joanna Briggs Institute study checklists based on identified study designs. Our primary outcome measure was components of health-related fitness (muscular; cardiorespiratory; motor, and morphological fitness). Results Twenty-seven studies (sample sizes = 28 to 419,562; 2002 to 2020) met the eligibility criteria. Neighbourhood destinations were the most consistent built environment correlate across all components of health-related fitness. The greatest number of significant associations was found between the neighbourhood built environment and morphological fitness while the lowest number of associations was found for motor fitness. The neighbourhood built environment was consistently associated with health-related fitness in studies that adjusted for physical activity. Conclusion The neighbourhood built environment is associated with health-related fitness in adults and these associations may be independent of physical activity. Longitudinal studies that adjust for physical activity (including resistance training) and sedentary behaviour, and residential self-selection are needed to obtain rigorous causal evidence for the link between the neighbourhood built environment and health-related fitness. Trial registration Protocol registration: PROSPERO number CRD42020179807.

Although significant advances have been made in measuring the outcomes of rehabilitation interventions, comparably less progress has been made in measuring the treatment processes that lead to improved outcomes. A recently developed framework called the Rehabilitation Treatment Specification System (RTSS) has potential to identify which clinician actions (ie, ingredients) actively improve specific patient functions (ie, targets). However, the RTSS does not provide methodology for standardly identifying specific unique targets or ingredients. Without a method to evaluate the uniqueness of an individual target or ingredient, it is difficult to know whether variations in treatment descriptions are synonymous (ie, different words describing the same treatment) or meaningfully different (eg, different words describing different treatments or variations of the same treatment). A recent project used vocal rehabilitation ingredients and targets to create RTSS-based lists of unique overarching target and ingredient categories with underlying dimensions describing how individual ingredients and targets vary within those categories. The primary purpose of this article is to describe the challenges encountered during the project and the methodology developed to address those challenges. Because the methodology was based on the RTSS's broadly applicable framework, it can be used across all areas of rehabilitation regardless of the discipline (speech-language pathology, physical therapy, occupational therapy, psychology, etc) or impairment domain (language, cognition, ambulation, upper extremity training, etc). The resulting standard operationalized lists of targets and ingredients have high face and content validity. The lists may also facilitate implementation of the RTSS in research, education, interdisciplinary communication, and everyday treatment.

Social enterprises implement business-like approaches to address social problems. Scale-up of these enterprises beyond one geographical context can extend their impact to better match the scope of problems being addressed. Unfortunately, many social enterprises start but relatively few expand to new contexts, making scale-up one of the most important but least understood outcomes of social entrepreneurship. We explore this outcome empirically, extending existing research that is predominantly conceptual. The study adopts a multicase study research design. A dynamic capabilities framework reveals how resources are amassed and configured for expansion, a process that can be more difficult for social compared to commercial enterprises. Findings suggest scale-up may be a second act of social entrepreneurship because dissimilarities between initial and scale-up contexts necessitate product modification, different partnerships, and idiosyncratic resource configurations. We thus call into question existing literature’s focus on standardization – generic resource configurations – for scaling-up social enterprises to new geographical contexts.

Purpose To determine whether implementation of an easily accessible electronic database promotes significant reporting of magnetic resonance imaging (MRI) acquisition errors. Additionally, we wanted to see if analysis of the error reports could be used to create a comprehensive checklist to avoid the most common errors. Methods A new, simple, and efficient electronic database reporting system was written in-house and implemented at our institution. Over the course of 4 months, the use of this database enabled collection and analysis of sufficient data for trend analysis. A simple 4-point checklist for MRI technologist use was developed based on the most commonly reported errors. Reported MRI acquisition error rates were collected and analyzed thereafter. Results By the first full month of implementation, MRI scan error reporting increased from a previous negligible baseline rate to 3.03%. The comprehensive checklist was based on the 4 most common issues reported. Verification of checklist use showed that adherence to this requirement averaged greater than 94%. Immediately following roll out of the checklist, the percentage of errors reported fell to 1.7% with a continued decline in error reports thereafter. An approximately 60% reduction in errors in the last month of the study was evident as compared to the first month of data collection. Conclusions The use of an efficient error reporting system and implementation of a checklist based on the most common MRI acquisition errors results in a substantial decrease in the baseline MRI acquisition error rates.

