Observation Unit Research Articles

Temporal association between atrial fibrillation burden in cardiac implantable electronic devices and the risk of heart failure hospitalization

Abstract Background high daily atrial fibrillation (AF) burden measured in cardiac implantable electronic devices (CIEDs) has been shown to be temporally associated with increased stroke risk.1 Purpose We investigated whether AF burden is temporally associated with an increased risk of heart failure (HF) events in a large real-world cohort of patients with CIED devices. Methods We linked a de-identified database of aggregated electronic health records from 2007-2021 to a manufacturer’s device data warehouse with device based continuous diagnostic monitoring data. Patients with dual or triple chamber CIED implants with capability to measure daily AF burden and having HF events with 120 days of AF burden data prior to the HF event were included in this study. HF event was defined as an inpatient admission, emergency department presentation, or observation unit stay in a hospital with primary diagnosis of HF with intravenous diuretics administration. AF burden of ≥5.5 hours (as defined in earlier studies) on any given day was compared during days 1-30 before (case period) and days 91-120 days (control period) before the first HF event in each patient in this case-crossover study.2 Results A total of 7257 earliest HF events with AF burden available in the case and control period were included. The average age of patients was 72 ±12years, with 74% being males, and following co-morbidities diagnosed prior to the HF event: 83% hypertension, 48% diabetes, 74% coronary artery disease, 31% stroke/TIA, 45% CKD, and 27% vascular disease. Comparison of occurrence of AF above threshold (≥5.5 hours on any given day) on days 1-30 versus 91-120 pre-HF event is shown in table to illustrate the effect of temporally proximate AF on risk of HF event. A total of 957 (13%) had discordant arrhythmic state between case and control period, with 763 (11%) having AF ≥5.5 hours on a day in case period versus 194 (2%) in the control period (OR: 3.93; 95% CI: 3.36-6.60). Higher odds of HF event was observed closer the day with AF ≥5.5 hours is to the HF event (table 1). Conclusions In a large real-world population of patients with CIED devices, AF burden of ≥5.5 hours or more on a given day increases risk of worsening HF.Table 1:odds ratio of HF eventFigure 1:Temporal association

Larger change in intra-thoracic impedance before and during heart failure hospitalization is associated with longer length of stay in patients with cardiovascular implanted electronic devices

Abstract Background Intra-thoracic impedance measured in implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRTD) is a measure of intravascular blood volume and have been shown to correlate with intracardiac pressures in previous studies. Purpose We investigated whether amount of change of intrathoracic impedance before admission is associated with length of stay (LOS) during heart failure (HF) hospitalizations in a large real-world cohort of patients with ICD/CRTD devices. Methods We linked a deidentified database of aggregated electronic health record during the period from 2007-2017 to a manufacturer’s device data warehouse with device based continuous diagnostic monitoring data. Patients with ICD/CRTD implants with intra-thoracic impedance measurements were included for this study. HF event was defined as an inpatient, emergency department, or observation unit stay in a hospital with primary diagnosis of HF and intravenous diuretics administration. Relative change of daily intra-thoracic impedance measurement from 60 days prior to admission and date of admission as well as from admission to discharge were compared in HF events with LOS < 5 days and LOS ≥ 5 days using a Wilcoxon rank sum test. Results A total of 17,886 patients with 1.8±1.2 years of follow-up met inclusion criteria. The average age of patients was 66.6 ±12.3 years, with 72% being males, and 51% with ICD devices. The relative change in intra-thoracic impedance from 60 days prior till date of admission and from admission to discharge for HF events with LOS < 5 days and LOS ≥ 5 days are shown in Table. A total of 1456 patients had 1720 HF events of which 874 events had LOS< 5 days and 846 had LOS≥ 5 days. HF events with a longer length of stay (LOS ≥ 5 days) had a higher relative decrease in intra-thoracic impedance prior to admission compared to HF events with a shorter length of stay. HF events with a longer length of stay (LOS≥ 5 days) had a higher relative increase in intra-thoracic impedance during hospital stay. Conclusions In a large real-world population of patients with ICD/CRTD devices, longer length of stay is more likely in patients with a larger relative decrease in intra-thoracic impedance prior to admission, indicating more accumulated fluid. Further, larger relative increase in intra-thoracic impedance during hospital stay was observed in patients with longer length of stay, indicating more fluid removal.

