Provision of Kidney Disease Education Service is Associated with Improved Vascular Access Outcomes among the US Incident Hemodialysis Patients

Background: Pre-end stage renal disease (ESRD) Kidney Disease Education (KDE) has been shown to improve multiple chronic kidney disease (CKD) outcomes but, its impact on vascular access outcomes is not well-studied. In 2010, Medicare launched KDE reimbursements policy for patients with advanced CKD. Methods: In this retrospective USRDS analysis, we identified all adult incident hemodialysis patients with a minimum of 6-months of pre-ESRD Medicare coverage during the first five-years of CMS-KDE policy and divided them into CMS-KDE services recipients (KDE-cohort) and non-recipients (non-KDE cohort). The primary outcome was incident arteriovenous fistula (AVF) and the composite of incident AVF or arteriovenous graft (AVG) utilization. Secondary outcomes were central venous catheter (CVC) with maturing AVF/AVG and pure CVC utilizations. Step-wise multivariate analyses were performed in four progressive models (model 1: KDE alone, model 2: multivariate model encompassing model 1 with socio-demographics, model 3: model 2 with comorbidity and functional status, and model 4: model 3 with pre-ESRD nephrology care). Results: Of the 211,990 qualifying incident hemodialysis patients during the study period, 2,887(1.4%) received KDE services before dialysis initiation. The rates of incident AVF and composite AVF/AVG were more than double (29.7% and 34.9% respectively, compared to 14.2% and 17.2%) and pure catheter use about a third lower (40.4% compared to 64.5%) in the KDE cohort compared to the non-KDE cohort. Maximally adjusted odds ratio(99% confidence interval) in model 4 for study outcomes were: incident AVF use: 1.78 (1.55-2.05), incident AVF/AVG use: 1.78 (1.56-2.03), incident CVC with maturing AVF/AVG: 1.69 (1.44-1.97)and pure CVC without any AVF/AVG: 0.51 (0.45-0.58). The benefits of KDE service were maintained even after accounting for the presence, duration and facility of ESRD care. Conclusion: Occurrence of pre-ESRD KDE service is associated with significantly improved incident vascular access outcomes. Targeted studies are needed to examine the impact of KDE on patient engagement and self-efficacy as a cause for improvement in vascular access outcomes.

The Epistemology of Tourism Security

The act of traveling needs higher levels of trust in view of the fact that the traveler is unfamiliar with the visited topography. The “sacred law” of hospitality not only reduces the anxieties in hosts and guests but also gives a veil of trust in order for the risk to be controlled. It is unfortunate that terrorism affects notably the organic image of the tourist destination. After hard work, policymakers see how their work of years evaporates in seconds. For this reason, scholars are captivated to present an all-encompassing model to understand risks and its impacts on the tourism industry. Somehow, theorist of risk perception enthusiastically embraced quantitative methodologies in detriment of qualitative ones. The authors review all conceptual and methodological limitations of the risk perception literature and lay the foundations to a new (more) qualitative definition of risk. This chapter explores the issue from a qualitative viewpoint introducing ethnography as a valuable instrument of research.

Defining and Operationalizing Disaster Preparedness in Hospitals: A Systematic Literature Review

Introduction:Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined nor operationalized in the international literature.Aim:This review aims to systematically assess definitions and operationalizations of disaster preparedness in hospitals, and to develop an all-encompassing model, incorporating different perspectives on the subject.Methods:A systematic search was conducted in five databases: Scopus, PubMed, Web of Science, Disaster Information Management Research Centre, and SafetyLit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text, were excluded, as were articles on prehospital care. The findings from literature were used to build a model for hospital disaster preparedness.Results:In the included publications, 13 unique definitions of disaster preparedness in hospitals and 22 different operationalizations of the concept were found. Although the definitions differed in emphasis and width, they also reflected similar elements. Based on an analysis of the operationalizations, nine different components could be identified that generally were not studied in relation to each other. Moreover, publications primarily focused on structure and process aspects of disaster preparedness. The aim of preparedness was described in seven articles.Discussion/Conclusion:This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining elements of definitions and components operationalized, disaster preparedness could be conceptualized in a more comprehensive and complete way than before. The model presented can guide future disaster preparedness activities and research.

Sustainable Growth in SMEs: A Review from the Malaysian Perspective

The importance of Small and Medium Enterprises (SMEs) contributions to the nations’ economies in the world is an undebatable fact. The same applies to Malaysia with 98.5% of the total business establishments being SMEs; contributing to 65.3% of total employment and 36.3% of GDP. Supports from the Government are never fading with huge allocations of budget every year but yet registering high failure rate. Sustainable growth of SMEs is long overdue. The awareness of the importance of sustainable growth of SMEs has resulted in the presence of various definitions and concepts of sustainable growth. This paper seeks to explore the literature on long-term and sustainable growth for SMEs and the enhanced knowledge on this area willbe aguidance to the policy makers, supporting agencies, advisors, entrepreneurs and academicians to seriously develop an all-encompassing model for sustainable growth of SMEs. This paper suggests an integrated sustainable growth model of SMEs with four dimensions of the economic factors.

