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To cope with the digital transition exacerbated by the COVID-19 pandemic, managers of manufacturing small and medium enterprises (SMEs) need to adopt innovative practices to face uncertain scenarios and create long-term value, identified as transformational entrepreneurship practices. Among emerging digital technologies, digital platforms are shaping and outgrowing the e-commerce channel representing a potential opportunity for manufacturing SMEs to embrace digital transformation. Drawing on affordance theory, this research uses a mixed method approach to investigate how manufacturing SMEs' e-commerce commitment and digital platform adoption stimulate the actualization of three e-commerce affordances: consumer knowledge generation, internationalization, and customer diversification. Based on survey responses from 165 manufacturing SME managers, we find that direct selling through owned websites actualizes consumer knowledge generation and internationalization, indirect selling actualizes customer diversification and internationalization, and agency selling through third-party platforms actualizes all three affordances. The relationship between e-commerce commitment and ecommerce performance is mediated by consumer knowledge generation and internationalization but not by customer diversification. A fsQCA analysis outlines seven configurations actualizing these e-commerce affordances by pairing different ecommerce approaches with degrees of e-commerce commitment. Finally, an analysis of open-ended questions from 24 respondents complements the study and deeply interprets the seven unique configurations outlined. © 2023 The Authors
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INTRODUCTION: The COVID-19 vaccines have effectiveness above 90% for avoiding hospitalization. However, 5% of vaccinated patients require hospitalization with a mortality ratio between 15% to 24%, similar to the one reported for unvaccinated hospitalized patients. These vaccinated patients belong to the most sensitive groups with a high comorbidity burden. The similarity in the mortality ratio between vaccinated and unvaccinated patients has been used to make claims against the vaccine's efficacy. A thoughtful analysis, taking into account the comorbidities of each group, on how vaccination protects patients with moderate or severe illness, is missing. METHOD(S): We perform a multi-continental retrospective cohort study in 111 hospitals in Spain and 37 in Argentina. We included hospitalized patients who received oxygen therapy older than 18 years with COVID-19. To assess the relation between COVID-19 vaccine status and death, we performed a logistic regression adjusting by confounders. Also, as a sensitivity analysis, we perform a propensityscore matching. Additionally, we studied the Population Attributable Risk (PAR). RESULT(S): Between January 2020 and May 2022, we included 21,479 patients, 717 (3 3%) were vaccinated. Hospitalized vaccinated patients with oxygen therapy had a higher proportion of comorbidities. The overall mortality in vaccinated patients was 20 9%, and 19 5% in unvaccinated patients. The crude Odds Ratio was 1 07 (IC95% 0 89-1 29;p=0 41), while the adjusted was 0 73 (IC95% 0 56-0 95;p=0 02) in the complete case analysis (6,352 patients) and 0 77 (CI 95% 0 54-0 97;p=0 02) in the complete dataset after multiple imputations. These observations were robust to the sensitivity analysis. The adjusted PAR reduction was 4 3% (95%CI 1%-5%). Therefore, as the death proportion in unvaccinated patients was 19 6% (95%CI 19%-20 1%), if they were vaccinated the expected death proportion would have been 15 3% (95%CI 12 9%-18%;p< 0 01). CONCLUSION(S): Even with the high protection of the COVID-19 vaccine, patients with a high burden of comorbidities will be hospitalized in future pandemic waves. In this study, we observed that the COVID-19 vaccines significantly reduce the probability of death even when lung inflammation has already been initiated, with moderate or severe COVID-19 disease.
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Background: Since the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefts of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group). Objectives: To evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://bright-oncollaboration.us/wp-content/uploads/2021/01/SO2-D2.1.2-V1.2-COVID-19- AESI-update-23Dec2020-review-fnal.pdf) Methods: The frst ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defned as at least one of the following: new manifestations attributable to disease activity, hospital-ization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants. Results: A cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren's syndrome (SS,12%), idiopathic infammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Dan-los's syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the frst and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%). Conclusion: This preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the frst month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.