Differences in risk stratification for worsening heart failure in patient with reduced versus preserved ejection fraction using diagnostic parameters available in implantable cardiac monitors

Abstract Background Ambulatory management of heart failure (HF) patients require the ability to identify when patients are at highest risk of impending HF events (HFE). The risk stratification ability based on diagnostic parameters measured by implantable cardiac monitors may differ depending on the left ventricular ejection fraction (LVEF) of HF patients. Objective The purpose of this study was to evaluate the difference in risk stratification performance of individual diagnostic parameters currently available in ICMs in identifying patients at increasing risk of HFE in patients with reduced versus preserved LVEF. Methods Patients with history of HFE who were implanted with an ICM was identified from the aggregated and de-identified electronic health record (EHR) database during 2007-2021. The device collected data were merged with the EHR data to create a de-identified database of real-world patients. Currently approved ICMs measure nighttime heart rate (NHR), heart rate variability (HRV), atrial fibrillation (AF) burden, ventricular rate during AF, and activity duration (ACT) daily and stores and transmits this information for the lifetime of the device. Each diagnostic parameter was categorized into high, medium, or low risk using a combination of features predefined in earlier studies. HFEs were defined as inpatient stay with a primary diagnosis of HF or HF related observation unit or emergency visit with IV diuresis administration. Patients were divided into two cohorts of patients with (1) median LVEF ≤ 40% (HFrEF), and (2) median LVEF > 40% (HFpEF). Performance evaluation was performed by simulating monthly follow-ups which consisted of looking at the individual parameter risk states in the last 30 days and evaluating the occurrence of HF events in the following 30 days. A marginal Cox proportional hazards model was used to compare HF events for different risk groups (high, medium, and low) for each individual diagnostic parameter. Results There was a total of 267 patients with median LVEF ≤ 40% (64±13 years old, 67% male) and 622 patients with LVEF>40% (69 ±12 years old, 47% male). For the reduced LVEF cohort, there was a total of 4,867 follow-up months with 65 monthly evaluations (1.3%) had an HF event in the next 30 days. For the preserved LVEF cohort, there was a total of 11,057 follow-up months with 224 monthly evaluations (2.0%) had an HF event in the next 30 days. The event rate comparisons between the risk groups for each individual diagnostic parameter are shown in Figure. As compared to ICM patients with HFrEF, ICM patients with HFpEF had higher absolute event rate across all risk groups, thus lowering the relative risk stratification between risk groups. Conclusion ICM patients with HFpEF showed a higher event rate and hence a higher absolute risk for each risk group, however relative risk between risk groups and hence the risk stratification performance for identifying risk for worsening HF was better in patients with HFrEF.

A Novel Heart Failure Diagnostic Risk Score Using a Minimally Invasive Subcutaneous Insertable Cardiac Monitor

BackgroundThe authors tested the hypothesis that physiological information from sensors within a minimally invasive, subcutaneous, insertable cardiac monitor (ICM) could be used to develop an ambulatory heart failure risk score (HFRS) to accurately identify heart failure (HF) patients, across the ejection fraction spectrum, at high risk of an impending worsening heart failure event (HFE). ObjectivesThe purpose of this study was to examine performance of ICM-based, multiparameter, dynamic HFRS to predict HFEs in patients with NYHA functional class II/III HF. MethodsIn 2 observational cohorts, HF patients were implanted with an ICM; subcutaneous impedance, respiratory rate, heart rate and variability, atrial fibrillation burden, ventricular rate during atrial fibrillation, and activity duration were combined into an HFRS to identify the probability of HFE within 30 days. Patients and providers were blinded to the data. HFRS sensitivity and unexplained detection rate were defined in 2 independent patient population data sets. HFEs were defined as hospitalization, observation unit, or emergency department visit with a primary diagnosis of HF, and intravenous diuretic treatment. ResultsFirst data set (development): 42 patients had 19 HFE; second data set (validation): 94 patients had 19 HFE (mean age 66 ± 11 years, 63% men, 50% with LVEF ≥40%, 80% NYHA functional class III). Using a high-risk threshold = 7.5%, development and validation data sets: sensitivity was 73.7% and 68.4%; unexplained detection rate of 1.4 and 1.5 per patient-year; median 47 and 64 days early warning before HFE. ConclusionsICM-HFRS provides a multiparameter, integrated diagnostic method with the ability to identify when HF patients are at increased risk of heart failure events. (Reveal LINQ Evaluation of Fluid [REEF]; NCT02275923, Reveal LINQ Heart Failure [LINQ HF]; NCT02758301, Algorithm Using LINQ Sensors for Evaluation and Treatment of Heart Failure [ALLEVIATE-HF]; NCT04452149)

Effects of Host and Weather Factors on the Growth Rate of Septoria nodorum Blotch Lesions on Winter Wheat.