This study examines the nature of the interaction between CEO leadership and organizational culture using 2 common metathemes (task and relationship) in leadership and culture research. Two perspectives, similarity and dissimilarity, offer competing predictions about the fit, or interaction, between leadership and culture and its predicted effect on firm performance. Predictions for the similarity perspective draw upon attribution theory and social identity theory of leadership, whereas predictions for the dissimilarity perspective are developed based upon insights from leadership contingency theories and the notion of substitutability. Hierarchical regression results from 114 CEOs and 324 top management team (TMT) members failed to support the similarity hypotheses but revealed broad support for the dissimilarity predictions. Findings suggest that culture can serve as a substitute for leadership when leadership behaviors are redundant with cultural values (i.e., they both share a task- or relationship-oriented focus). Findings also support leadership contingency theories indicating that CEO leadership is effective when it provides psychological and motivational resources lacking in the organization's culture. We discuss theoretical and practical implications and delineate directions for future research. (PsycINFO Database Record

We explore supervision of international students’ theses and dissertations relative to existing literature and Kanter’s (1977) theory of tokenism. This topic is underresearched despite the huge gro...

This article explores the emotional and psychological functioning of entrepreneurs after venture failure. Accordingly, it investigates the extent to which entrepreneurs exhibit resilience, defined by psychologists as stability in functioning over time, despite experiencing a traumatic event. Entrepreneurial resilience is rarely investigated in the context of failure despite it being a debilitating experience. Our exploration is critical to venture creation as resilience plays a key role in re-entry into entrepreneurship. A qualitative, narrative research design reveals how 11 entrepreneurs functioned after failure. The majority of entrepreneurs show resilience; that is, they exhibit stable levels of functioning. This stability is different from the disruptions in functioning that psychologists label as ‘recovery’ from a severe event. Our findings, therefore, challenge the assumption that recovery is required after venture failure. Implications for re-entry into entrepreneurship and learning from, and coping with, failure are explored.

We empirically explore the process of corporate entrepreneurship (CE) through the conceptual lens of effectuation, a theory describing how entrepreneurs innovate. In particular, we investigate how endogenous innovations emerge and evolve into new products or services. The study thus provides an alternative perspective to most CE research that assumes a causation or rational-analytic approach to innovation. We implement a qualitative, multi-case study research design with corporate innovation projects as the level of analysis. Data are from interviews as well as secondary sources and were analyzed using within and cross case analysis. Findings reveal organic stages through which ideas are shaped into viable products. Findings show important effectuation principles at work including stakeholder commitments, affordable loss thinking, and a focus on control instead of prediction. Interestingly, findings illustrate how effectuation may differ in the corporate as compared to the new venture context. Implications for the wider literature are discussed along with limitations of the research design.

This study is concerned with the determination of an optimal appointment schedule in an outpatient-inpatient hospital system where the inpatient exams can be cancelled based on certain rules while the outpatient exams cannot be cancelled. Stochastic programming models were formulated and solved to tackle the stochasticity in the procedure durations and patient arrival patterns. The first model, a two-stage stochastic programming model, is formulated to optimize the slot size. The second model further optimizes the inpatient block (IPB) placement and slot size simultaneously. A computational method is developed to solve the second optimization problem. A case study is conducted using the data from Magnetic Resonance Imaging (MRI) centers of Lahey Hospital and Medical Center (LHMC). The current schedule and the schedules obtained from the optimization models are evaluated and compared using simulation based on FlexSim Healthcare. Results indicate that the overall weighted cost can be reduced by 11.6% by optimizing the slot size and can be further reduced by an additional 12.6% by optimizing slot size and IPB placement simultaneously. Three commonly used sequencing rules (IPBEG, OPBEG, and a variant of ALTER rule) were also evaluated. The results showed that when optimization tools are not available, ALTER variant which evenly distributes the IPBs across the day has the best performance. Sensitivity analysis of weights for patient waiting time, machine idle time and exam cancellations further supports the superiority of ALTER variant sequencing rules compared to the other sequencing methods. A Pareto frontier was also developed and presented between patient waiting time and machine idle time to enable medical centers with different priorities to obtain solutions that accurately reflect their respective optimal tradeoffs. An extended optimization model was also developed to incorporate the emergency patient arrivals. The optimal schedules from the extended model show only minor differences compared to those from the original model, thus proving the robustness of the scheduling solutions obtained from our optimal models against the impacts of emergency patient arrivals.Timestamped operational data was analyzed to identify sources of uncertainty and delays. Stochastic programming models were developed to optimize slot size and inpatient block placement. A case study showed that the optimized schedules can reduce overall costs by 23%. Distributing inpatient and outpatient slots evenly throughout the day provides the best performance. A Pareto frontier was developed to allow practitioners to choose their own best tradeoffs between multiple objectives.

