Improve Performance Outcomes Research Articles

Strategic leadership and management factors driving sustainability in health-care organizations in Thailand

Purpose This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.Design/methodology/approachThe investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.Findings The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.Research limitations/implicationsThe study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.Originality/value This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.

The Impact of Evolving Transatlantic Relations on International Partnerships in Higher Education

This paper investigates the impacts of recent, macro-level developments in transatlantic relations on the ability of United States and European Union higher education institutions (HEIs) to leverage international partnerships in achieving their traditional missions of teaching, research, and service. Using literature to place international education within the broader context of transatlantic relations from the post-World War II era to today, the connection between geopolitics and HEI international partnerships is made explicit. Comprehensive internationalization theory is then applied to illustrate the importance of HEI international partnerships in realizing international education outcomes that are congruent with traditional HEI missions. After establishing the link between transatlantic relations, internationalization in higher education, HEI international partnerships and overall HEI performance, recent developments within transatlantic relations are directly analyzed with regards to HEI international partnerships, highlighting impacts on their ability to function. Finding that progressive transatlantic relations result in improved performance outcomes through HEI international partnerships for US and EU HEIs, and that regressive transatlantic relations produce the opposite outcome, the study offers implications for policy makers and HEI administrators.

Systematic Review and Meta-Analysis of Endurance Exercise Training Protocols for Mice.

Inbred and genetically modified mice are frequently used to investigate the molecular mechanisms responsible for the beneficial adaptations to exercise training. However, published paradigms for exercise training in mice are variable, making comparisons across studies for training efficacy difficult. The purpose of this systematic review and meta-analysis was to characterize the diversity across published treadmill-based endurance exercise training protocols for mice and to identify training protocol parameters that moderate the adaptations to endurance exercise training in mice. Published studies were retrieved from PubMed and EMBASE and reviewed for the following inclusion criteria: inbred mice; inclusion of a sedentary group; and exercise training using a motorized treadmill. Fifty-eight articles met those inclusion criteria and also included a “classical” marker of training efficacy. Outcome measures included changes in exercise performance, O2max, skeletal muscle oxidative enzyme activity, blood lactate levels, or exercise-induced cardiac hypertrophy. The majority of studies were conducted using male mice. Approximately 48% of studies included all information regarding exercise training protocol parameters. Meta-analysis was performed using 105 distinct training groups (i.e., EX-SED pairs). Exercise training had a significant effect on training outcomes, but with high heterogeneity (Hedges’ g=1.70, 95% CI=1.47–1.94, Tau2=1.14, I2=80.4%, prediction interval=−0.43–3.84). Heterogeneity was partially explained by subgroup differences in treadmill incline, training duration, exercise performance test type, and outcome variable. Subsequent analyses were performed on subsets of studies based on training outcome, exercise performance, or biochemical markers. Exercise training significantly improved performance outcomes (Hedges’ g=1.85, 95% CI=1.55–2.15). Subgroup differences were observed for treadmill incline, training duration, and exercise performance test protocol on improvements in performance. Biochemical markers also changed significantly with training (Hedges’ g=1.62, 95% CI=1.14–2.11). Subgroup differences were observed for strain, sex, exercise session time, and training duration. These results demonstrate there is a high degree of heterogeneity across exercise training studies in mice. Training duration had the most significant impact on training outcome. However, the magnitude of the effect of exercise training varies based on the marker used to assess training efficacy.

