Variability In Outcomes Research Articles

Measuring fisheries outcomes from coastal wetland restoration: a review and meta‐analysis

Coastal wetlands, including saltmarshes, mangrove forests, and seagrass meadows, can support fisheries by providing habitat and exporting food and nutrients to adjacent or distant ecosystems. However, there is insufficient understanding about the extent to which wetland restoration can benefit fishery species. Here, we report qualitative and quantitative reviews of literature to evaluate the approaches used to measure or estimate fisheries outcomes of coastal wetland restoration and test for the effects of restoration on fisheries outcomes. Most studies focused on saltmarshes and mangroves, with fewer studies focussing on seagrasses. We found that effects of wetland restoration on fish populations have mainly been assessed for species that reside in coastal wetlands for at least part of their life cycle, while few studies have tested effects on fish populations via trophic subsidies. Moreover, few studies have directly assessed the effects of restoration on fisheries production. Instead, most studies have measured abundances of individual species at restored sites and compared those to undisturbed and/or disturbed areas. Restored areas contained similar fish densities to undisturbed or disturbed areas; but few studies compared restored areas to both undisturbed and disturbed areas at the same time. Overall, we did not find consistent and robust evidence for fisheries outcomes from wetland restoration projects because (1) there were not many studies, (2) the studies reported substantial variability in outcomes, and (3) the density of fish measured at a restoration site is not an accurate measure of the total fisheries benefit as adult fishes do not always reside in the restored habitat.

Host Genetics Background Affects Intestinal Cancer Development Associated with High-Fat Diet-Induced Obesity and Type 2 Diabetes

Background: Obesity and type 2 diabetes (T2D) promote inflammation, increasing the risk of colorectal cancer (CRC). High-fat diet (HFD)-induced obesity is key to these diseases through biological mechanisms. This study examined the impact of genetic background on the multimorbidity of intestinal cancer, T2D, and inflammation due to HFD-induced obesity. Methods: A cohort of 357 Collaborative Cross (CC) mice from 15 lines was fed either a control chow diet (CHD) or HFD for 12 weeks. Body weight was tracked biweekly, and blood glucose was assessed at weeks 6 and 12 via intraperitoneal glucose tolerance tests (IPGTT). At the study’s endpoint, intestinal polyps were counted, and cytokine profiles were analyzed to evaluate the inflammatory response. Results: HFD significantly increased blood glucose levels and body weight, with males showing higher susceptibility to T2D and obesity. Genetic variation across CC lines influenced glucose metabolism, body weight, and polyp development. Mice on HFD developed more intestinal polyps, with males showing higher counts than females. Cytokine analysis revealed diet-induced variations in pro-inflammatory markers like IL-6, IL-17A, and TNF-α, differing by genetic background and sex. Conclusions: Host genetics plays a crucial role in susceptibility to HFD-induced obesity, T2D, CRC, and inflammation. Genetic differences across CC lines contributed to variability in disease outcomes, providing insight into the genetic underpinnings of multimorbidity. This study supports gene-mapping efforts to develop personalized prevention and treatment strategies for these diseases.

Some Challenging Questions About Outcomes in Children With Cochlear Implants

Purpose: Cochlear implants (CIs) have improved the quality of life for many children with severe-to-profound sensorineural hearing loss. Despite the reported CI benefits of improved speech recognition, speech intelligibility, and spoken language processing, large individual differences in speech and language outcomes are still consistently reported in the literature. The enormous variability in CI outcomes has made it challenging to predict which children may be at high risk for limited benefits and how potential risk factors can be improved with interventions. In this article, we consider four challenging, unresolved issues that exist in the field of pediatric cochlear implantation (age at implantation, comorbid diagnoses, preimplant functioning in infants, and communication modality) to illustrate the value of adopting a broader integrated multidisciplinary approach to explaining variability and individual differences in outcomes. Conclusions: Four challenging and unresolved issues concerning our ability to predict individual differences before implantation were discussed. In order to address some of the current barriers to progress in dealing with these unresolved issues, a biopsychosocial system model is proposed as a possible unifying approach to conceptualizing these issues. Additionally, several new research directions to better understand and explain variability in pediatric CI outcomes are suggested.