OBJECTIVE. The purpose of this article is to describe how establishing routine practice sessions facilitates adoption by modality operations managers of the just culture model of error management in a radiology department. CONCLUSION. Implementation of ongoing just culture training among radiology operations managers can help them approach uniformity, equity, and transparency in managing errors. Managers see the just culture method as an effective tool that helps improve the safety of patient care.

© 2019 Elsevier Inc. Background: In patients with neurological disorders, a divergence can exist between patients' perceptions regarding the outcomes and the objective neurological findings. Degenerative cervical myelopathy (DCM), a prevalent condition characterized by progressive compression of the cervical spinal cord, can produce debilitating symptoms and profound neurological findings. The purpose of the present study was to determine whether the physician-derived neurological examination findings, as recorded by American Spine Injury Association (ASIA) summary score, correlated with the patient-derived outcome measures for DCM. Methods: A total of 78 patients underwent surgical management of DCM with completion of preoperative and 6-month follow-up assessments. Surgical management consisted of either anterior or posterior cervical decompression. All patients underwent a neurological evaluation, including an ASIA assessment before surgery and 6 months after surgery, and completed the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and Short-Form 36-item (SF-36) scales pre- and postoperatively to measure both disease-specific and general perceived outcomes. Results: The objective physician-derived neurological testing (ASIA) did not correlate with the patient-derived scales (mJOA, NDI, and SF-36) pre- or postoperatively. Patients reported significant improvements (P < 0.001) at 6 months postoperatively in extremity functioning (mJOA), neck pain (NDI), overall physical health (SF-36), and objective strength and sensory functioning (ASIA). All patient-perceived outcome measures correlated with each other pre- and postoperatively (P < 0.01). Conclusions: Objective scoring of postoperative neurological function did not correlate with patient-perceived outcomes before and after surgery for DCM. Traditional testing of motor and sensory function as part of the neurological assessment may not be sensitive enough to assess the scope of neurological changes experienced by patients with DCM.

The paper examines how spirituality, an inner awareness especially of a greater force or power beyond the individual self, affected entrepreneurs’ experience of an important but under-researched part of the entrepreneurial process – venture failure. We implement a qualitative, narrative research design and present a collective narrative of nine entrepreneurs whose spirituality played a role in experiencing venture failure. Unexpectedly, findings revealed entrepreneurs engaging deeply with failure instead of indulging in the self-deception and denial suggested by research that applies psychological theories to venture failure. Furthermore, findings provided a rare, positive outcome from failure – entrepreneurs’ spirituality deepened through experiencing this negative life event. Finally, results indicate how spirituality influenced entrepreneurs’ decisions about founding future ventures after failure.

What process of socioeconomic transformation might move humanity towards sustainability-as-flourishing, an ideal view of sustainability where life flourishes indefinitely on Earth? We suggest entrepreneurship as one such process and review the literature on three types of entrepreneurship said to transform society by creating value beyond profit: social, environmental and sustainable entrepreneurship. From environmental and social scientific literature, we distil a set of requisites for sustainability-as-flourishing, a topic of growing interest. We then review the literature on social, environmental and sustainable entrepreneurship relative to these requisites. Findings show contributions and also limitations towards sustainability-as-flourishing reflected in research on each type of entrepreneurship. We propose a research agenda to address the most glaring limitations including a failure to study critical reflection processes that can shape entrepreneurs’ actions and a lack of emphasis on the Earth’s physical carrying capacity. Future research could also zero in more on complex systems thinking and consider root causes.

Background Quality and patient safety (PS) are critical components of medical education. This study reports on the self-reported PS competence of medical students and postgraduate trainees. Methods The Health Professional Education in Patient Safety Survey was administered to medical students and postgraduate trainees in January 2012. PS dimension scores were compared across learning settings (classroom and clinical) and year in programme. Results Sixty-three percent (255/406) of medical students and 32% (141/436) of postgraduate trainees responded. In general, both groups were most confident in their learning of clinical safety skills (eg, hand hygiene) and least confident in learning about sociocultural aspects of safety (eg, understanding human factors). Medical students’ confidence in most aspects of safety improved with years of training. For some of the more intangible dimensions (teamwork and culture), medical students in their final year had lower scores than students in earlier years. Thirty-eight percent of medical students felt they could approach someone engaging in unsafe practice, and the majority of medical students (85%) and postgraduate trainees (78%) agreed it was difficult to question authority. Conclusions Our results suggest the need to improve the overall content, structure and integration of PS concepts in both classroom and clinical learning environments. Decreased confidence in sociocultural aspects of PS among medical students in the final year of training may indicate that culture in clinical settings negatively affects students’ perceived PS competence. Alternatively, as medical students spend more time in the clinical setting, they may develop a clearer sense of what they do not know.