A Review of Nanomaterial Based Scintillators

Recently, nanomaterial-based scintillators are newly emerging technologies for many research fields, including medical imaging, nuclear security, nuclear decommissioning, and astronomical applications, among others. To date, scintillators have played pivotal roles in the development of modern science and technology. Among them, plastic scintillators have a low atomic number and are mainly used for beta-ray measurements owing to their low density, but these types of scintillators can be manufactured not in large sizes but also in various forms with distinct properties and characteristics. However, the plastic scintillator is mainly composed of C, H, O and N, implying that the probability of a photoelectric effect is low. In a gamma-ray nuclide analysis, they are used for time-related measurements given their short luminescence decay times. Generally, inorganic scintillators have relatively good scintillation efficiency rates and resolutions. And there are thus widely used in gamma-ray spectroscopy. Therefore, developing a plastic scintillator with performance capabilities similar to those of an inorganic scintillator would mean that it could be used for detection and monitoring at radiological sites. Many studies have reported improved performance outcomes of plastic scintillators based on nanomaterials, exhibiting high-performance plastic scintillators or flexible film scintillators using graphene, perovskite, and 2D materials. Furthermore, numerous fabrication methods that improve the performance through the doping of nanomaterials on the surface have been introduced. Herein, we provide an in-depth review of the findings pertaining to nanomaterial-based scintillators to gain a better understanding of radiological detection technological applications.

Analysis of collective team behaviour: sub-elite female rugby 7s

Introduction: Current technology enables the capture of a player’s location on the field using computer vision technologies, providing insight into the complex, non-linear interactions between individuals that are responsible for team-level formations and collective movement that emerge without apparent central control. Self-organisation and emergent behaviour has been widely studied in biological systems and can be observed in the impressive displays of ‘flocking’ and ‘shoaling’/’schooling’ behaviour seen in species such as fish and birds. Studies of pedestrian movement have also demonstrated emergent collective behaviour and this provides a basis to study the development of collective behaviours that are embedded within the movement of individuals in team-based sport. This study performs a preliminary analysis, using techniques previously applied to biological systems, to study collective movement in Rugby 7s. Methods: Two segments of gameplay from a game of Rugby sevens were selected for analysis; one in which a try was scored (Play 1) and one which ended in a foul (Play 2). The player positions were recorded semi-autonomously using the Channel and Spatial Reliability Tracker (CSRT) algorithm implemented in OpenCV, and then transformed to a metre based coordinate system. Location was recorded every 3 frames from 30 fps video resulting in 222 records (~22 seconds) for play 1 and 624 records (~62 seconds) for play 2. Two collective motion order parameters, Polarisation (Op) and Rotation (Or) were calculated. Polarisation measures the consensus in movement direction between all team members, whereas rotation measures the tendency of the team to rotate about the team centre in a consistent sense (clockwise or anticlockwise). Results: Order parameters follow consistent trends in response to game events, such as passing through multiple players and tackling. Play 2 provides multiple examples of successful tackles which differ in group order from the unsuccessful attempt that allowed a break in Play 1, resulting in a try. Discussion: By using tools from biological systems we can quantify the coordination of team members and compare this to performance outcomes. The plays studied demonstrated different collective movement patterns, which resulted in either a positive or negative outcome. Rigorous quantitative analysis of collective team behaviour will help practitioners in tactical and technical training design for improved performance outcomes. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis.

Objective The objective of our paper is to review all of the relevant literature in ophthalmology microsurgical education and identify which teaching methodologies were most effective. Methods A systematic review and meta-analysis of the literature was conducted. Electronic databases, including Ovid MEDLINE, Cochrane CENTRAL, and EMBASE, were searched with preset terms. The search was through December 11, 2019. Eligibility criteria included studies with sufficient data for analyzing associations between surgical teaching techniques and success rates in surgical skills and the organization of the intervention as a microsurgical skills course, curriculum, or program. The articles were independently reviewed by two authors. Each included study was evaluated for quality using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach and risk of bias using the Cochrane Collaboration's tool for assessing bias. Data Extraction and Synthesis Data extraction was performed by two reviewers and disagreements were checked by a third reviewer. A random-effects analysis was used to pool the outcomes of studies. Main Outcomes and Measures Outcomes included time for completion of surgical task, level of preparedness, competency score, and number of surgeries with complications. Results A total of 439 studies were reviewed and 13 studies ( n = 8,790 surgical cases; n = 115 trainees) were included in the meta-analysis. Excluded articles studied cataract simulation training as the primary intervention or were not related to ophthalmology. All pooled results demonstrated a positive association with surgical outcomes; however, video-based education (standardized mean difference [SMD] = 2.49 [95% confidence interval (CI): 0.36-4.63]; four effects [four studies]; n = 69; I 2 = 90%) and stepwise teaching method (odds ratio [OR = 3.84 [95% CI: 2.66-5.55]; six effects [six studies]; n = 6,968; I 2 = 39%) interventions were the most favorable. Conclusion and Relevance The following five interventions evaluated in this paper were found to be effective methods of improving performance outcomes in ophthalmic microsurgery: (1) didactic lectures, (2) video-based education, (3) surgical wet-laboratory, (4) stepwise method, and (5) direct supervision and feedback. Our meta-analysis concludes that video-based education and stepwise teaching interventions are the most effective methods for a microsurgical ophthalmology training curriculum. Combining the strengths of the interventions analyzed in this study should be considered when implementing and adjusting ophthalmic surgical skills curriculums.