Neuronutrition and Its Impact on Post-Stroke Neurorehabilitation: Modulating Plasticity Through Diet

The recovery of neurological deficits after ischemic stroke largely depends on the brain’s ability to reorganize its undamaged neuronal circuits and neuronal plasticity phenomena. The consolidated evidence highlights the involvement of the patient’s impaired nutritional conditions in post-stroke recovery and unsatisfying rehabilitative outcomes. Standardized nutritional protocols usually applied in hospitalized patients in a rehabilitation setting aim mainly to improve the general health conditions of patients, do not consider the high inter-individual variability in neurorehabilitation outcomes, and are not sufficiently modifiable to provide neuroprotective and restorative dietary patterns that could promote neuronal plasticity and functional recovery during neurorehabilitation. Neuronutrition, an emergent scientific field of neuroscience, represents a valid model of a personalized nutritional approach, assuring, for each patient, nutrients having antioxidant and anti-inflammatory properties, ensuring a balanced microbiota composition, and providing adequate neurotrophic support, essential for improving neuronal plasticity, brain functional recovery, and rehabilitative outcomes. In the present narrative review, we provide an overview of the current knowledge on neuronutrition as an adjuvant strategy of a personalized nutritional approach potentially effective in improving post-stroke neuroplasticity and neurorehabilitation by counteracting or at least limiting post-stroke oxidative/nitrosative stress, neuroinflammation, and gut–brain axis disturbance.

A Century of Surgical Quality: Origins, Evolution, and Future Directions.

Over a century has passed since Ernst A. Codman's pioneering call for surgeons to take open responsibility for patient care, a concept integral to the emergence and leadership of the American College of Surgeons (ACS). Codman's End Result Idea, originating in the early 20th century, laid the groundwork for professional responsibility and accountability in surgical practice, catalyzing the formation of the ACS. His innovative use of the "end result" technique at Massachusetts General Hospital highlighted significant variability in surgical outcomes, spurring debates on specialization and accountability. The ACS, under John Bowman's leadership, aimed to ensure optimal care through defined standards and verification mechanisms. Codman's Bone Sarcoma Registry, initiated in 1920, marked an early attempt at quality assessment and improvement through data collection. Despite facing resistance, Codman's vision laid the foundation for modern quality initiatives in surgical care. ACS programs, spanning trauma care to cancer treatment and beyond, have significantly enhanced patient outcomes while reducing costs. Looking forward, advancing surgical quality requires measuring quality, leveraging trusted data, embracing change management, fostering collaboration, and empowering specialists. The future of surgical care depends on collective efforts to uphold standards that ensure optimal care for all.

Early-Stage Femoral Head Hypoperfusion Correlates with Femoral Head Deformity at Intermediate Follow-up in Legg-Calvé-Perthes Disease.

Perfusion MRI (pMRI) can quantify femoral head hypoperfusion in early-stage Legg-Calvé-Perthes disease. We investigated whether the severity of hypoperfusion measured at the early stage correlates with femoral head deformity at intermediate-term follow-up. Sixty-three patients who were 5 to 11 years of age at the diagnosis of Legg-Calvé-Perthes disease and who had pMRI performed at an early stage (Waldenström Stage 1 to 2a) were retrospectively reviewed. Twenty-eight patients were treated nonoperatively and 35 were treated with proximal femoral varus osteotomy (PFVO). The sphericity deviation score (SDS) was used as the primary outcome. Femoral head perfusion and SDS were measured by 2 observers. Models assessing the relationship between hypoperfusion and SDS were fitted without and with stratifications by age at diagnosis and treatment method. All 63 patients had a minimum of 4 years of follow-up (mean follow-up, 7.5 ± 2.6 years). All had reached the healed stage (Stage 4), and their mean age was 15.6 ± 2.8 years. The SDS outcome showed a significant positive correlation with the hypoperfusion % (p < 0.001). In the <50% hypoperfusion range, the SDS indicated no-to-low deformity, with narrow variability of outcome. However, the SDS became exponentially worse and had a wider variability of outcome at the ≥50% hypoperfusion range. Multivariable analyses revealed age at diagnosis, hypoperfusion %, and treatment method as significant prognostic factors for SDS (p = 0.007, <0.001, and 0.042, respectively). When treatment outcomes were stratified by age at diagnosis and hypoperfusion %, PFVO showed significantly better SDS outcome than nonoperative treatment in patients with an age at diagnosis of ≥8 years and low (<50%) and intermediate (50% to 80%) hypoperfusion ranges (p = 0.036 and 0.021, respectively). Our study found a significant relationship between femoral head hypoperfusion measured in early-stage Legg-Calvé-Perthes disease and femoral head deformity at intermediate-term follow-up. This study provides new insight into the relationship between early-stage femoral head hypoperfusion and deformity. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Literature Review: Historical Review of Traumatic Brain Injury Caused by Fishing Speargun & a New Suicide Case