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We conducted a retrospective cohort study to report the clinical characteristics, incidence and outcomes of patients with severe COVID-19 with acute kidney injury (AKI). One-hundred and sixtytwo intensive care unit (ICU) admitted patients in a tertiary level hospital in the city of Buenos Aires with COVID-19 diagnosis were included. We hypothesized that COVID-19 related AKI would develop in the period of more severe hypoxemia as an early event and late AKI would be more probably related to intensive care unit complications. For this purpose, we divided subjects into two groups: those with early AKI and late AKI, before and after day 14 from symptom onset, respectively. A stepwise multivariate analysis was conducted to find possible AKI predictors. AKI incidence was 43.2% (n = 70) of the total patients admitted into ICU with severe COVID-19, 11.1% (n = 18) required renal replacement therapy. In-hospital mortality was higher (58.6%) for the AKI group. AKI occurred on a median time of 10 (IQR 5.5-17.5) days from symptom onset. A history of hypertension or heart failure, age and invasive mechanical ventilation (IMV) requirement were identified as risk factors. Late AKI (n = 25, 35.7%) was associated with sepsis and nephrotoxic exposure, whereas early AKI occurred closer to the timing of IMV initiation and was more likely to have an unknown origin. In conclusion, AKI is frequent among critically ill patients with severe COVID-19 and it is associated with higher in-hospital mortality.
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In order to address the main challenges related to the rare diseases (RDs) the European Commission launched the European Reference Networks (ERNs), virtual networks involving healthcare providers (HCPs) across Europe. The mission of the ERNs is to tackle low prevalence and RDs that require highly specialised treatment and a concentration of knowledge and resources. In fact, ERNs offer the potential to give patients and healthcare professionals across the EU access to the best expertise and timely exchange of lifesaving knowledge, trying to make the knowledge travelling more than patients. For this reason, ERNs were established as concrete European infrastructures, and this is particularly crucial in the framework of rare and complex diseases in which no country alone has the whole knowledge and capacity to treat all types of patients. It has been five years since their kick-off launch in Vilnius in 2017. The 24 ERNs have been intensively working on different transversal areas, including patient management, education, clinical practice guidelines, patients' care pathways and many other fundamental topics. The present work is therefore aimed not only at reporting a summary of the main activities and milestones reached so far, but also at celebrating the first 5 years of the ERN on Rare and Complex Connective Tissue and Musculo-skeletal Diseases (ReCONNET), in which the members of the network built together one of the 24 infrastructures that are hopefully going to change the scenario of rare diseases across the EU.
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Like many different and relevant sectors, the leather industry is currently facing a major environmental issue that may affect the competitiveness of all the stakeholders across the value chain. Drawing the conceptual model on the natural resource-based view (NRBV), this study seeks to examine the mediating role of individual green values (IGV) between green transformational leadership (GFTL) and environmental performance (EP). Furthermore, government regulations are used as a moderator concerning the relationship between GTFL and EP. An online survey was randomly distributed to Pakistan's leather industry employees to test the hypothesis by collecting data from 205 respondents. Partial Least Square Structural Equation Modeling (PLS-SEM) has been used to analyze data. The results demonstrate that green transformational leadership (GTFL) positively affects EP. Moreover, this study also reveals that GTFL significantly contributes to developing the IGV that consequently affects EP. Thus, the current study provides a significant sequential GTFL, IGV and EP path. However, surprisingly, the results show that government regulations do not moderate the relationship between GTFL and IGV. This study significantly contributes to the theory and stakeholders and leaders in a vast variety of manufacturing industries. It suggests that all organizations should adopt GTFL principles that encourage employees to engage in environmentally friendly activities by developing green values at the individual level to enhance EP. With this regard, GTLF, IGV, and government regulations may thus play a vital role for organizations and industry for better EP and competitiveness.