This paper implements a qualitative, narrative approach to investigate entrepreneurs' personal experience of stigma associated with venture failure. Findings draw on the lived experience of 12 entrepreneurs and tell a collective story of how stigma affects entrepreneurs, shapes their actions, and engenders outcomes for them and their ventures. The story covers three episodes of entrepreneurs anticipating, meeting, and then transforming venture failure. Overall the paper shifts the focus of stigma research from the socio-cultural perspective pervading research to date, to micro-level processes underlying socio-cultural trends. Findings offer unexpected insights into failure stigmatization. First, findings suggest stigmatization is best viewed as a process that unfolds over time rather than a label. Second, this process begins before, not after, failure and contributes to venture demise. Third, there is a positive ending to the collective story in that stigmatization ultimately triggers epiphanies or deep personal insights which transform entrepreneurs' view of failure from a very negative to a positive life experience. This transformation results in entrepreneurs distributing learning from failure to the founding of future ventures, even when ventures are not their own.

The notion of shared value presents business with a challenge: to generate social benefit and profit simultaneously. This challenge involves resolving tensions/paradoxes inherent when integrating the apparent contradictory elements of social and economic values. Unfortunately, resolving such tensions is difficult due to the habitual, automatic nature of sensemaking. This paper offers a mechanism whereby individuals can, over time, begin to overcome habitual sensemaking and potentially resolve tensions inherent in shared value. The mechanism is labeled inner knowledge creation (IKC). IKC is described and its role in creating shared value for businesses is illustrated through a conceptual model. The model shows how IKC develops metacognitive capabilities, builds capacities to resolve tensions/paradoxes, and cultivates openness to others’ perspectives.

We propose conscious awareness as a mechanism for creating “shared value”; a form of value that Porter describes as putting social and community needs before profit. We explore the mechanism empirically in an entrepreneurial context and find that spiritual practices increase conscious awareness which, in turn, shapes entrepreneurial intentions and venture characteristics focused on shared value.

OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of reversible spinal cord dysfunction in people over the age of 55 years. Following surgery for symptomatic CSM, patients demonstrate motor improvement early in the postoperative course, whereas sensory improvement can lag behind. The authors of the present study hypothesized that changes in the concentration of N-acetylaspartate (NAA) in the motor and sensory cortices in the brain would emulate the time course of neurological recovery following decompression surgery for CSM. Their aim was to compare and contrast how metabolite levels in the motor and sensory cortices change after surgery to reverse downstream spinal cord compression. METHODS Twenty-four patients with CSM and 8 control subjects were studied using proton MR spectroscopy (1H-MRS) images acquired on a 3.0-T Siemens MRI unit. The 1H-MRS data (TE 135 msec, TR 2000 msec) were acquired to measure absolute levels of NAA from the motor and sensory cortices in the cerebral hemisphere contralateral to the side of greater deficit at baseline in each subject. Data were also acquired at 6 weeks and 6 months following surgery. Control subjects were also evaluated at 6 weeks and 6 months following baseline data acquisition. Neurological function was measured in each subject at all time points using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) questionnaire, and the American Spinal Injury Association (ASIA) neurological classification. RESULTS In the motor cortex of patients, NAA levels decreased significantly (p < 0.05) at 6 weeks and 6 months postsurgery compared with baseline levels. In the sensory cortex of patients, NAA levels decreased significantly (p < 0.05) only at 6 months after surgery compared with baseline and 6-week levels. No significant changes in NAA were found in control subjects. Clinical scores demonstrated significant (p < 0.05) motor recovery by 6 weeks, whereas sensory improvements (p < 0.05) appeared at only 6 months. CONCLUSIONS Findings suggest that metabolite changes in both the motor and sensory cortices mimic the time course of functional motor and sensory recovery in patients with CSM. The temporal course of neurological recovery may be influenced by metabolic changes in respective cortical regions.

This article explores dynamic capability formation in new ventures examining technology commercialization at the microlevel of entrepreneurs’ actions and decisions. The research reflects a longitudinal, qualitative, multi-case study design to build theory. Findings reveal two interdependent micro-level patterns that reflect dynamic entrepreneurial capabilities. First, prospecting problems or the capacity to identify problems in industrial settings that a commercially untried technology might solve. Second, openly sharing technological features with prospective customers in order to jointly design prototype products. Revealing technology helped ensure new venture survival in contrast with conventional wisdom that links firm survival to the insulation and protection of technology. Moreover, micro-level patterns shaped macro-level change in venture/customer dyads and in related customer’ industries.