Traumatic brain injury (TBI) is a severe neurosurgical emergency and a significant public health concern. Fishing spearguns TBIs are included in nonmissile injuries and have been implicated in only few cases of TBI in the past 68 years, mainly of accidental etiology. To introduce a novel case report of a TBI in a 38-year-old man shot himself with a speargun in a suicide attempt and to present a thorough review of related case reports along with the management strategies, prognosis, and outcomes. We conducted a literature review of case reports in accordance with the PRISMA guidelines, including incidents of TBI by speargun published in Pubmed, Scopus, and Web of Science until January 2024. A total of 22 publications, reporting 26 cases of speargun-related TBIs formulated the 27 investigated cases including the current patient which were used in this descriptive and inferential statistical analysis. Predominantly affecting males (88.89%) with a median age of 29 years, these injuries were primarily due to accidents (65.38%), with a noticeable shift towards suicide. Outcome variability ranged from intact recovery (48.15%) in majority of cases to a range of unfavorable outcomes. Significant factors impacting outcomes included initial GCS score <8, major initial CT head findings, and major complications. Survival analysis indicated early manifestation of unfavorable outcomes. In summary, the diverse presentation, management, outcomes and identified influencing factors highlight the complexity of managing speargun-related injuries, and the need for personalized approaches and further research to enhance care protocols.

Addressing Semantic Variability in Clinical Outcome Reporting Using Large Language Models

Background/Objectives: Clinical trials frequently employ diverse terminologies and definitions to describe similar outcomes, leading to ambiguity and inconsistency in data interpretation. Addressing the variability in clinical outcome reports and integrating semantically similar outcomes is important in healthcare and clinical research. Variability in outcome reporting not only hinders the comparability of clinical trial results but also poses significant challenges in evidence synthesis, meta-analysis, and evidence-based decision-making. Methods: This study investigates variability reduction in outcome measures reporting using rule-based and large language-based models. It aims to mitigate the challenges associated with variability in outcome reporting by comparing these two models. The first approach, which is rule-based, will leverage well-known ontologies, and the second approach exploits sentence-bidirectional encoder representations from transformers (SBERT) to identify semantically similar outcomes along with Generative Pre-training Transformer (GPT) to refine the results. Results: The results show that the relatively low percentages of outcomes are linked to established rule-based ontologies. Analysis of outcomes by word count highlighted the absence of ontological linkage for three-word outcomes, which indicates potential gaps in semantic representation. Conclusions: Employing large language models (LLMs), this study demonstrates its ability to identify similar outcomes, even with more than three words, suggesting a crucial role in outcome harmonization efforts, potentially reducing redundancy and enhancing data interoperability.

Regional variation of age-related blood pressure trajectories and their association with blood pressure control rates, disability-adjusted life years and death