Does Protein Supplementation Support Adaptations to Arduous Concurrent Exercise Training? A Systematic Review and Meta-Analysis with Military Based Applications.

We evaluated the impact of protein supplementation on adaptations to arduous concurrent training in healthy adults with potential applications to individuals undergoing military training. Peer-reviewed papers published in English meeting the population, intervention, comparison and outcome criteria were included. Database searches were completed in PubMed, Web of science and SPORTDiscus. Study quality was evaluated using the COnsensus based standards for the selection of health status measurement instruments checklist. Of 11 studies included, nine focused on performance, six on body composition and four on muscle recovery. Cohen’s d effect sizes showed that protein supplementation improved performance outcomes in response to concurrent training (ES = 0.89, 95% CI = 0.08–1.70). When analysed separately, improvements in muscle strength (SMD = +4.92 kg, 95% CI = −2.70–12.54 kg) were found, but not in aerobic endurance. Gains in fat-free mass (SMD = +0.75 kg, 95% CI = 0.44–1.06 kg) and reductions in fat-mass (SMD = −0.99, 95% CI = −1.43–0.23 kg) were greater with protein supplementation. Most studies did not report protein turnover, nitrogen balance and/or total daily protein intake. Therefore, further research is warranted. However, our findings infer that protein supplementation may support lean-mass accretion and strength gains during arduous concurrent training in physical active populations, including military recruits.

Excellent reliability of toe strength measurements in children aged ten to twelve years achieved with a novel fixed dynamometer

BackgroundStronger toe flexor muscles improve performance outcomes in children, including balance, sprinting, jumping and side stepping. Toe flexor strength (TFS) is recommended as part of the clinical assessment of foot function in children. Fixed dynamometry, rather than handheld, is the gold standard of measurement; however, it can be prohibitively costly. No fixed dynamometer reliability studies on toe flexion have been conducted in children to date. Research questionsDoes the novel fixed hand-held dynamometer (HHD) protocol provide reliable intra-rater and test-retest measurements of toe flexor strength in children aged 10 to 12? MethodsTwo trials were recorded from 14 healthy children (10–12 years), 7–14 days apart by the same rater. A Lafayette HHD (model 01163) measured peak force. The HHD was secured in a mobile custom mould below a step with a strap, which secured the foot of the participant. The receptor pads of the HHD were level with the upper surface of the step, maintaining neutral toe joints at rest. The participant was seated on an adjustable stool to ensure the hip, knee and ankle were each at 90° flexion, with the testing foot flat on the upper surface of the step. The averages of three maximal five second efforts were used for data analysis using a two-way mixed effects model with repeated measures ANOVA (intraclass correlation coefficient ICC 3,3). Standard error of measurement (SEM) was calculated to determine the absolute between trial variability. ResultsThe novel fixed HHD protocol provided excellent test-retest reliability with small measurement error for hallux (ICC 3,3 = 0.93, 95 % CI 0.78−0.98, SEM = 4.31 N) and lesser toe flexor strength testing (ICC 3,3 = 0.96, 95 % CI 0.87−0.99, SEM = 1.86 N). SignificanceThe fixed HHD protocol described in this study has excellent reliability for the test-retest evaluation of children’s toe flexor strength.

