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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.

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.