Abstract Background/Introduction While the relationship between blood pressure (BP) changes and increasing age is well described, age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. Purpose The dataset of the May Measurement Month (MMM) international campaigns enables a unique investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcomes. Method Global BP data from more than 4,5 million adult (≥18 years) screenees obtained during the cross-sectional MMM campaigns in 2017, 2018, 2019, and 2021 were used for analysis. Average BP and slopes of BP changes across age groups were calculated within regional, socio-economic and sex strata. BP slopes of individuals between 30 and 70 years of age were derived from adjusted linear regression models, along with baseline BP estimates at young age. These BP slopes were correlated in regression models adjusted for baseline BP at young age with country-specific all-cause rates of DALYs (Disability-Adjusted Life Years), death (both from Global Burden of Disease Study 2019), life expectancy (World Bank data SP.DYN.LE00.IN 2019) and BP control rates (NCD Risk Factor Collaboration). Results Age-related BP changes differed distinctly across global geographic regions, income levels, and between sexes. The steepest increase in BP with age was observed in populations from Africa and Europe, whereas a more gradual rise in BP with increasing age was seen in South-East Asian populations. Women had lower BP levels than men at younger ages (twenties and thirties), but subsequently experienced a more pronounced age-related BP increase resulting in diminishing sex differences across older age groups. Geographically divergent age-related BP trajectories were significantly associated with major national public health indicators. Globally, the steeper the age-related BP slope, the stronger the association with poor BP control (β = -0.46 [95% CI: -0.74; -0.19], p=0.001), increased DALY’s (β = 66155.68 [95% CI: 44847.0; 87464.36], p&amp;lt;0.001) and death rates. (β = 1017.3 [95% CI: 351.72; 1682.89], p=0.003). Conclusion Age-related BP trajectories vary considerably across global populations and contribute considerably to the variability in BP-related risks and adverse outcomes across regions. Effective public health strategies may require region-specific targeting of lifestyle and other factors contributing to adverse BP trajectories to improve health outcomes.Average blood pressure by ageAssiciations with public health metrics

Variability in patient-reported outcomes among different congenital heart defects: a comparative analysis of 7,498 patients from 32 countries

Abstract Background Patient-reported outcomes (PROs) may not always correlate with the complexity of congenital heart defects (CHDs), as significant variation has been observed between CHDs within complexity levels. Accurate comparisons across various types of CHDs necessitate large sample sizes. Purpose The objective of this study was to compare PROs across different CHDs in a large international sample. Methods ‘Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study II’ (APPROACH-IS II) was an international cross-sectional investigation, in which 8,415 patients from 32 countries in 6 continents were enrolled (20 high; 7 upper-middle; 4 lower-middle; and 1 low income). For the comparison across different CHDs, conditions with at least 50 patients were included in the analysis. Hence, the sample consisted of 7,498 patients (median age=33y; 53.1% women). Patients completed questionnaires to measure perceived health status (RAND-12 Health Survey; EuroQOL-5D Visual Analog Scale); depressive symptoms (Patient Health Questionnaire-8); anxiety (General Anxiety Disorder-7) and quality of life (Linear Analog Scale). Generalized linear mixed models (GLMMs) were performed with center as random effect. Results Cyanotic heart defects were associated with the lowest scores for physical functioning, mental health, self-rated health, and quality of life (see Figure). Other CHDs found to be associated with poor PRO scores encompassed unrepaired secundum atrial septal defect, Ebstein anomaly, single ventricle, and truncus arteriosus. Conversely, the most favorable scores for all PROs, except for anxiety, were observed with isolated pulmonic stenosis. Other CHDs with favorable PRO scores comprised coarctation of the aorta, isolated small ventricular septal defect, congenital aortic valve disease, and repaired ventricular septal defect. Adjusted for sociodemographic and physiological factors, GLMMs revealed significant differences across defects, using the best score for each PRO as the reference (see Figure). Conclusion Substantial variation in PROs was observed among different types of CHDs. Interestingly, some complex heart defects demonstrated relatively good PRO scores, comparable to some simple defects. On the other hand, unrepaired simple defects or those with residual lesions, were associated with worse PROs.

