Impact of company and country antecedents on B2B buyer perceived supplier performance

Purpose To date, country-of-origin research has commonly explored structural relationships among country image (CI) constructs, together with attitudinal constructs, using a variety of halo, summary construct and flexible models, drawing on consumer samples. There has been no previous attempt to examine or synthesize these three models with respect to business-to-business (B2B) buying behavior. To fill this gap, this study reconceptualized these three models with B2B constructs using multi-cue settings and tested on B2B samples. This study aims to examine and estimate the relative impact of company- and country-specific images on B2B buyers’ evaluations of suppliers, and the direction of structural relationships with mediation among the constructs. Design/methodology/approach Data collection was administered through a web-based structured questionnaire. The final sample consisted of 276 purchasing managers. Structural equation modeling was used to test the study’s hypotheses. Findings Company image is significantly influenced by product country image (PCI) but not by overall CI. The existence of a significant relationship between PCI and perceived supplier performance in a multi-cue setting is an important new finding. In addition, company image significantly influences supplier performance and mediates the relationship between PCI and supplier performance. Among the three models that test structural relationships among CI and other constructs, the reconceptualized halo model fits the data best. Practical implications The study results revealed the contribution of company and country-related facets on B2B buyers’ perceptions of supplier performance while purchasing intermediate goods internationally. The significance of PCI on supplier performance emphasizes the strength of the industry sector within a country that may enable an industry to build a product-specific CI in international marketing. Originality/value This study advances the country-of-origin issue and debate concerning the strength of the country influence in the academic literature by addressing B2B buyers’ international purchasing behavior of intermediate goods. Additionally, the examination of multiple country facets, multi-cue settings and the CI influence structure in a single study, from a B2B perspective, offers a novel dimension to CI studies.

Endoscopic submucosal dissection combined with clip closure is effective to close gastrointestinal fistulas including refractory ones.

ABSTRACT Objective: Gastrointestinal (GI) fistula, a life-threatening condition, represents a therapeutic challenge. Rescue surgery could be hazardous and/or impact quality of life justifying endoscopic con-servative approach including mucosal abrasion, clip closure or stent diversion with moderate success rates in the long term. We assessed whether Fistulas Endoscopic Submucosal Dissection with clip Closure (FESDC) could lead to complete resolution of fistulas even if previous endoscopic therapy failed. Results: 23 patients with GI fistulas were retrospectively included, 57% of those were defined as refractory fistulas since previous endoscopic treatment failed. Tight immediate sealing was obtained for 19 patients (83% [95% CI: 61%, 95%]) who received FESDC. Long term closure (>3 months) was obtained in 14 cases (61% [95% CI: 39%, 80%]) with a median follow-up of 20 months. Ad-verse events occurred in 9% of cases. Previous local malignancy (p=0.077) or radiation therapy (p=0.047) were associated with a higher risk of failure. Conclusion: The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula.

Investigating how neonicotinoids effect Abundance, Behaviour, Condition, Reproductive success and Survival for non-target terrestrial arthropods.

This meta-analysis aims to update and improve upon a previous attempt at understanding the effects neonicotinoids have on non-target terrestrial arthropods. While the original authors carried out sufficient analysis on the data they collected, there are new methodologies that can improve the accuracy of the final effect sizes produced. This new meta-analysis will use a multi-level approach, meaning that it will not consider data to be independent from the studies they were collected from. Instead the data and subsequent effect sizes will be nested within the studies, allowing for a truer effect size to be synthesised.

P–127 Does sperm quality really matter for conceiving through an intrauterine insemination program? A retrospective analysis of 5920 attempts taking into account repetition of cycles