Septoria nodorum blotch (SNB), caused by Parastagonospora nodorum, is a major disease of winter wheat that occurs frequently in the central and southeastern United States. Quantitative resistance to SNB in wheat is determined by various disease resistance components and their interaction with environmental factors. A study was conducted in North Carolina from 2018 to 2020 to characterize SNB lesion size and growth rate and to quantify the effects of temperature and relative humidity on lesion expansion in winter wheat cultivars with different levels of resistance. Disease was initiated in the field by spreading P. nodorum-infected wheat straw in experimental plots. Cohorts (groups of foliar lesions arbitrarily selected and tagged as an observational unit) were sequentially selected and monitored throughout each season. Lesion area was measured at regular intervals, and weather data were collected using in-field data loggers and the nearest weather stations. Final mean lesion area was approximately seven times greater on susceptible than on moderately resistant cultivars, and lesion growth rate was approximately four times higher on susceptible than on moderately resistant cultivars. Across trials and cultivars, temperature had a strong effect of increasing lesion growth rates (P < 0.001), while relative humidity had no significant effect (P = 0.34). Lesion growth rate declined slightly and steadily over the duration of cohort assessment. Our results demonstrate that restricting lesion growth is an important component of SNB resistance in the field and suggest that the ability to limit lesion size may be a useful breeding goal.

Job Stressors and Employee Performance in County Governments in Kenya.

In the majority of devolved County Governments, there has been an increased focus on employee well-being compared to previous years. However, it is crucial to acknowledge the significant impact of the trauma experienced by employees, as they continue to face exceptional demands in order to meet organizational expectations. Consequently, there has been a corresponding rise in performance expectations placed upon employees. The study focused on investing the relationship between job stressors and employee performance in Kenya. The study was anchored on the following specific objectives; -to explore the influence of workplace conflict stress, work ambiguity stress, time stress and workload stress on employee performance in Kenya. The study adopted Hertzberg Two Factor Theory, Mwelford’s performance and Demand theory, Relational theory and Michigan theory. The study targeted 166 employees from selected County Governments. The unit of observation was chief officers, and selected public service board members. The unit of analysis was 166 employees. The study adopted Yamane and stratified random sampling technique to get a sample size of 177 respondents. The researcher used questionnaires as the research instrument. Then data was analysed both qualitatively and quantitatively according to the study objectives. Qualitative data was presented in a descriptive form while quantitative data through statistical tables of percentages and frequency. Data analysis was conducted using the statistical programme SPSS V.22. The study results established that workplace conflict stress have a statistically significant and positive effect on employee performance. The results of the regression analysis that are provided that work ambiguity stress has a statistically significant positive effect on employee performance. The findings of the regression analysis indicated a statistically significant positive effect of between time stress and employee performance. The study findings of the regression analysis, there is a statistically significant and positive association between workload stress and employee performance. The study recommends that several factors that contribute to stress, as highlighted in the study. These factors include workplace conflict stress, work ambiguity stress, time stress and workload stress. The study recommends that the provision of assistance and encouragement from head of departments, supervisors and coworkers plays a significant role in mitigating stress related to management and work relationships. This study recommends that using formal corporate communication practices might effectively reduce relationship strain and alleviate management stress by minimizing work ambiguity. The presence of open communication offers a distinct advantage in the resolution of conflicts that may arise between supervisors and subordinates.