Value co-creation in sustainable express delivery: intergenerational perspectives

PurposeThe express delivery industry faces challenges engaging consumers in sustainable practices. This study explores how sustainable service quality affects corporate loyalty, mediated by value co-creation (VCC) and green customer satisfaction. It also scrutinizes low-carbon knowledge as a moderator and investigates variances in VCC outcomes between Generation Y and Generation Z consumer groups.Design/methodology/approachAn empirical study involves a scenario experiment and a questionnaire answered by 596 Chinese consumers in 2023. Partial least squares structural equation modeling (PLS-SEM) tests proposed relationships. Regression analysis examines the chain mediating effect of VCC and green satisfaction, while group analysis assesses intergenerational differences.FindingsSustainable service quality positively influences consumer VCC, which in turn impacts customers’ green satisfaction and corporate loyalty. VCC and green satisfaction act as intermediaries between sustainable service quality and corporate loyalty. Low-carbon knowledge positively moderates sustainable service quality's impact on VCC. Generation Y and Generation Z show differences in the relationship between VCC and loyalty.Practical implicationsExpress delivery firms should enhance sustainable service quality and encourage consumer participation in VCC activities. This can improve consumer green satisfaction, loyalty and competitive advantages.Originality/valueThis study expands service marketing literature by clarifying VCC's role in sustainable services and offers insights into VCC's causes and effects. It proposes strategies for the express delivery industry to influence consumer behavior through sustainable service practices.

Explained and unexplained inter-center variability in outcomes: Where should we go next?

Explained and unexplained inter-center variability in outcomes: Where should we go next?

Research on the impact of WTO trade policy review mechanism (TPRM) on the employability of Chinese college students during the economic structural transformation of its member countries

The WTO TPRM is a very important machinery where the WTO members submit for evaluation their trade policies and structures as well as their economic reforms. This research used secondary evidence from employment reports, government statistics and various industry research and employed expert policy and economic opinion. It analyses employment rates prior to and after the implementation of the “mass entrepreneurship and mass innovation” policy and the policy of integrated enterprise-school and university-enterprise. In total, the general sample consists of 500 students half of whom are male and the other half are female. The employment rates stands at an average of 78% among the students. In terms of the standard deviation, the figure is equal to 9.3% which he described as moderate variability of employment outcomes. . Similarly the analysis reveals a positive relationship between GPA, entrepreneurial intention and participation in vocational programs on employability ( p &lt; 0. 001). The coefficient for entrepreneurial intention is especially significant (β = 0. 38), which means that students, who had entrepreneurial intentions, are more likely to be employed. Employment prospects for college students were found to be especially enhanced through adoption of the above policies showing a very strong implication of education and training to economic needs especially during structural change. This study has implication for policy formation and course offering for higher institutions of learning to enhance the employment status of graduates in the current world economy.

Focal Vibration Therapy for Motor Deficits and Spasticity Management in Post-Stroke Rehabilitation

Background: Focal mechanical vibration therapy has gained attention as a potential intervention to improve motor function while decreasing spasticity and pain in post-stroke patients. Despite promising results, there remains variability in study designs and outcomes, warranting a review of its clinical efficacy. Methods: A review was conducted to evaluate randomized controlled trials (RCTs) investigating the effects of focal mechanical vibration therapy on post-stroke rehabilitation. Six studies were included, assessing outcomes such as spasticity reduction (using the Modified Ashworth Scale), motor function recovery (Wolf Motor Function Test, Fugl-Meyer Assessment), and pain management (Visual Analog Scale, Numerical Rating Scale). The quality of studies was evaluated using the PEDro scale and RoB-2 tool. An overview review was conducted to provide a comprehensive analysis of the topic. Results: The included studies demonstrated significant reductions in spasticity and improvements in motor function in most patients receiving focal vibration therapy. Notable improvements were observed when focal vibration was combined with other rehabilitation techniques, such as progressive modular rebalancing or robotic rehabilitation. Pain levels were also reduced in several studies. However, differences in vibration parameters (frequency, amplitude), small sample sizes, and short follow-up periods limit the generalizability of the findings. Conclusions: Focal mechanical vibration therapy appears to be an effective adjunct in post-stroke rehabilitation, particularly for reducing spasticity and improving motor function. Although short-term benefits are promising, further research is required to determine long-term efficacy and optimal treatment parameters. This review evaluates the effectiveness of focal vibration therapy in treating motor deficits and spasticity in post-stroke patients. The results suggest its potential to improve these conditions, though further studies with larger sample sizes are needed to confirm its long-term efficacy.

A replicate crossover trial on the inter-individual variability of sleep indices in response to acute exercise undertaken by healthy men.