The purpose of this article was to extend existing research on opportunity identification in the social entrepreneurship literature through empirically examining this phenomenon. We used an inductive, theory–building design that surfaced patterns in social value creation across multiple case studies. The patterns showed actors seeing a social need and prospecting ideas that could address it. Data also revealed multiple, not individual, actors, dynamically engaged in interactions that nudged an opportunity into manifestation. Also, data suggested complementarities to effectuation and rational/economic processes that are divergent theoretical approaches to the study of entrepreneurship to date.

Definitions of spiritual organization include the notion of connectedness but generally consider only connectedness with respect to employees. We extend the notion of connectedness and thereby the definition of what constitutes spiritual organizations by systematically considering other ways in which organizations can enact connectedness. Classic open systems theory is integrated with the organizational spirituality literature to build a framework that identifies multiple paths to connectedness for a spiritual organization. A case study was chosen for its unusual and distinctive ability to illustrate this framework and reveals connectedness as it relates to functions connectedness (through international suppliers, accreditation, research and development, marketing and education), and to eco‐systems connectedness, where the organization demonstrates explicit awareness of social and environmental connectedness. We suggest that together these different forms of connectedness illustrate an awareness of an interdependent connectedness at a deep ecological level.

The objectives of the study was to compare pentagastrin- and calcium-stimulated serum human calcitonin (hCT) levels for nonsmoking healthy adults without evidence of thyroid disorders and determine reference ranges of basal and pentagastrin- and calcium-stimulated serum hCT levels.This was a healthy volunteer study including within-group and intergroup comparisons.The study was conducted at a tertiary referral center.Subjects included 50 healthy, nonsmoking volunteers (25 female; aged 22-57 yr) without evidence of thyroid abnormality.hCT was measured using a calcitonin two-site automated chemiluminescent immunometric assay (the most common hCT assay in clinical practice) in serum samples obtained before and 2, 5, and 15 min after iv stimulation using pentagastrin, 0.5 microg/kg body weight, or calcium gluconate, 2.5 mg/kg.Reference ranges for basal, unstimulated, and pentagastrin- or calcium-stimulated hCT and pentagastrin and calcium tolerability in healthy adults were measured.The 95th percentile basal hCT values did not differ between males and females (5.0 vs. 5.7 pg/ml). The 95th percentile maximal stimulated hCT values rose distinctly after pentagastrin (peak men, 37.8 pg/ml; women, 26.2 pg/ml) and even more so after calcium (peak men, 131.1 pg/ml, women, 90.2 pg/ml). No hCT increase was detected in four of 25 men and 12 of 25 women after pentagastrin vs. none of 24 men and two of 18 women after calcium. Calcium was associated with fewer and less intense adverse effects than was pentagastrin.High-dose calcium is a more potent and better-tolerated hCT stimulator than is pentagastrin. The reference ranges for basal and stimulated hCT established via automated chemiluminescent assay were lower than those reported for other assays.

The relationship between workplace spirituality and business ethics is extended by integrating the "yamas", yoga's guidelines for social interaction, with existing literature. I developed a theoret...

The author extends theory on the relationship between workplace spirituality and business ethics by integrating the “yamas” from yoga, a venerable Eastern spiritual tradition, with existing literature. The yamas are five practices for harmonizing and deepening social connections that can be applied in the workplace. A theoretical framework is developed and two sets of propositions are forwarded. One set emanates from the yamas and another one conjectures relationships between spirituality and business ethics surfaced by the application of these spiritual practices from yoga.

Research on entrepreneurship focuses predominantly on success which ignores the high failure rate of new ventures and precludes a holistic view of the entrepreneurial process. The current study addresses failure by asking three research questions: how do entrepreneurs experience failure, how do they cope with it, and what do they learn from it? Rich interview data is analyzed using multiple frameworks from the literature. Findings suggest that more coping and learning occurs in the economic aspect of failed entrepreneurs' lives in comparison to the social, psychological and physiological aspects. Findings also provide a proposition for testing in future research: Type of coping engaged in by failing entrepreneurs is related to the kind of learning experienced through failure.

This article describes a case competition that reflects the four elements of a grounded learning exercise. These elements include creating a real-world experience, optimizing learning transfer, integrating theory and practice, and shifting learning responsibility to the students. The authors also provide details on implementing this exercise in an undergraduate capstone strategy course and using a real-time case that brings the competition to life.