Peer Effects in Competitive Environments: Field Experiments on Information Provision and Interventions

Prior studies of social-norms interventions have focused on nudging behavior in non-competitive settings. This research evaluates such interventions in competitive environments, e.g., a class with a competitive grading policy. Field experiments on a learning management system show that providing descriptive information about peers’ behavior has mixed effects in reducing procrastination and improving performance outcomes. Specifically, the effects are moderated by individual characteristics and contextual variables. First, peer information interventions are more effective for males, and the effects are stronger in a male-majority environment than in a female-majority environment. These findings differ from prior studies of social-norms interventions conducted in non-competitive settings, in which females are found to be more responsive to interventions. Gender differences in our competitive settings can be explained by males and females’ differential preferences for competition: males are more competitive-oriented and thus are more responsive to peer information in competitive environments. Second, we find that individuals who are in great need of interventions, i.e., those with poor past behavior and performance, are also more likely to benefit from peer information interventions, suggesting that peer information interventions motivate positive change. This study highlights the heterogeneous effects of peer information interventions and has implications for targeted interventions.

Mental toughness of first division women football players in Gauteng Province, South Africa

The mental preparation of woman athletes, including woman football players, have been neglected for quite some time. For woman football players to perform to their full potential, they need to know how to play under pressure, get out of difficulties effectively and maintain their good performance when faced with continuous challenges during the game. The aim of this study was therefore to determine the psychological profiles of woman football players in first division leagues in Gauteng Province of South Africa, with a specific focus on their mental toughness. A quantitative approach was used to gather and analyse both the descriptive and inferential data. A purposive sample of 148 participants (aged 20.2 ± 5.7 years) from both the Sasol and South African Football Association (SAFA) leagues were asked to complete the Mental Skills Inventory (MSI), Sport Mental Toughness Questionnaire (SMTQ), Sport Competition Anxiety Test (SCAT) and Rosenberg Self-esteem Scale (RSQ) to assess their mental toughness levels. The results indicated that woman football players in South African first division leagues have a moderate ability for all variables of mental toughness, and could benefit from a psychological skills training programme aimed at increasing their self-esteem and anxiety management. A number of woman football players (26.4%) had high anxiety levels, while 33.8% showed low self-esteem, which could have a negative impact on the players while in a match setting. Furthermore, the outcomes of the results showed that self-esteem and anxiety were inversely related to the mental toughness of the players (.625 and -.436, respectively). These are two of the most important mental skills required for improving performance in a football match. Improving the mental toughness of the players could lead to an increase in self-esteem thereby reducing their anxiety levels to perform better. The study recommended that mental preparation be included in team preparation to improve performance outcomes as indicated by the positive relationship between physiological skills, mental toughness and sport performance.

The Link Between Asset Risk Management and Maintenance Performance: A Study of Industrial Manufacturing Companies

Purpose: The purpose of this paper is to examine risk management practices and their impact on performance. Specifically, the study aimed to examine risk management practices as part of physical asset management and their impact on maintenance management and its performance.Methodology/Approach: The empirical data were obtained from 76 manufacturing companies. Partial Least Squares Path Modeling (PLS-PM) was applied to evaluate the measurement and structural model.Findings: The results emphasized the importance of integrating risk management practices into asset management processes in order to improve performance outcomes.Research Limitation/Implication: This study contributes to a better understanding of how companies could achieve higher performance results by implementing risk management practices. The results of this study can help managers identify key asset risk management practices. Despite the important implications that can be derived from this study, further research that would extend the model to include additional performance measures and/or asset management dimensions would be of great importance.Originality/Value of paper: By analyzing the interrelationships between asset risk management practices and their direct and indirect effects on maintenance performance, the study provides important insights for the development of strategies to promote the novel and important discipline of asset management.

The impact of flipped classrooms in nurse education

Flipped classroom pedagogy is increasingly seen to be useful in the tertiary education sector and has recently been more frequently offered in nursing education. This literature review aims to critically examine empirical published work which reports of the impact of flipped classroom pedagogies on nursing students’ learning and performance. Global themes identified include student performance outcomes, engagement and enhanced/diminished student satisfaction. Synthesis of the findings of this literature review indicates that in nurse education the flipped classroom supports retention of knowledge, improves performance outcomes in areas as diverse as caring and examination results and there is enhanced student satisfaction with this method of learning. Enhancements to student learning and achievement using the flipped classroom model are connected to extra time and opportunities available for development of critical thinking and complex reasoning skills in class. As well, improvements are linked to the flexibility and self-efficacy accorded to students by the provision of learning opportunities in the form of deeply personalised online support. There is also evidence to suggest that students initially find this method stressful but with tutors and faculty staff providing information and rationale for the flipped classroom approach this stress can be reduced.