Using the necessary replicate-crossover design, we investigated whether there is inter-individual variability in home-assessed sleep in response to acute exercise. Eighteen healthy men (mean(SD): 26(6) years) completed two identical control (8-h laboratory rest, 08:45-16:45) and two identical exercise (7-h laboratory rest; 1-h laboratory treadmill run [62(7)% peak oxygen uptake], 15:15-16:15) trials in randomised sequences. Wrist-worn actigraphy (MotionWatch 8) measured home-based sleep (total sleep time, actual wake time, sleep latency, sleep efficiency) two nights before (nights 1-2) and three nights after (nights 3-5) the exercise/control day. Pearson's correlation coefficients quantified the consistency of individual differences between the replicates of control-adjusted exercise responses to explore: (1) immediate (night 3 minus night 2); (2) delayed (night 5 minus night 2); and (3) overall (average post-intervention minus average pre-intervention) exercise-related effects. Within-participant linear mixed models and a random-effects between-participant meta-analysis estimated participant-by-trial response heterogeneity. For all comparisons and sleep outcomes, the between-replicate correlations were non-significant, ranging from trivial-to-moderate (r range = -0.44 to 0.41, P≥0.065). Participant-by-trial interactions were trivial. Individual differences SDs were small, prone to uncertainty around the estimates indicated by wide 95% confidence intervals and did not provide support for true individual response heterogeneity. Meta-analyses of the between-participant, replicate-averaged condition effect revealed that, again, heterogeneity (τ) was negligible for most sleep outcomes. Control-adjusted sleep in response to acute exercise was inconsistent when measured on repeated occasions. Inter-individual differences in sleep in response to exercise were small compared to the natural (trial-to-trial) within-subject variability in sleep outcomes.

Deep-Learning-Based Segmentation of Cells and Analysis (DL-SCAN)

With the recent surge in the development of highly selective probes, fluorescence microscopy has become one of the most widely used approaches to studying cellular properties and signaling in living cells and tissues. Traditionally, microscopy image analysis heavily relies on manufacturer-supplied software, which often demands extensive training and lacks automation capabilities for handling diverse datasets. A critical challenge arises if the fluorophores employed exhibit low brightness and a low signal-to-noise ratio (SNR). Consequently, manual intervention may become a necessity, introducing variability in the analysis outcomes even for identical samples when analyzed by different users. This leads to the incorporation of blinded analysis, which ensures that the outcome is free from user bias to a certain extent but is extremely time-consuming. To overcome these issues, we developed a tool called DL-SCAN that automatically segments and analyzes fluorophore-stained regions of interest such as cell bodies in fluorescence microscopy images using deep learning. We demonstrate the program’s ability to automate cell identification and study cellular ion dynamics using synthetic image stacks with varying SNR. This is followed by its application to experimental Na+ and Ca2+ imaging data from neurons and astrocytes in mouse brain tissue slices exposed to transient chemical ischemia. The results from DL-SCAN are consistent, reproducible, and free from user bias, allowing efficient and rapid analysis of experimental data in an objective manner. The open-source nature of the tool also provides room for modification and extension to analyze other forms of microscopy images specific to the dynamics of different ions in other cell types.

Fall prevention among adult surgical patients in Tabriz, Iran: a best practice implementation project.

Falling out of bed is the most common unintentional cause of injury among patients and is a major safety problem in health care facilities. Current practices for fall prevention may not always be aligned with established best practices, leading to variability in patient outcomes. This uncertainty underscores the need to assess and improve compliance with best practice guidelines for fall prevention. This project aimed to improve fall prevention in the surgical ward of a general hospital in Tabriz, Iran. This study was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted using eleven audit criteria representing best practices for fall prevention. After the implementation of improvement strategies, a follow-up audit was conducted to evaluate changes in practice. The results revealed significant improvements, notably, fall risk assessment upon admission (87% to 92%), fall risk assessment upon ward transfer (39% to 79%), patient participation in fall risk assessment (26% to 68%), reassessment upon change in condition (53% to 74%), communicating fall prevention information to at-risk patients and their families/caregivers (42% to 63%), engagement of patients (100% to 100%), implementation of targeted strategies (89% to 92%), post-fall assessment and interventions (82% to 87%), revising patient fall risk status and reviewing care management plan (41% to 74%), fall prevention information to patients and their families/caregivers upon discharge (44% to 66%), and person-centered education of health care professionals (77% to 81%). The use of standard clinical audit tools in hospitals can improve the quality of patient care and increase the effectiveness of interventions by identifying weaknesses in the patient care process. http://links.lww.com/IJEBH/A283.