Study question Are parameters of sperm quality part of the prognosis factors for an infertile couple to obtain a live birth when entering an intrauterine insemination program considering repetition of attempts? Summary answer Paradoxically, a lower sperm morphology independently predict quick live birth through IUI, as well as younger female age, lower D3 FSH, and higher triggering estradiol. What is known already Many studies have highlighted different prognosis factors for obtaining a live birth after IUI involving: male parameters (semen),female parameters (age, parity, ovulation, tubal, and endometriosis status, history of pelvic surgery),couple parameters (duration of infertility, number of previous attempt),IUI parameters (follicle number, endometrial thickness, estradiol at triggering, day of IUI, number of spermatozoa inseminated). However, most of these studies have included small number of attempts, semen parameters were either not collected or assessed with heterogeneity, and repetition of attempts (although iconic for IUI) was not considered, allocating inappropriate weight to cycles which failed in conceiving. Study design, size, duration We retrospectively studied the entire cohort of IUI attempts carried out with partner’s sperm at our center between 09/09/2003 and 01/17/2017. We included all male, female, couple and IUI parameters available. Each basic semen analyzes included have been carried out by a restricted number of skilled andrologists from our center. The closest semen assessment performed before IUI was considered as male parameter. IUI attempts were considered repeated unless a live birth or IUI abandonment occurred. Participants/materials, setting, methods Our primary outcome was live birth occurrence. We included 2228 couples having performed 5920 IUI attempts, with 636 live births obtained. A mixed logistic regression model was used to take into account IUI repetition before obtaining a live birth. A survival analysis using Cox model, with IUI rank as time variable, live birth as endpoint, and taking into account recurrences was carried out to determine which parameter best predict a quick live birth through IUI. Main results and the role of chance Included women were 33.7 ± 4.6 years old in mean. Baseline semen assessment was available for 64% of couples. Muti-variate analysis showed that live birth was more frequent when: Femal factors: age was young (33 to 38yo, OR 0.76 [0.60;0.96], >38 yo OR 0.49 [0.35;0.67], p = 0.0001), FSH ≤ 8.0 (OR 0.59 [0.45;0.79], p = 0.0002), AMH > 8.9ng/mL (OR 0.59 [0.45;0.79], p = 0.0001), endometriosis was absent (OR 0.56 [0.36;0.88], p = 0.0109), the patient already delivered (OR 1.36 [1.06;1.74], p = 0.0034) Male factors: sperm motility ≤26.0% (OR 0.71 [0.53;0.96], p = 0.0062), sperm vitality ≤72.0% (OR 0.65 [0.47;0.90], p = 0.0032), sperm typical form ≤ 25.0% (OR 0.51 [0.34 ; 0.78], p = 0.0016), IUI attempt factors: total dose of gonadotropin > 495.0 (OR 1.54 [1.26;1.88], p = 0.0001) follicle number > 2 (OR 1.23 [1.69;2.21], p = 0.0296), Estradiol at trigerring > 215.0pg/ml (OR 1.90 [1.53;2.36], p = 0.0001), Endometrial thickness >9.6mm (OR 1.43, p = 0.0024), day of IUI >13 (1.53 [1.24;1.89], p = 0.0001). Using Cox model, couples obtained quickly a livebirth if: woman age was below 33yo: For 33 to 38 yo, OR 0.37 [0.25;0.54], p = 0.0001, >38yo OR 0.19 [0.11;0.32], p = 0.0001 D3 FSH<8 (if above, OR 0.55 [0.34;0.90], p = 0.0160) - Sperm typical form ≤25.0 (if above, OR 0.34 [0.20;0.58], p = 0.0001) Triggering estradiol >215.0pg/ml, OR 1.99 [1.51;2.63], p = 0.0001) Limitations, reasons for caution Baseline semen assessment was missing a bit more when cycles were successful, so that a bias connot be excluded. This weird result concerning semen parameters which appear to lower the live birth rate when they are good should thus be considered with caution. Wider implications of the findings: Good baseline semen parameters do not appear as primordial for obtaining an IUI live birth, and were even found deleterious. However, thresholds highlighted in the present study were high, i.e. of limited clinical mean, and semen below them to remain normal. After confirming, explanations should be investigated: excessive acrosome reaction. Trial registration number Not applicable

Improving stroke care in Ghana: a roundtable discussion with communities, healthcare providers, policymakers and civil society organisations