Background: Of the many studies of slipped capital femoral epiphysis, none have specifically addressed Amish children. The Amish reflect a small gene pool relative to the general white North American population. Additional knowledge of the demographics of this disorder in Amish children may provide genetic insights. The purpose of this study was to review the demographics of slipped capital femoral epiphysis in the Amish population. Methods: A retrospective review of the cases of twenty-five Amish children with slipped capital femoral epiphysis treated at two institutions was performed. The child's gender, age, weight, height, and body mass index at the time of the diagnosis; duration of symptoms; laterality of the slip; birth weight; family history; and slip severity were recorded. The slip was classified as stable or unstable. Patients who had been included in a previously published multicenter study served as a control group. Results: There were seventeen boys and eight girls with a total of thirty-three slipped capital femoral epiphyses; eight of the slips were bilateral. At the time of the diagnosis, the mean age (and standard deviation) was 13.4 ± 1.6 years, the mean weight and height were 55.6 ± 12.4 kg and 155.5 ± 10.2 cm, and the mean body mass index was 23.4 ± 5.4 kg/m2. The mean duration of symptoms was 6.6 ± 9.0 months. There were thirty-one stable and two unstable slips with a mean slip angle of 38° ± 20°. Nine (39%) of twenty-three children for whom the information had been recorded had a positive family history of slipped capital femoral epiphysis, a rate that is higher than the 9% and 14.5% rates reported in two other series (p = 0.002). The Amish children were not as heavy as their non-Amish counterparts (55.6 ± 12.4 kg compared with 66.4 ± 17.7 kg, p = 0.0036). Conclusions: Although the children in this study were moderately heavy, they could not be classified as obese on the basis of weight-for-age or body-mass-index percentiles. The high prevalence of family members with slipped capital femoral epiphysis may reflect either a genetic or environmental component, or an interaction between genetics and environment (for example, work load or common chores requiring particular physical positions) in the Amish population. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

INTRODUCTION Theory about what constitutes entrepreneurial success is explored using case studies of the 2003 Ernst & Young Entrepreneur of the Year Award winners for Australia and New Zealand. Findings suggest the need to more equally emphasize what theory presents as elements of successful entrepreneurship, and importantly, incorporate ethics as a key dimension. Further, the analysis offers insight into how business awards processes in general might be conducted. Entrepreneurship has long been considered an important economic activity. The past twenty years has witnessed an explosion of research into entrepreneurs and their actions (Venkatarman 1997; Hannafey 2003) with considerable emphasis on the elements that constitute successful entrepreneurship. However, there has been little empirical work substantiating these elements or exploring the extent to which they appear to be considered when judgements are made about entrepreneurial success. Additionally, some entrepreneurs that are judged successful, such as Monty Fu who won an entrepreneur of the year award in the United States, are later shown to be unsuccessful along a number of elements. It may be that some elements are more emphasized when judging entrepreneurial endeavours, than are others. For these reasons, the current paper focuses on the construction of successful entrepreneurship. It addresses the following research questions: Are there some elements of entrepreneurship that appear to be more emphasized than are others when judgements are made about successful entrepreneurs? Would recourse to theory help decide successful entrepreneurship? The paper identifies elements of successful entrepreneurship from the literature and assesses the extent to which each element prevails in the context of two awards - the Ernst & Young (EY) Entrepreneur of the Year (EOY) Award for 2003 conducted in both New Zealand and Australia. EOY awards provide headline cases within which successful entrepreneurship is svstematically judged. case studies of the two award-winning entrepreneurs are presented, and a comparative analysis provided together with a more in-depth analysis of the New Zealand case, prior to conclusions being drawn regarding the robustness of extant entrepreneurship theory and the implications for awards processes in general. CONCEPTUAL FRAMEWORK: ELEMENTS OF SUCCESSFUL ENTREPRENEURSHIP Although theory in entrepreneurship is said to be underdeveloped (Shane & Venkataraman 2000), the literature does reveal a preoccupation with the success or failure of individual entrepreneurs and firms (Venkataraman 1997). The current paper strives for a comprehensive view of successful entrepreneurship based on both foundational classics and more recent literature in the field. The paper thus adopts a view of entrepreneurship that reflects elements of innovation (Schumpeter, 1934), social and economic change (Menger 1892), risk (Mill 1848; Knight 1921), and reward (Hawley 1901; McClelland 1961). These elements of successful entrepreneurship are generally recognized in the more recent literature which advocates a focus on the behaviour of creating new ventures (Gartner 1988) ', as elucidated below. Opportunity Identification. Be they opportunities created, or opportunities identified, entrepreneurs seize opportunities. Entrepreneurs' special talent lies in recognising and exploiting particular opportunities (Shane & Venkataraman 2000; Shane 2003). Sarasvathy, Simon and Lave (1988) show successful entrepreneurs see opportunities where others tend to see risk. Moreover, "they can spot opportunities that turn the commonplace into the unique and unexpected" (Mitton 1989, p. 12). The concept of opportunity identification thus spills over into elements of vision and innovation. Vision. Entrepreneurs are considered successful, in part, if they visualize a future not seen or thought possible by others in their industry (Hamel & Prahalad 1994). …