Novel virtual reality based training system for fine motor skills: Towards developing a robotic surgery training system.

Training surgeons to use surgical robots are becoming part of surgical training curricula. We propose a novel method of training fine-motor skills such as Microscopic Selection Task (MST) for robot-assisted surgery using virtual reality (VR) with objective quantification of performance. We also introduce vibrotactile feedback (VTFB) to study its impact on training performance. We use a VR-based environment to perform MST with varying degrees of difficulties. Using a well-known human-computer interaction paradigm and incorporating VTFB, we quantify the performance: speed, precision and accuracy. MST with VTFB showed statistically significant improvement in performance metrics leading to faster completion of MST with higher precision and accuracy compared to that without VTFB. The addition of VTFB to VR-based training for robot-assisted surgeries may improve performance outcomes in real robotic surgery. VTFB, along with proposed performance metrics, can be used in training curricula for robot-assisted surgeries.

ACADEMIC STAFF TRAINING TRANSFER AND ITS IMPACT ON ORGANIZATIONAL PERFORMANCE

Purpose: This study investigates the effect of training transfer to organizational performance through collaboration among academic staff. It provides a clear understanding of specific training transfer concepts and processes during their engagement in the university activities. Several issues affecting training transfer from the learning environment to impact the performance of academic staff were reported.
 Methodology: A semi-structured interview among four academic staffs through a purposive sampling method. The qualitative analysis had been transcribed and coded. The data gained from the interviews were themed for the purpose of the analysis.
 Main findings: The findings suggest that there should be training, honest communication, knowledge management, creating the right environment, identifying collaborative leaders, and making collaboration a natural part of the workflow. This was motivated by the increasing need to improve worker's skills through training which encompasses a significant aspect of the modern organization. It is concluded that deciphered training to improve specific task requirements. Therefore, monitoring training transfer provides organizations the opportunity to improve specific work environments and academician’s performance. It is recommended that training transfer and collaboration need to be an important aspect of the organizational process to improve performance outcomes.
 Implications/Applications: This research is important for academic staff at the Faculty of leadership and management at (USIM) who participated in the research to enhance organizational performance. Therefore, it has provided insights to other academic staff to imitate and the authorities to create a room for achievement for the organization.

Awareness of performance on outcomes after total hip and knee arthroplasty among Dutch orthopedic surgeons: how to improve feedback from arthroplasty registries

Background and purpose — The Netherlands Registry of Orthopedic Implants (LROI) uses audit and feedback (A&F) as the strategy to improve performance outcomes after total hip and knee arthroplasty (THA/TKA). Effectiveness of A&F depends on awareness of below-average performance to initiate improvement activities. We explored the awareness of Dutch orthopedic surgeons regarding their performance on outcomes after THA/TKA and factors associated with this awareness. Methods — An anonymous questionnaire was sent to all 445 eligible Dutch orthopedic surgeons performing THA/TKA. To assess awareness on own surgeon-group performance, they were asked whether their 1-year THA/TKA revision rates over the past 2 years were below average (negative outlier), average (non-outlier), above average (positive outlier) in the funnel plot on the LROI dashboard, or did not know. Associations were determined with (1) dashboard login at least once a year (yes/no); (2) correct funnel-plot interpretation (yes/no) and; (3) recall of their 1-year THA/TKA revision rate (yes/no). Results — 44% of respondents started the questionnaire, 158 THA and 156 TKA surgeons. 55% of THA surgeons and 55% of TKA surgeons were aware of their performance. Surgeons aware of their performance more often logged in on the LROI dashboard, more often interpreted funnel plots correctly, and more often recalled their revision rate. 38% of THA and 26% of TKA surgeons scored “good” on all 3 outcomes. Interpretation — Only half of the orthopedic surgeons were aware of their performance status regarding outcomes after THA/TKA. This suggests that to increase awareness, orthopedic surgeons need to be actively motivated to look at the dashboard more frequently and educated on interpretation of funnel plots for audit and feedback to be effective.

