IntroductionIn highly developed countries, as many as 16 percent of children are physically abused each year. Traumatic brain injury (TBI) is the most common injury in non-accidental trauma (NAT) and is responsible for 80 percent of fatal NAT cases, with most deaths occurring in children younger than three years old. Cases of abusers who refuse withdrawal of life-sustaining medical treatment (LSMT) to avoid criminal charges have previously been reported. Therefore, we hypothesized that NAT is associated with a lower risk for (...) withdrawal LSMT in pediatric TBI.MethodsThe pediatric Trauma Quality Improvement Program database was analyzed (2014 to 2016) for patients aged 16 and younger with TBI and Glasgow Coma Scale (GCS) of 8 and lower on admission. Patients with a head Abbreviated Injury Scale (AIS) of 2 or less or who died within 48 hours were excluded. A multivariable logistic regression model was used for analysis.ResultsOf 2,209 TBI patients, 92 (4.2 percent) had withdrawal of LSMT. Compared to those without withdrawal of LMST, those with LMST had statistically similar median age (three years of age versus seven years, p = 0.07) and a higher rate of NAT (33.7 percent versus 13.5 percent, p < 0.001). The most common specified perpetrator was a father/stepfather/ male partner (70 percent). After adjusting for covariates, factors associated with higher risk for withdrawal of LSMT included age of less than three years (OR 2.38, CI 1.34-4.23, p < 0.05) and NAT (OR 1.86, CI 1.02-3.41, p < 0.05).ConclusionNAT is associated with increased risk for withdrawal of LSMT in pediatric TBI. Age of less than three years is similarly associated with a higher risk for withdrawal of LSMT. Future research in this population is needed to determine what other factors predict withdrawal of LSMT and what resources, such as social workers and/or ethics consults, are utilized. (shrink)

Abstract“Shut the door,” the chief resident said to me. While I was green enough at the beginning of my clinical clerkships to believe that most of my medical education would happen at the bedside, at that moment, I was learning another important fact: a large part of my ethical education was going to happen behind the closed doors of a call room. The health care team was polluted by a pervasive atmosphere of frustration, as silent but tangible as a thick (...) layer of fog, that obscured the patient's ability to evaluate the consequences of the choice that lay before her. The attending did not permit, let alone create, an environment that provided room for dissent.Institutions should encourage the leaders of clinical education to foster an emotionally safer learning environment in which honest moral dialogue may occur without fear of repercussions. If students cannot learn to apply the principles of ethics actively throughout their clerkships, it will be much harder to do so when they practice independently, and ultimately, patient care will suffer. Conversely, when students and trainees are empowered by their teachers, patient care improves. (shrink)

Although current literature about the “cure versus care” issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the hidden curriculum (...) perpetuates the notion that “cure” and “care” based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach. (shrink)

The Public Sphere from Outside the West brings together established and emerging new voices from philosophy, literature, anthropology, history, migration studies and information technology to address the present reality of the public sphere. In the age where everyone is in the public and everything is visible, this volume creates a delay in which the internet of things, mass surveillance and social media are asked "What is/not the Public?†? The essays bring to attention the formation of geo-politically and historically distinct public (...) spheres from South Africa, India, America and Europe. Such formations are found not only in the postcolonial histories of print, photography, cinema and caricature but also those underway in the digital era, such as the Arab Spring, Occupy movements and Anonymous. Through critical engagement with philosophers such as Kant, Heidegger, Benjamin, Habermas and Arendt, the determining concepts of the Public Sphere-privacy, secrecy, reason, the people-are shown to be undergoing epistemological and practical ruptures. Demonstrating the necessity of these considerations to understand the world public that is rapidly transforming this concept in radical ways through technologies today, this is the first collection on the subject to feature an impressive range of international thinkers. Global and timely in outlook, it breaks new ground and changes our way of looking at politics in the 21st century. (shrink)

This paper argues that in social circumstances deformed by persistent anti-black racisms, invisibility does not necessarily constitute a failure of recognition or acknowledgment by others. Rather, it comes forth as a protective shield, to resist reductive and objectifying forms of seeing that often result in violence. But such invisibility has its limits. In this paper, I read Incendiary Art (2017) by Patricia Smith, a collection of poems set in the context of the Black Lives Matter movement in the US, to (...) interrogate both the limits of such protective invisibility, and the responsibility of the reader to acknowledge the potential violence of their own gaze. I examine the emancipatory political value of the poetic as showing a way towards a transformative engagement with others as ‘who’ they are, and subsequently towards a mutual co-constitution that is at the very heart of actualising a democratic political plurality. (shrink)

BackgroundA requisite for ethical human subjects research is that participation should be informed and voluntary. Participation during the informed consent process by way of asking questions is an indicator of the extent to which consent is informed.AimsThe aims of this study were to assess the extent to which parents providing consent for children's participation in an observational tuberculosis (TB) research study in India actively participated during the informed consent discussion, and to identify correlates of that participation.MethodsIn an observational cohort study (...) of tuberculosis in infants in South India, field supervisors who were responsible for obtaining informed consent noted down questions asked during the informed consent discussions for 4,382 infants who were enrolled in the study. These questions were post-coded by topic. Bivariate and multivariate analysis was conducted to examine factors associated with asking at least one question during the informed consent process.ResultsIn total, 590 out of 4,382 (13.4%) parents/guardians asked any question during the informed consent process. We found that the likelihood of parents asking questions during the informed consent process was significantly associated with education level of either parent both parents being present, and location.ConclusionsThe findings have implications for planning the informed consent process in a largely rural setting with low levels of literacy. Greater effort needs to be directed towards developing simple participatory communication materials for the informed consent process. Furthermore, including both parents in a discussion about a child's participation in a research study may increase the extent to which consent is truly informed. Finally, continuing efforts need to be made to improve the communication skills of research workers with regard to explaining research processes and putting potential research participants at ease. (shrink)