Summary: An important clinical issue concerns the efficacy of current voice therapy approaches in treating voice disorders, such as vocal nodules. Much research focuses on finding reliable methods for documentation of treatment results. In this second treatment study of ten patients with vocal nodules, who participated in a behaviorally based voice therapy program, 11 aerodynamic (transglottal air pressure and glottal waveform) and acoustic (spl, f0, and spectrum slope) measures were used. Three pretherapy baseline assessments were carried out, followed by one assessment after each of five therapy phases. Measurements were made of two types of speech materials: Strings of repeated /pae/ syllables and sustained /ae/ phonations in two loudness conditions: comfortable loudness and loud voice. The data were normalized using z-scores, which were based on data from 22 normal subjects. The results showed that the aerodynamic measures reflected the presence of vocal pathology to a higher degree than did the acoustic spectral measures, and they should be useful in studies comparing nodule and normal voice production. Large individual session-to-session variation was found for all measures across pretherapy baseline recordings, which contributed to nonsignificant differences between baseline and therapy data.

The number of OR/MS courses offered has declined in the last 15 years. Academics and practitioners have debated how to reverse this trend to insure the managerial relevance of OR/MS courses. We use a teaching technique, discussion leadership, designed to augment the managerial relevance of OR/MS topics that is a variant of case teaching. It is nondirective and focused on management as problem solving. Discussion leadership also helps students develop managerial skills, including strategic thinking, communication, conflict resolution, logic, and visualization of links between technical solutions and competitive advantage. We particularly recommend it for teaching MBA and executive students. The synergy between the use of cases with their descriptions of managerial problems and the discussion leadership approach yields real benefits.

Teaching quantitative research design continues to challenge management educators. Challenges arise because this research requires expertise in multiple design elements including theory development, measurement, and statistical analysis. Moreover, capable design necessitates the seamless integration of these separate elements with each other. To aid educators, this article proposes an integrative model for teaching quantitative research. The model specifically focuses on matching design elements and is delineated by exercises that teach integrative skills. The author also discusses the applicability of the model to executive learning wherein managers test their beliefs or theories-in-use.

E-business is touted as a key technology for developing the competitiveness of small and medium sized enterprises (SMEs) in New Zealand because it can help overcome the barriers of distance and limited resources that challenge these companies. However, it is important to know exactly where SMEs are in the adoption process. Such knowledge is critical to providing support and incentives for further adoption (Ivis, 2000). The purpose of the current study is to provide a relatively comprehensive description of SMEs’ e-technology adoption. We also examine strategies SMEs use to create competitive advantage through e-business. Findings reveal that medium-sized companies are poised to transact business and restructure business processes in the electronic medium. Strategies pursued by such enterprises include both low cost and differentiation. Micro and small companies lag behind medium-sized ones in embracing e-business and require support and incentives to achieve the “website” stage of adoption.

The aim of this study was to assess the effects on vocal function of voice therapy for vocal nodules. Perceptual and physiological progressive changes were examined during a strictly structured, behaviorally based voice therapy protocol in which 11 women with vocal nodules participated. Randomized audio recordings from pretherapy and from each of the therapy approaches (vocal hygiene, respiration, direct facilitation, carryover) were used for perceptual evaluations. Six speech-language pathologists rated ten voice quality parameters. Two evaluation procedures were performed and compared. Interlistener reliability was sufficiently high in both tests. Significant effects of therapy were found for decreased overall dysphonia, press, instability, gratings, roughness, vocal fry, and "scrape." Nonsignificant group effects were found for breathiness, aphonic instances, and lack of sonority. No significant parameter changes occurred between baseline assessment and the completion of the initial (vocal hygiene) phase of therapy. Significant changes were found following the direct facilitation and respiration phases of therapy. Videostroboscopic evaluations made by two laryngologists showed that in no case were the nodules completely resolved. However, the nodules had decreased in size and edema was reduced after therapy for all clients, but one. Combined results suggest: (1) Alterations in vocal function were reflected in perceptual parameters, and (2) the voice therapy had a positive effect on voice quality, vocal status, and vocal function for the majority of the vocal nodule clients.

Team processes that convert top team demography into firm outcomes are assumed in theory but rarely tested explicitly. The present study tests a model wherein top teams' collective information proc...