Assessing the ecological complexity and uncertainty of predicting forest ecosystem services under climate change

Climate change affects Central European forest ecosystems in different ways and, consequently, these changes result in different feedbacks on the provision of forest ecosystem services. Regarding the complexity and the variability in climate-forest interactions outcome, forest decision makers necessitate reliable information about changes in the forest ecosystem services for planning and adaptation purposes. However, forest productivity predictions incorporate multiple levels of uncertainty that have to be regarded to ensure building realistic expectations in forest decision-making. Besides the chosen forest simulation model, uncertainties come from the climate change data represented by a set of representative concentration pathways (RCP), within the underlying ensemble of global circulation and regional climate models (GCM-RCM), and further in the treatment of the CO2-fertilization effect. We considered the mentioned uncertainties in a framework on simulating forest growth and water services for two forest sites, a Sessile oak and a Scots pine stand in Rhineland-Palatine, Germany. The framework revealed a high variability in future forest ecosystem services. Particularly, the variability among the selected GCM-RCM models within the same Representative Concentration Pathway (RCP) was higher than the variability among different RCPs (RCP2.6 and RCP8.5 representing the low and high CO2-emission scenarios, respectively). Sessile oak productivity increased under all scenarios, whereas Scots pine growth declined in the lower end of the RCP8.5 scenario. Water services remained mostly stable at both sites. Moreover, we applied a panel data model to estimate what climate indices caused changes in the forest ecosystem services. We found that Scots pine is more sensitive to a multitude of climate indices, such as temperature changes and Sessile oak showed strong response to the CO2-fertilization. We propose applying this framework to evaluate forest management options under climate change.

Strategic entrepreneurship in VUCA environment: the competing forces of outcome variability

Purpose Scholars have extensively studied the concept of strategic entrepreneurship (SE), shedding light on its antecedents, dynamics and outcomes. However, a notable gap exists in understanding the reliability of its performance implications, which explains the inherent risks as well as the possibility of yielding outliers (instances of exceptionally high or low performance). Addressing this gap, this study aims to present a detailed analysis of the implications of SE for the variance of resulting performance distribution. Design/methodology/approach This conceptual study uses the deductive theory-building approach to dissect the four dimensions of SE (entrepreneurial mindset, entrepreneurial leadership and culture, managing resources strategically and applying creativity and developing innovations) as presented by Ireland et al.’s (2003) model, offering theoretical propositions on how each of them influences the variability of resulting performance distribution. Findings This study demonstrates that the strategic entrepreneurship (SE) dimensions have distinct impacts on the reliability/variability of performance outcomes, acting as boosters or attenuators in the volatile, uncertain, complex and ambiguous (VUCA) context. Originality/value The study uniquely links each component of SE with outcome variability in VUCA environments, thereby shifting the focus from traditional performance metrics to outcome variability. This approach complements the existing body of knowledge on the performance implications of the SE construct by integrating a previously neglected critical perspective on the reliability of resulting performance distribution. These insights allow subsequent investigation of SE’s outcomes, including explaining the likelihood of obtaining positive outlier performance or firm failure.

Research progress of cardiovascular disease risk prediction models among patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have a relatively high risk of cardiovascular disease (CVD). Risk stratification guided by CVD risk prediction models is essential for managing CKD populations. We reviewed the outcome events, predictive variables, modeling methods, and predictive performance of CVD risk prediction models in CKD populations. We found a large variability in predictive outcomes, number of predictors, and sample sizes across studies. The models tended to overestimate the CVD risk of CKD populations. There are few independently validated or constructed CVD risk prediction models for CKD populations in developing countries, and in particular, there is a lack of independent external validation studies of model calibration. Future studies should comply with the reporting standards of risk prediction models to better support the application of CVD risk prediction models for CKD populations.