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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

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth, however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes’ physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.

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.

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.

© 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.

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.

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.

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 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.

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.

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.

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...

This paper investigates entrepreneurs’ experience of stigma associated with venture failure. We implement a narrative approach to understand how stigma was experienced personally by entrepreneurs. ...

We examined three strategy frameworks in the social entrepreneurship context: industrial/organization economics; the resource-based view; and the relational view. Our qualitative study investigated...

A study of leukocyte antibodies is presented using (1) the sera of rabbits immunized with human leukocytes, and (2) the sera of three patients screened for the presence of such antibodies from among 36 patients with hematologic disease, 31 of whom (including the 3 studied in detail) had received multiple transfusions. The following technics are described and were employed: Leukoagglutination, leukoprecipitation including tube and agar-plate methods, agglutination of antigen-coated tanned and untanned sheep erythrocytes, the effect of antisera upon phagocytosis of heat-killed staphylococci by leukocytes, and upon ameboid motility of leukocytes. The leukoagglutinin test gives reliable clearcut results providing that appropriate controls are included and certain criteria adhered to, in order to facilitate the recognition of clumping due to other factors than true antigen-antibody union. No leukoprecipitins were detected in human sera with the technics used in this study. Immune rabbit sera, on the other hand, gave two reaction-lines in agar media, when set up against leukocyte extract. Immune rabbit sera reacted strongly with antigen-coated tanned sheep red blood cells. Human sera did not so react. One of the three selected human sera reacted with antigen-coated untanned erythrocytes, suggesting the presence of a polysaccharide antigen extractable from human leukocytes and capable of stimulating antibody formation in the human. Immune rabbit sera, and other human sera, did not react in this test. A suggestive but perhaps not a conclusive effect upon phagocytosis of bacteria by leukocytes exposed to human leukocyte antibody for 1 hour could be demonstrated. By means of ameboid motility studies, a cytotoxic effect of the human antisera upon human leukocytes could be demonstrated after 18 hours of incubation, but not after 3 hours. This was interpreted as evidence of a delayed reaction. Certain cardinal points from a clinical and theoretical standpoint with regard to the genesis of leukocyte antibodies in man are briefly reviewed. A possible analogy between leukocyte antibody formation and the homograft reaction is discussed. It is suggested that the rarity of leukocyte iso-antibody formation following transfusion is related to the fact that the intravenous pathway may be a poor route of immunization for these antigens.