This paper presents summary statistics regarding the characteristics of decisions identified in a recent review of 86 applications of decision analysis. The goals of this summary are (1) to identify values for important parameters which characterize the structure of decisions which have been analysed using decision analysis; (2) to see what proportion of studies use the various available analysis tools; and (3) to draw implications from these results, particularly in terms of simplifying applied decision analysis. The results show that decisions tend to be multiattributed, involve a modest number of alternatives, and uncertainties appear to be the major source of influence on the chosen alternative. Furthermore, applications generally appear to take advantage of tools dealing with problem structuring, assessing uncertainty and performing sensitivity analysis.

The dynamic capabilities of firms and its underlying human capital resources are thought to underlie the competitive advantage of firms. In this study we examine empirically the process whereby human capital is amassed, and combined with other resources to manifest operational, then dynamic capabilities. Our research question asks, how do new ventures amass and configure the human capital of their firms? We utilize an inductive longitudinal, multi-case study approach to reveal the micro-processes through which biotechnology start-up firms amassed and configured their human capital resources for viability and competitive advantage. Our findings reveal two important overlapping micro-processes: gathering and hunting, and potentiating. These two micro-processes converge to form organizational capabilities and outcomes for the firm. We discuss the implications of the findings in extending the literature on human capital emergence and dynamic capabilities.

Existing information processing theories of strategic choice focus on either the organizational or individual level of analysis. This single level focus makes these theories incomplete representations of how strategic decisions are actually made in organizations. We believe an integration of these two levels is necessary for a comprehensive view of choice. This paper thus proposes a parallel process model of strategic decision making that integrates organizational and individual level information processing perspectives. The integrated, comprehensive view afforded by the proposed model enhances understanding of strategic decision making by identifying (1) multiple ways in which bias can enter into choices and (2) dual level influences on decision activities such as information gathering and alternative generation. The proposed model portrays strategic decision making as complex, multilevel information processing and choices as emergent outcomes of that processing. The model is developed as follows. First, the individual level of the model is generated by recognizing that people process information in stages. The notion of stages is used because it depicts the basic structure of information processing and is widely supported by empirical research. Second, the organizational level of the model is articulated by acknowledging organizations (1) process information in stages and (2) exhibit information processing activities analogous to those at the individual level. Third, a series of linking mechanisms connecting individual information processing stages to analogous organizational level ones is proposed. These linking mechanisms thus conceptually operationalize the integration of the two levels. Fourth, three contingency variables are presented to flesh out the model and formulate propositions. Contingency variables specifically acknowledge differences in information processing across organizations. A final section of the paper explains how key variables in the proposed model can be operationalized and outlines a test for the presence of multiple levels of information processing in a strategic choice context.

The paper explores entrepreneurial resilience in the context of venture failure. We implement a qualitative, narrative research design and present a collective story of seven entrepreneurs’ resilie...

The article applies upper echelon theory to explain variation in parent firms’ post-acquisition financial performance. We develop and test a latent variable model hypothesizing that top management team (TMT) demographic diversity affects financial outcomes through teams’ collective beliefs. In so doing we identify three constructs which potentially underlie classic TMT demographic diversity measures. Also, we propose two fundamental structural properties of team beliefs extrapolated from individual level cognitive complexity theory. Results show both positive and negative effects on financial outcomes from the TMT demographic diversity constructs through the belief constructs. We discuss the importance of including mediating constructs when attempting to unravel TMT diversity’s effects on firm level outcomes.

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions. 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorous vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

The purpose of this evaluation was to determine the accuracy of a portable ultrasound instrument in assessing bladder volume in an acute care neuroscience population and the effect of ultrasound assessment on nursing practice in an acute care neuroscience unit. In a 6-week prospective evaluation, 105 paired ultrasound measurements were performed by 45 nurses on 30 patients suspected to be retaining urine. Sixty-seven catheterizations were performed, and volumes were compared with corresponding ultrasound readings. The first ultrasound volume readings slightly underestimated the catheterized volumes, but the volumes from the first ultrasound readings and the catheterized volumes were highly correlated. Volume readings from a second ultrasound, the average of the first and second ultrasound readings, and the higher of the two ultrasound readings did not add to the ability of the ultrasound instrument to predict catheterized volumes. Patient age and gender did not change the relationship between ultrasound and catheterized volumes. The ultrasound assessment changed nursing practice in 51% of the instances; the most common change (32%) was that nurses did not catheterize the patient. The ultrasound assessment did not change nursing practice in 49% of the instances; the most common reason (41%) was that the ultrasound confirmed the need to catheterize the patient. The instrument was therefore judged to be an accurate and reliable tool that changed nursing practice in an acute care neuroscience unit.

We reflect on our experiences of supervising international students’ theses and dissertations against the background of existing literature, some of which takes a critical perspective on this issue...