Description of Divergence of Subpopulations in the Hierarchical System under the Analysis of Isonymy. II. Probabilities of Non-Isonymic Encounters

Metapopulations with typical for human populations hierarchical subdivision into parts (subpopulations) are considered, corresponding to classifications based on administrative-territorial division (say, village, village council, district, region, and so on) or on a genealogical approach based on ethnogenesis, as well as on other principles of biological classification. The purpose of this work is to analyze the general properties of the distribution of the surname concentration over subpopulations in their hierarchical structure. Attention is focused on the description of the surname divergence of subpopulations, as an indicator of which the total probability of two person with different surnames encounter is considered, which is understood as the probability of the encounter in a randomly chosen subpopulation, a unit of observation, from metapopulation with a hierarchical structure. Its decomposition by hierarchy levels is obtained, which generalizes the Wahlund effect in population genetics. The total probability of non-isonimic encounters in a hierarchically subdivided metapopulation is less than the probability of random encounters in it by the sum of the average surname concentration intragroup variances corresponding to separate levels. Such properties are purely statistical characteristics of the hierarchical structure, and not a feature of a particular population system, and are not derived from the regularities of one or another model of microevolution. They are computationally formulated in the same way for any hierarchical system, although in the general case they do not coincide quantitatively. The results obtained refer to rural and urban hierarchical metapopulations as separate components of the entire population.

Research Population and Sampling in Quantitative Study

The study underscores the paramount importance of meticulous population selection and sampling strategy in research design. Providing researchers with a comprehensive overview of population considerations and sampling methods, it offers a valuable resource for enhancing the robustness and applicability of research outcomes across diverse disciplines. Researchers discuss the unit of analysis, unit of observation, population of interest, target population, sampling framework, and sampling methods in light of employee work engagement in Malaysia. Simple random sampling, stratified random sampling, systematic random sampling, cluster sampling (single-stage, double-stage, and multi-stage), phase sampling (two-phase and multiphase), convenience sampling, purposive sampling, quota sampling, snowball sampling, and volunteer sampling have been discussed for selecting the appropriate sampling method for the research titled Revisiting of JD-R Theory and the effect of leadership style and meaningful work on employee work engagement among the full-time operational employee in Malaysia. According to the discussion on population and sampling methods, researchers use non-probability sampling, specifically convenience sampling techniques, based on the accessibility and availability of the full-time operational employees of successful organisations in Malaysia. Researchers and practitioners alike can leverage the insights presented in this review to make informed decisions about population selection and sampling methods, ultimately contributing to the advancement of credible and impactful research.

Organizational routines: between change and stability—Introduction to the special section

Abstract The notion of organizational routine has been at the core of behavioral and evolutionary theories in economics, management and organization studies, but has also been a source of debate and controversy. The discussion has concerned the very definition of what organizational routines are (and are not), their nature, consequences, and units of observation and analysis. In this short introductory article, we try to establish some useful common grounds which, notwithstanding the diversity of definitions and approaches, could promote future useful lines of research. We see the contributions to this special section as moving forward the research on routines in that direction.

Sourcing Strategies and Organizational Performance of Muranga Co-Operative Creameries Kenya

Purpose: The general objective of this study was to establish the influence of sourcing strategies on organizational performance of Murang’a Co-operative Creameries in Kenya. Specifically, the study sought to establish the influence of single sourcing strategy, multiple sourcing strategy, delegated sourcing strategy and parallel sourcing strategy on organizational performance of Murang’a Co-operative Creameries in Kenya. The theories anchoring the study comprised of Agency theory, Network Theory and Systems Theory.&#x0D; Methodology: This study utilized a descriptive research design. The target population comprised of Murang’a Co-operative Creameries where the units of observation comprised of employees from human resource department, quality assurance department, production department, maintenance department, sales department and accounts, finance department in Muranga Co-operative Creameries. A total of 76 employees were targeted in the study. Primary data was utilized in the study and collected using semi structured questionnaire that were administered by drop and pick methods. The research used a mixed approach to data analysis. Descriptive analysis involved use of measure of central tendency and standard deviation as a measure of dispersion. Inferential statistics comprised of both correlation and regression analysis. Statistical Package for Social Sciences (SPSS) version 24.0 was used to generate the statistics. The results of the study were presented in form of tables and figures.&#x0D; Findings: The study established that single sourcing strategy, multiple sourcing strategy, delegated sourcing strategy and parallel sourcing strategy bears a positive and significant influence on organizational performance of Murang’a Co-operative Creameries in Kenya. This is shown by beta values of 0.216, 0.549, 0.406 and 0.315 and significant values of 0.011, 0.000, 0.000 and 0.003 respectively. The results implies that increasing the independent variables with one unit results to increase in the levels of organizational performance of Murang’a Co-operative Creameries with the respective beta units.&#x0D; Unique contribution to theory, practice and policy: The study provides recommendation to Murang’a Co-operative Creameries to enhance the levels of sourcing strategies comprising of single sourcing strategy, multiple sourcing strategy, delegated sourcing strategy and parallel sourcing strategy since the practices positively and significantly influences organizational performance.