Research Methods in Dark Tourism Fields

The current chapter delves into the methodologies as well as limitations of used method in dark tourism fields. As fieldworkers are familiar, sometimes interviewees not only are incognizant of their inner-world, but in other occasion, they simply do not say the truth to protect their own interests. Though in tourism and dark tourism fields, researchers are prone to administer questionnaires or interviews as the main methodological option, no less true is that results are far from being clear or have very problems to be organized in an all-encompassing model.

Emotion regulation strategies in trauma-related disorders: pathways linking neurobiology and clinical manifestations

Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.

TESTING CONSUMPTION OPTIMALITY USING AGGREGATE DATA

This paper tests the optimality of consumption decisions at the aggregate level, taking into account popular deviations from the canonical constant-relative-risk-aversion (CRRA) utility function model—rule of thumb and habit. First, we provide extensive empirical evidence of the inappropriateness of linearization and testing strategies using Euler equations for consumption—a drawback for standard rule-of-thumb tests. Second, we propose a novel approach to testing for consumption optimality in this context: nonlinear estimation coupled with return aggregation, where rule-of-thumb behavior and habit are special cases of an all-encompassing model. We estimated 48 Euler equations using GMM. At the 5% level, we only rejected optimality twice out of 48 times. Moreover, out of 24 regressions, we found the rule-of-thumb parameter to be statistically significant only twice. Hence, lack of optimality in consumption decisions represent the exception, not the rule. Finally, we found the habit parameter to be statistically significant on four occasions out of 24.

Employee empowerment: factors affecting the consequent success or failure (Part II)

Purpose – The purpose of this paper is to uncover and synthesise the main factors that affects and determines the success or failure of empowerment initiatives from a macro and micro perspective. Design/methodology/approach – A thorough review of scholarly articles and empirical evidence was conducted on the topic of empowerment in order to bring to light the correlation between the different factors affecting structural empowerment, psychological empowerment and the effect of leadership style. Findings – It has been determined that a team based structure and a culture based on trust and open communication are the key factors affecting the successful implementation of empowerment. Furthermore, although, many positive points can be made for transformational leadership, transactional leadership cannot be discounted as the research shows that the right combination of incentives and rewards, coupled with a certain organisational culture can breed empowerment among certain types of employees. Research limitations/implications – Going forward in terms of research on the increasingly popular concept of empowerment, it is believed that a more fully integrated model should be developed. Although some models do incorporate analysis of various macro and micro variables a more comprehensive and encompassing model would prove useful. Such a model would allow for a far more in-depth understanding of empowerment and its defining factors and would provide an invaluable tool to organisations wishing to implement empowerment in the most optimal way. Practical implications – In applying a combination of theories on empowerment, leadership and individuals as part of an organisation, the authors posit that empowerment initiatives are predisposed to either success or failure. In order for empowerment to permeate the corporate culture and prove successful, the predispositions of decentralised management and personal ambition are strong factors of success. Social implications – The authors postulate that the deciding factors regarding the success or failure of empowering an employee originate from the employees themselves. Even though employees can adopt new corporate cultures and be transformed by their leaders, their core traits remain the same and will have a decisive impact on the eventual success or failure of empowerment initiatives. Originality/value – Going forward in terms of research on the increasingly popular concept of empowerment, it is believed that a more fully integrated model should be developed. Although some models do incorporate analysis of various macro and micro variables, a more comprehensive and encompassing model would prove useful.

Employee empowerment: factors affecting the consequent success or failure – Part I

Purpose – The purpose of the paper is to uncover and synthesise the main factors that affects and determines the success or failure of empowerment initiatives from a macro and micro perspective. Design/methodology/approach – A thorough review of scholarly articles and empirical evidence was conducted on the topic of empowerment in order to bring to light the correlation between the different factors affecting structural empowerment, psychological empowerment and the effect of leadership style. Findings – It has been determined that a team based structure and a culture based on trust and open communication are the key factors affecting the successful implementation of empowerment. Furthermore, although, many positive points can be made for transformational leadership, transactional leadership cannot be discounted as the research shows that the right combination of incentives and rewards, coupled with a certain organisational culture can breed empowerment among certain types of employees. Research limitations/implications – Going forward in terms of research on the increasingly popular concept of empowerment, it is believed that a more fully integrated model should be developed. Although some models do incorporate analysis of various macro and micro variables a more comprehensive and encompassing model would prove useful. Such a model would allow for a far more in-depth understanding of empowerment and its defining factors and would provide an invaluable tool to organisations wishing to implement empowerment in the most optimal way. Practical implications – In applying a combination of theories on empowerment, leadership and individuals as part of an organisation, the authors posit that empowerment initiatives are predisposed to either success or failure. In order for empowerment to permeate the corporate culture and prove successful, the predispositions of decentralised management and personal ambition are strong factors of success. Social implications – The authors postulate that the deciding factors regarding the success or failure of empowering an employee originate from the employees themselves. Even though employees can adopt new corporate cultures and be transformed by their leaders, their core traits remain the same and will have a decisive impact on the eventual success or failure of empowerment initiatives. Originality/value – Going forward in terms of research on the increasingly popular concept of empowerment, it is believed that a more fully integrated model should be developed. Although some models do incorporate analysis of various macro and micro variables, a more comprehensive and encompassing model would prove useful.