Positive Psychological Capital Mediates the Association between Burnout and Nursing Performance Outcomes among Hospital Nurses.

Nursing burnout is associated with reduced nursing performance outcomes. Positive psychological capital is known to play an important role in improving workers’ job performance. However, the association among the three variables has rarely been addressed. The purpose of this cross-sectional descriptive study was to explore the association between burnout and nursing performance outcomes among Korean nurses working at a tertiary hospital and the mediating role of psychological capital in this relationship. Recruited through convenience sampling, a total of 285 nurses provided data on their demographic characteristics and completed a structured questionnaire consisting of items from the Professional Quality of Life Scale (burnout), Nursing Performance Scale, and Psychology Capital Questionnaire. Descriptive statistics, student’s t-tests, one-way analysis of variance, Pearson’s correlation coefficients, and multiple linear regression analyses were used to analyze data. The significance of the mediation effect was obtained using a bootstrap approach with the PROCESS macro. The mean age of participants was 30.51 years, and most participants were females (94.0%) and unmarried (71.6%); more than half (57.5%) experienced a severe workload. The average (±standard deviation) scores of burnout, nursing performance outcomes, and positive psychological capital were 28.77 ± 4.93, 2.98 ± 0.32, and 3.19 ± 0.45, respectively. Burnout was associated with nursing performance among clinical nurses (β = −0.20, p < 0.001). Positive psychological capital mediated the association between burnout and nursing performance outcomes (β = 0.41, p < 0.001). These findings contribute to the understanding that burnout among nurses could be reduced by increased positive psychological capital, which results in improved performance outcomes. The findings also indicate that interventions to improve positive psychological capital should be developed and implemented for nurses’ burnout management and improvement in nursing performance outcomes.

Peer supervision experiences of drug sellers in a rural district in East-Central Uganda: a qualitative study

BackgroundSupport supervision improves performance outcomes among health workers. However, the national professional guidelines for new licenses and renewal for Class C drug shops in Uganda prescribe self-supervision of licensed private drug sellers. Without support supervision, inappropriate treatment of malaria, pneumonia and diarrhoea among children under 5 years of age continues unabated. This study assessed experiences of drug sellers and peer supervisors at the end of a peer supervision intervention in Luuka District in East Central Uganda.MethodsEight in-depth interviews (IDIs) were held with peer supervisors while five focus group discussions (FGDs) were conducted among registered drug sellers at the end of the peer supervision intervention. The study assessed experiences and challenges of peer supervisors and drug sellers regarding peer supervision. Transcripts were imported into Atlas.ti 7 qualitative data management software where they were analysed using thematic content analysis.ResultsInitially, peer supervisors were disliked and regarded by drug sellers as another extension of drug inspectors. However, with time a good relationship was established between drug sellers and peer supervisors leading to regular, predictable and supportive peer supervision. This increased confidence of drug sellers in using respiratory timers and rapid diagnostic tests in diagnosing pneumonia symptoms and uncomplicated malaria, respectively, among children under 5 years. There was also an improvement in completing the sick child register which was used for self-assessment by drug sellers. The drug shop association was mentioned as a place where peer supervision should be anchored since it was a one-stop centre for sharing experiences and continuous professional development. Drug sellers proposed including community health workers in monthly drug shop association meetings so that they may also gain from the associated benefits. Untimely completion of the sick child registers by drug sellers and inadequate financial resources were the main peer supervision challenges mentioned.ConclusionDrug sellers benefitted from peer supervision by developing a good relationship with peer supervisors. This relationship guaranteed reliable and predictable supervision ultimately leading to improved treatment practices. There is need to explore the minimum resources needed for peer supervision of drug sellers to further inform practice and policy.