Even though there have been advances in medical research and technology for acute stroke care treatment and management globally, stroke mortality has remained high, with a higher burden in low- and middle-income countries (LMICs) such as Ghana. In Ghana, stroke mortality and disability rates are high, and research on post-stroke survival care is scarce. The available evidence suggests that Ghanaian stroke survivors and their caregivers seek treatment from pluralistic health care providers. However, no previous attempt has been made to bring them together to discuss issues around stroke care and rehabilitation. To address this challenge, researchers from the Institute of Advanced Studies, University College London, in collaboration with researchers from the African Centre of Excellence for Non-communicable diseases (ACE-NCDs), University of Ghana, organised a one-day roundtable to discuss issues around stroke care. The purpose of the roundtable was fourfold. First, to initiate discussion/collaborations among biomedical, ethnomedical and faith-based healthcare providers and stroke patients and their caregivers around stroke care. Second, to facilitate discussion on experiences with stroke care. Third, to understand the healthcare providers’, health systems’, and stroke survivors’ needs to enhance stroke care in Ghana. Finally, to define practical ways to improve stroke care in Ghana.

Colonial botany and the shifting identity of Balanostreblus ilicifolius Kurz (Moraceae)

The protologue of Balanostreblus ilicifolius Kurz included the citation of specimens from Bangladesh and Myanmar of a plant now called Taxotrophis ilicifolia (Kurz) S.Vidal. However, the description in the protologue and the accompanying illustration were based largely on the Neotropical Sorocea guilleminiana Gaudich., which was cultivated in the Royal Botanic Garden, Calcutta and has similar vegetative characters. This paper seeks to resolve a century of confusion over the identity of Balanostreblus ilicifolius and reviews its history in light of historical correspondence relating to its identity and the trans-continental exchange of plants under British colonialism. The paper concludes that a previous attempt to typify Balanostreblus ilicifolius with an uncited cultivated specimen of Sorocea guilleminiana should be superseded with material from Myanmar cited in the protologue. A lectotype is designated, fixing the application of the name, which can now serve as the basionym of Taxotrophis ilicifolia.

Resilience Assessment Scale for the Prediction of Suicide Reattempt in Clinical Population

The objective of this work was to construct and validate an instrument for assessing resilience to suicide attempts in a Spanish clinical population that has made a previous attempt, and to verify its efficacy for predicting future suicide reattempts at 6 months. For the construction of a Scale of Resilience to Suicide Attempts (SRSA) the theoretical-rational strategy was used. The constructed SRSA-18 consisted of 18 items and 3 subdimensions (internal and external protection and emotional stability), had high internal consistency (α = 0.88; ω = 0.89) and a high positive correlation with the Suicide Resilience Inventory-25, SRI-25 (r = 0.91; p < 0.01), and to a lesser extent with general resilience scales such as the Connor-Davidson Resilience Scale, CD-RISC (r = 0.79; p < 0.01) and the Resilience Scale of 14 items, RS-14 (r = 0.76; p < 0.01). Additionally, a specific SRSA-18 score predicted future suicide reattempts 6 months after the first attempt. This new scale (SRSA-18) assesses in a brief and rapid way, through protective factors rather than risk factors, the level of resilience to the suicide attempt in specific clinical subpopulations in hospital emergency services, being able to prevent suicide reattempts with higher lethality.

Partial Inferior Pubectomy in the Delayed Repair of Pelvic Fracture Urethral Injury: Adopting a Bone-nibbling Technique

Background: The use of wedge inferior pubectomy can be challenging to many urethral surgeons. Our objective was to introduce a bone-nibbling technique to accomplish a partial inferior pubectomy (PIP) in a resource-poor setting, and to report the medium- to longterm outcome of using the technique. Methods: Five patients were recruited (mean age: 38.8 years) who presented, over a 30-month period, with posterior urethral fibrosis from a pelvic fracture urethral injury (PFUI). One had failed a previous attempt at posterior urethral reconstruction elsewhere. The length of urethral defect was from 2 to 4 cm. We describe a bone-nibbling technique used to carry out PIP for the delayed repair of PFUI in these patients. The outcomes in the medium to long term of surgical procedures done with this technique are presented. Results: Immediate postoperative complications in all were essentially a Clavien–Dindo grade I. Peak flow rate assessed 12 weeks’ post operation was between 20 mL/s and 23 mL/s (mean: 21 mL/s). The longest duration of follow-up was 34 months, and all patients were voiding satisfactorily. Conclusions: A satisfactory and durable outcome can be obtained from nibbling at the bone from the inferior margin of the pubic bone to achieve PIP. This is of interest to lower urinary tract reconstructive surgeons who have concerns with chiseling-out wedge of the inferior pubis. Keywords: Bone nibbling, Partial inferior pubectomy, PFUI, Posterior urethra, Urethral anastomosis