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Purpose This study aims to explore how corporate social responsibility (CSR) dimensions (i.e. economic;legal;ethical;philanthropic) foster employee creativity during the COVID-19 pandemic. Specifically, an attempt is made to investigate the mediating role of affective commitment to explain the above linkage. Design/methodology/approach The survey data were collected from 167 employees in the emerging market of Saudi Arabia. The data was analysed using PLS-SEM for frequency, reliability, confirmatory factor analyses and structural equation modelling. Findings The CSR dimensions, particularly the ethical and philanthropic dimensions, showed both direct and indirect effects on the creativity behaviour of employees during the COVID-19 pandemic. Moreover, affective commitment mediated the relationship between the legal, ethical and philanthropic CSR dimensions and creativity behaviour. Originality/value This study enriches previous CSR empirical research and adds to current literature focused on the determinants of CSR dimensions' effectiveness;particularly, the research is set in a challenging scenario characterized by the pandemic. So, this paper extends previous studies by investigating under which key conditions CSR dimensions are most effective, in particular in two main directions. First, it contributes to the CSR literature by determining how various CSR dimensions influence creativity behaviour during a pandemic. Pandemics are events that occur regularly, and the COVID-19 pandemic, in particular, offers the opportunity to explore its effects on employees' behaviours in the current context. Second, the study's mediation findings contribute to new empirical evidence which suggests that affective commitment has a positive effect on the CSR dimensions of employee creativity behaviour during a pandemic in an emerging market.
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Background : Since the beginning of the SARS-CoV 2 pandemic, there have been many reports of increased incidence of VTE (venous thromboembolism) and arterial events as a complication, which were the basis for the hypothesis that patients should receive higher doses of thromboprophylaxis (TP) or full anticoagulation. Aims : To determine the incidence of thrombotic events (TE) in patients hospitalized for moderate or severe SARS-CoV2 disease (Covid-19). Methods : Retrospective single center cohort study with adult patients with a positive rt-PCR for SARS-CoV2 , included as from the date of hospital admission due to Covid-19 and followed for 90 days or until death. Results : A total of 1621 patients were included. The mean age was 68.7 years (SD 21.1) and 57% (913) were female, of which 6.5% (59) were pregnant. Overall mortality was 21.6% (348). The overall incidence of symptomatic thrombotics events within 90 days was 1.72% (28/1621, 95%CI 1.19-2.49%), whereas the incidence of pulmonary embolism (PE) was 0.98% (15, 95%CI 0.60-0.16%), deep venous thrombosis (DVT) 0.74% (11, 95%CI 0.42-0.12%), ischemic stroke 0.24% (4, 95%CI 0.09-0.65%) and ischemic arterial events 0.06% (1, 95%CI 0.008-0.43%). No acute coronary syndrome events were recorded. Median hospital stay length percentage under adequate TP was 78%. The median time since positive rt-PCR for the thrombotic event to develop was 22 days (IQR 25th-75th 19-43 days). Median hospital stay length percentage under adequate thromboprophylaxis was 78% (IQR 25th-75th 50-89%). Conclusions : Unlike previous reports, the incidence of thrombotic events was low among our patients with moderate or severe Covid-19.
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With increasing frequency, people are using social media sites to obtain timely information about the world's grand challenges and this phenomenon is amplified during crises. However, little research has been conducted to determine how people participate and how their involvement can be promoted on social media sites, although the critical role played by those sites has been well documented. Based on the theory of planned behavior (TPB), this study develops and tests a theoretical model to establish the effect of several factors with survey data collected during the COVID-19 pandemic, in Saudi Arabia. The relationship was verified on a sample of 213 respondents active on Twitter, using Partial Least Square (PLS). The study found that attitude, perceived behavioural control and subjective norm affect Twitter users' active participation significantly within the context of a time of crisis. It also found a positive effect of utilitarian and hedonic values and trust. These results will provide a more comprehensive evaluation of Twitter users in grand challenges (and more specifically during a crisis) and furnish academics and managers with instructive guidance. © 2021 Elsevier Ltd