Contract complexity and trust in construction project subcontracting

PurposeThe purpose of this paper is to unpack the “black box” of the relationship between contract and inter-organizational trust, both theoretically and empirically. Two mediators, namely perceived safeguard and restriction, are identified to build up two seemingly contrary possible paths between contract and trust from current literature. Both paths are tested in the context of Chinese construction industry due to our access to sample.Design/methodology/approachA survey of 295 contractor-subcontractor relationships from Chinese construction industry was conducted. A three-step multiple regression model was employed to test the mediating effect of perceived safeguard and restriction. Then, a hierarchical regression model was used to test the possible moderating effect of bilateral transaction-specific investment.FindingsThe empirical results support the mediating effect of perceived safeguard between contract and trust in the construction subcontracting industry. Bilateral transaction-specific investments enhance the positive effect of contract on safeguard perception.Originality/valueTheoretically, this study contributes to governance literature by opening up the “black box” of the relationship between contract and trust. It provides a better understanding of how and when contract complexity impacts trust, instead of simply focusing on whether contract and trust act as complements or substitutes. Practically, this study provides guidelines for construction firms to decide the degree of contract complexity under various degrees of bilateral transaction-specific investments to enhance the other party’s trust, so as to improve performance outcomes.

Good performance of p16/Ki-67 dual-stain cytology for detection and post-treatment surveillance of high-grade CIN/VAIN in a prospective, cross-sectional study.

The limited sensitivity of Papanicolaou (Pap) cytology and the low specificity of HPV testing in detecting cervical or vaginal lesions means that either precancers are missed or women without lesions are overtreated. To improve performance outcomes, p16/Ki-67 dual-stain cytology has been introduced as a useful biomarker. A prospective, cross-sectional study was performed and included 599 patients. Clinical performance estimates of Pap cytology, HPV DNA assay, and p16/Ki-67 dual-stain cytology for the detection of CIN2+/VAIN2+ were determined and compared. The sensitivity and specificity of p16/Ki-67 dual-stain cytology in detecting histology proven CIN2+/VAIN2+ was 91.6% and 95.0%, respectively, while that of Pap cytology was 42.1% and 95.2%, respectively, and that of HPV DNA testing was 100% and 41.6%, respectively. Among the three tests, the AUC of p16/Ki-67 immunocytochemistry was the largest, both for detecting cervical lesions and vaginal lesions, at 0.932 and 0.966, respectively. Among women who were HPV 16/18 positive or 12-other hrHPV positive and Pap positive (≥ASCUS), dual staining reduced the number of unnecessary colposcopy referrals from 274 to 181. Among the women who were 12-other hrHPV positive and Pap negative, dual staining could prevent underdiagnosis in six patients with CIN2+/VAIN2+ when used as a triage marker. Dual staining also identified four women with high-grade lesions detected by diagnostic conization but with negative colposcopy-guided biopsy results. p16/Ki-67 dual staining may be a promising tool for predicting high-grade cervical and vaginal lesions.

Short-Term FIFA 11+ Improves Agility and Jump Performance in Young Soccer Players.

Studies dealing with the effectiveness of the Fédération Internationale de Football Association (FIFA) 11+ prevention program to improve performance outcomes in children aged < 14 years are limited. This study aimed to point out the effects of the application of short-term FIFA 11+ warm-up program on physical performance in young football players. Participants were 36 youth male football players, divided into a FIFA 11+ (n = 19; mean (SD) age: 11.15 (0.79) y) and a control group (CG: n = 17; age: 10.87 (0.8) y) and trained for 4 weeks. Before and after the training period, standing long jump performance, agility, repeated sprint ability, sit and reach, and “30–15” intermittent fitness tests were assessed. A mixed ANOVA showed significant differences between the groups in the standing long jump test (FIFA 11+: 5.6% vs. CG: −1.9%) in favor of FIFA 11+ over CG. Additionally, the FIFA 11+ performance of the Illinois agility test was significantly better compared to the CG performance (FIFA 11+: −1.9% vs. CG: 0.03%). The main findings of this study suggest that just 4 weeks of implementation of the FIFA 11+ improves physical performance compared with traditional warm-up routines in young soccer players.