Hyperactive delirium during emergency department stay: analysis of risk factors and association with short-term outcomes

To investigate factors related to the development of hyperactive delirium in patients during emergency department (ED) stay and the association with short-term outcomes. A secondary analysis of the EDEN (Emergency Department and Elderly Needs) multipurpose multicenter cohort was performed. Patients older than 65 years arriving to the ED in a calm state and who developed confusion and/or psychomotor agitation requiring intravenous/intramuscular treatment during their stay in ED were assigned to delirium group. Patients with psychiatric and epileptic disorders and intracranial hemorrhage were excluded. Thirty-four variables were compared in both groups and outcomes were adjusted for age, sex, Charlson Comorbidity Index, Barthel Index and polypharmacy. Hyperactive delirium that needed treatment were developed in 301 out of 18,730 patients (1.6%). Delirium was directly associated with previous episodes of delirium (OR: 2.44, 95% CI 1.24–4.82), transfer to the ED observation unit (1.62, 1.23–2.15), chronic treatment with opiates (1.51, 1.09–2.09) and length of ED stay longer than 12 h (1.41, 1.02–1.97) and was indirectly associated with chronic kidney disease (0.60, 0.37–0.97). The 30-day all-cause mortality was 4.0% in delirium group and 2.9% in non-delirium group (OR: 1.52, 95% CI 0.83–2.78), need for hospitalization 25.6% and 25% (1.09, 0.83–1.43), in-hospital mortality 16.4% and 7.3% (2.32, 1.24–4.35), prolonged hospitalization 54.5% and 48.6% (1.27, 0.80–2.00), respectively, and 90-day post-discharge combined adverse event 36.4% and 35.8%, respectively (1.06, 0.82–2.00). Patients with previous episodes of delirium, treatment with opioids and longer stay in ED more frequently develop delirium during ED stay and preventive measures should be taken to minimize the incidence. Delirium is associated with in-hospital mortality during the index event.

Analisis Perbandingan Kinerja Keuangan PT. ABC, Tbk. Sebelum dan Sesudah Mengakuisisi PT. DEF,Tbk

This study aims to determine the financial performance before and after the acquisition listed on the Indonesian Stock Exchange. This type of research is quantitative comparative, this research is to compare financial performance before and after the acquisition. This study uses quantitative data types, meaning that in analyzing the data used is data in the form of numbers. The unit of observation in this study is the 2016-2020 financial statements of PT ABC, Tbk. Data analysis methods used in this research are profitability ratios, liquidity ratios, solvency ratios and activity ratios by comparing the financial performance before and after the acquisition. Based on the results of research showing that financial performance as measured by financial ratios ROA, ROE, NPM, CR, QR, TATO and FATO has decreased after the acquisition compared to before the acquisition. The DAR, DER, and ITO ratios have increased after the acquisition compared to before the acquisition. The acquisition strategy has not been fully achieved within 2 years due to the condition of the financial performance of PT ABC Tbk. before the acquisition is better than after the acquisition.

GeriCarED: Feasibility of a pilot program of a geriatric personal care attendant addressing mentation, mobility and matters most in an Emergency Department Observation Unit

GeriCarED: Feasibility of a pilot program of a geriatric personal care attendant addressing mentation, mobility and matters most in an Emergency Department Observation Unit

The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study

Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke. Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables. CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects. In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level. NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.