Meaningful use of COMSAE Phase 1 in preparation for COMLEX-USA Level 1

Context The Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is a three level national standardized licensure examination for the practice of osteopathic medicine. The Comprehensive Medical Self Assessment Examination (COMSAE) is a three phase self assessment tool designed to gauge the base knowledge and ability of candidates preparing for COMLEX-USA. Objectives To investigate how COMSAE Phase 1 (Phase 1) was used by candidates and how completing Phase 1 impacted their performance on the COMLEX-USA Level 1 (Level 1) examination. Methods Using data from the 2018–2019 administration of Level 1 and Phase 1 examinations, we counted the frequency of the unique Phase 1 forms taken by the candidates and calculated the correlation between the candidates’ first attempt Phase 1 scores and the number of Phase 1 forms taken. We then calculated the correlation between the Level 1 scores and the Phase 1 scores. Next, we applied a multilevel regression model to examine the candidates’ score improvement on the multiple Phase 1 forms taken. Finally, we investigated the effect of practicing through Phase 1 on the candidates’ Level 1 performance using logistic regression models. Results The majority of candidates took one (2,414; 33.9%) to two (2,196; 30.8%) timed Phase 1 forms prior to the Level 1 examination. There was a significant negative correlation (r=−0.48, t (6,505)=−44.05, p<0.001) between the candidates’ first attempt Phase 1 scores and the number of Phase 1 forms taken. There was a strong and positive correlation (r=0.66 to 0.74, p<0.001) between Phase 1 and Level 1 scores. With other variables controlled, on average, candidates’ Phase 1 scores increased 23.2 points on one attempt from the previous attempt. Having the most recent Phase 1 score controlled, a greater number of Phase 1 forms taken was associated with an improvement on the Level 1 performance. Conclusions The significant correlation between Phase 1 and Level 1 performance provided validity evidence for Phase 1. Moreover, our results suggested that candidates, especially those with lower performance on their initial Phase 1 attempt, might improve their Level 1 performance by taking multiple Phase 1 forms to monitor their academic improvement and gauge their readiness for Level 1.

Submandibular Push Exercise Using Visual Feedback from a Pressure Sensor in Patients with Swallowing Difficulties: A Pilot Study

Objectives: We aimed to determine the usefulness and effectiveness of a submandibular push exercise with visual feedback from a pressure sensor in patients with dysphagia through continuous exercise sessions. Methods: Twelve patients with dysphagia of various etiologies were included. A total of five exercise sessions (every 3 or 4 days) over three weeks were conducted. During the submandibular push exercise, patients were instructed to maintain a maximum force for 3 s, repeated for 1 min to measure the number of exercises, the maximum pressure, and the area of the pressure-time graph. We statistically compared the values of each exercise trial. Results: Among the 12 patients, eight completed the exercise sessions. As the number of exercise trials increased, the maximum pressure and the area in the pressure-time graph showed a significant increase compared to the previous attempt (p < 0.05). The maximum pressure and the area of the pressure-time graph improved from the first to the fourth session (p < 0.05). The values were maintained after the fourth session, and there was no significant difference between the fourth and the fifth exercise (p > 0.05). There was no significant difference between successful and non-successful groups, except for the Modified Barthel Index (p < 0.05). Conclusion: Through repetitive exercise training, the submandibular push exercise using visual feedback from a pressure sensor can be applied as an exercise method to strengthen swallowing related muscles, such as the suprahyoid and infrahyoid muscles. However, additional studies including more patients and a long-term study period are warranted to evaluate the effects of the exercise for improvement of dysphagia.