Role of ICT Risk Management on Insider Fraud Prevention in Commercial Banks in Nairobi County

Purpose: The main objective of the research was to investigate the role of ICT risk management on reduction of insider frauds in the Kenyan banks in Nairobi County. The research explored ICT risks management practices incorporated in the banking industry to mitigate and control insider fraud.&#x0D; Methodology: Explorative research design and inferential statistics were used. The unit of analysis was the ICT risk management professionals in all the commercial banks in Nairobi County. 42 commercial banks formed the population of the study. The unit of observation were the ICT security, audit and risk professionals mandated with implementing ICT risk management. The targeted number was at least one respondent from each bank from the three departments identified: internal audit, Information technology, and security managers. In total, the study targeted 42 respondents and a total 29 responses were received which formed 69% of the targeted population. Responses from the distributed questionnaires were analyzed using statical packages for social science (SPSS). The open-ended questions were listed, analysed and reported by descriptive narrative with such statistics as mean and standard deviation. The ANOVA test was used to test the results.&#x0D; Findings: The findings revealed that there is a positive but insignificant correlation between ICT risk assessment, ICT awareness, Information security implementation and a significant positive correlation between information security audits and Insider fraud prevention. This study recommends that ICT risk assessment; ICT risk awareness; information security audits; and information security policy are important for preventing insider fraud in commercial banks, but there is need to implement them in conjunction with other stringent measure to increase efficiency&#x0D; Unique Contribution to Theory, Practice and Policy: The findings give a theoretical basis for validating the effectiveness of ICT risk management practices in Banks in Nairobi County, this can be adopted by other counties in Kenya. For policy implementation, the study will be important to the central bank of Kenya and any other institution that regulates the banking sector in Kenya in reviewing the current ICT Risk management guidelines. The study shows the adoption of the selected ICT risk management practices by different banks and gives a measure of their effectiveness that ICT Security professionals can use. The study gives the banking sector ICT security professionals a perspective on how ICT risk management can help them improve their ability to curb insider fraud. The study adds to the pool of knowledge for to scholars and academicians.

Engaging marginal stakeholders on social networking sites. A cross‐country exploratory analysis among Generation Z consumers

AbstractThis research explores the marginal stakeholder engagement and propensity to value cocreation in the fast‐fashion industry by taking Generation Z consumers (GZCs) as observation unit and social networking sites (SNSs) as context of investigation. By undertaking 24 in‐depth interviews with US and Italian GZCs, the study uncovers the main elements that influence their engagement generation on SNSs and highlights that at least four main paradoxes (PXs) exist in this scenario. Specifically, the interviewees reported that they do not trust those brands that make them feel as marginal consumers (PX1) and that they are likely to be extremely loyal to those brands that actively take them into consideration in their activities on SNSs (PX2). In addition, although GZCs concerned about the environment, in most cases, they will buy repeatedly from fast‐fashion brands for convenience reasons (PX3). Finally, social dimension of GZCs engagement appears to be influenced by their peers' preferences (PX4). This research is the first that explored GZCs by considering them under the lenses of stakeholder engagement and offering novel insights about common believes on this generation of consumers. Therefore, theoretical and managerial implications are discussed to advance current knowledge on GZCs and to help the development of new strategies to engage them on SNSs.

Generic Strategies and Operational Performance of Manufacturing Cement Companies in Kenya.

In an organization, performance is affected by various factors. The performance of the cement industry in Kenya has been adversely affected by the challenge of inadequate employee training, inefficiency, not meeting the targets, inadequate employee development and reduced sales volume. Cost leadership, differentiation and focus strategies are used in enhancing the organizational performance. This current study was to determine the influence of generic strategies on performance of manufacturing cement companies in Kenya. The specific objectives were to examine the influence of cost leadership strategy, differentiation strategy and focus strategy on performance of manufacturing cement Companies in Kenya. Theories guiding the study included; Porter's Competitive Business Strategy Typology, Configuration theory, Result-based View Theory, and Miles and Snow typology. The current study used descriptive research design. The unit of analysis was Cement Companies in Kenya. The unit of analysis was 7 manufacturing Cement Companies in Kenya that include; Bamburi Cement Limited, Mombasa Cement Ltd (MCL), East Africa Portland Cement Company, Savannah Cement Limited ,ARM Cement Limited and National Cement Company . The observation unit was the employees working with these companies. Therefore, the target population was 454 managers of the targeted manufacturing firms. Stratified sampling method was used to group respondents into departments in order to ensure representativeness of all the cases. Simple random sampling method was used to select the respondents. Therefore, the sample size was 189 which represented a 41.6% of the total population. Data was collected using self- administered questionnaire which was on the basis of drop and pick later method. Reliability and validity of research instruments was ascertained. Data was analyzed by means of descriptive as well as inferential statistics. The study found that cost leadership strategy, differentiation strategy and focus strategy had a positive significant influence on the performance of cement manufacturing companies. The study concluded that a firm following a cost leadership strategy offers products or services with acceptable quality and features to a broad set of customers at a low price. A differentiation strategy enables firm to create a product/service, which is considered unique in some aspect that the customer values because the customer’s needs are satisfied. Focus strategy allows cement companies to concentrate on promotional resources on the sectors that match their quality advantage. The study recommended that the cement companies should diagnose their changing cost economics all the way from the raw materials stage to the final price paid by the ultimate consumer. Cement companies should exploit different ways in which they can make the products and services unique. The cement companies should get to know as much about their customers as they can so that they can anticipate what their customers want, how they want it, when they want it, and most importantly, how they can solve it for them.

On Sherds, Vessels, and Pragmatics: Reaction to Feathers

AbstractFeathers addresses the dual challenges of inferring original vessel counts from sherds and inference to use life from reconstructed vessels. His solution assumes the validity of sherd assemblages as units of observation that considerable research invalidates and overlooks methods that estimate original vessels from sherds. Feathers also doubts that use life can be inferred for reconstructed vessels. Although not a focus of my article, the larger study from which it derived addresses this matter in detail that strongly warrants vessel size as use-life measure. Of course we must be pragmatic in quantifying pottery assemblages, but first we must identify valid units of observation, and only then attend to pragmatics.

Pengaruh Fee Audit dan Masa Perikatan Audit Terhadap Kualitas Audit

This study aims to analyze the effect of audit fee and audit tenure on audit quality. The research method used is a quantitative research method with a descriptive and verification approach. The unit of analysis in this study was the Public Accounting Firm and the observation units were 39 fellowship partners. Hypothesis testing was carried out using multiple linear regression analysis method. The results of the hypothesis test show that partially audit fee have a positive and significant effect on audit quality, while audit tenure has no effect on audit quality. While simultaneously the audit fee and the audit tenure have a positive and significant effect on audit quality.

Associations between subclinical intramammary infection and milk fatty acid profile at the quarter level in Holstein cattle.

Mastitis, especially the subclinical form, is the most common economic and health problem in dairy cows. Little is known about changes in milk fatty acid (FA) composition according to infection/inflammation status of the mammary gland. The aim of this study was to investigate the associations between naturally occurring subclinical intramammary infection (IMI) from different pathogens, i.e. Streptococcus agalactiae, Staphylococcus aureus, Streptococcus uberis and Prototheca spp., and the detailed milk FA profile assessed at quarter level in Holstein cows. After an initial bacteriological screening (T0) on 450 Holstein cows reared in three dairy herds, we identified 78 cows positive at the bacteriological examination. These animals were followed up at the quarter level two weeks (T1) and six weeks (T2) after T0. In total, 600 single-quarter samples were obtained at T1 and T2. Individual FAs were determined using the gas chromatography analytical method. Investigated traits were 70 individual FAs, 12 FA groups, and six desaturation indices. The associations between subclinical IMI combined with somatic cell count (SCC) and milk FA profile were investigated using a hierarchical linear mixed model (i.e., observational unit was quarter within cow) with the following fixed effects: days in milk (DIM), parity, herd, SCC, bacteriological status (BACT, positive and negative), and the SCC × BACT interaction. The random effect of individual cow nested within herd, DIM and parity was used as the error term for the latter effects. The most significant associations were detected at T2. Notably, IMI reduced the proportions of individual short-chain FA, especially 4:0 and 6:0 (-14%), but increased the proportion of the most abundant medium-chain FA (MCFA), 16:0 (+4%). A reduction in the desaturation indices was observed mostly for 14:1 index (-9%), in line with the reduction in 14:1 (-10%). Somatic cell count significantly affected 14 individual FAs. In particular, samples with high SCC (≥200 000) had significantly lower proportions of 8:0, 10:0, 11:0, 12:0, and 13:0 compared with samples with low SCC (<200 000). Increasing SCC in animals positive at the bacteriological examination were associated with a reduction in total MCFA at T2 (while in negative animals, they remained constant across SCC classes), possible evidence that elongation of the FA chain from 11 to 16 carbons is affected by a combination of infection and SCC. This study showed that subclinical IMI and SCC are mainly associated with reductions in the synthesis of FA and the desaturation process in the mammary gland.