This paper uses Castoriadis’s idea of the imaginary and Agnes Heller’s conceptualization of modernity as an interplay of the historical and technological imaginations, to examine how modernity engages with the idea of development to foster a particular vision of the future as always in progression. It uses the examples of Tasmania and Kerala, in Australia and India, respectively, as case studies which challenge the dominant perception of development as a linear and progressive ideology of growth that translates into ‘the development (...) of productive forces and the rational mastery of nature’. The case studies also show how, despite the radically different paths through modernity, it is the same logics of modernity that are at work in both locations. (shrink)

Our moral compass is not the only thing that compels us to provide compassionate health care, which also improves patient outcomes and patient and provider satisfaction. In the current era of increasing medical complexity, provider burnout, and value-based reimbursement, health care systems struggle to durably improve their providers’ compassion in the provision of care. A religious retreat curriculum for leaders at OSF HealthCare, in Illinois and Michigan, has led to a significant, long-term increase among employees in their compassion toward patients, (...) colleagues, and self. (shrink)

Demanding work-life and excessive workload, the conflict between professional and personal lives, problems with patients and those related to the occurrence of death and high risk for their own life are a few factors causing burnout, disengagement, and dissatisfaction in the professional lives of healthcare professionals. The situation worsened during the COVID-19 pandemic. It is of utmost importance to find effective solutions to mitigate the stress and anxiety adversely affecting the mental well-being and professional lives of HCPs. This study was (...) designed to examine the efficacy of Sudarshan Kriya Yoga for alleviating work exhaustion, improving Professional Fulfillment, and influencing positivity among HCPs during COVID-19. In a comparative observation before the intervention, after the intervention, and 30 days after the intervention in the Experimental Group and Control Group, it was found that immediately after SKY, HCPs experienced a significant improvement in Professional Fulfillment, work exhaustion, positive affect, and negative affect compared to the Control Group. The effect of SKY continued until Day 30 for Professional Fulfillment and had positive and negative effects. Findings suggest that SKY elevated Professional Fulfillment among HCPs during the COVID-19 pandemic and reduced their work exhaustion and the negative effect on their mental health. SKY can aid HCPs in maintaining their well-being when faced with unprecedented challenges. (shrink)

In the fight against racism, philosophy has to interrogate caste in its own histories and current decolonial consensus. Caste has been evading its interrogation as the oldest race theory and racist practice, which continue to oppress the lower-caste peoples who constitute the majority population of the Indian subcontinent. Caste and race are species of the hypophysics of man, which consecrates scaled intrinsic value in human nature through the notion of “being born as” by “being born to.” They are analogues in (...) having the same denigrate-dominate function of exploiting by including as born inferior. However, caste and race are also homologues since the hypophysics of caste has been at the origins of the hypophysics of race from at least the eighteenth century, culminating in the “Aryan doctrine” of the Nazis, now being revived. Caste was the empirical, conceptual, and textual resource for Europeans as it showed that large groups could be dominated as well as excluded through the self-designated superiority, supplied by the Brahminical texts, of the oppressing group. Rather than a colonial construct, caste is the oldest racism, which in colonial times devised new calypsologies—ways to mask itself against rising anticaste thought and politics. Postcolonial and subaltern theories disguise caste’s racism as “religion,” “culture,” and subaltern subjectivity, while some sociologists have denigrated Dalit scholarship as unacademic and emotional. The homologies of caste are still dangerously regnant today. (shrink)

This chapter discusses intergenerational class mobility, which is the extent to which sons — and even daughters — follow in their father's footsteps. It asks how ‘open’ India is, and whether it is becoming more ‘open’ with greater equality of opportunity as it slowly modernises. The discussion is limited to the patterns of intergenerational mobility of men and women who are actually in paid employment.

The practice of paying prisoners to for their participation in research has long been debated, and the controversy is reflected in the differing policies in the U.S. prison systems. Empirical study of financial payments to inmates who enroll in research has focused on whether this practice is coercive. In this study, we examined whether monetary incentives have the potential to be unduly influential among fifty HIV‐positive prisoners. The majority of prisoners surveyed believed that inmates should receive some compensation for their (...) involvement in research and disagreed with statements suggesting that the offer of payment constitutes undue influence. However, a sense of potentially being susceptible to undue influence was significantly higher among participants who had spent a longer time in prison and had less education. Overall, our findings suggest that most prisoners feel that they would be able to make a decision about research enrollment that is not solely based on an offer of monetary payment. (shrink)

Is there a philosophical nationalism? Reading Fichte’s Addresses to the German Nation and its use by the Nazis, Derrida concluded that all nationalisms are philosophical and onto-theological as they are posited beyond race, biology, and nature. However, Fichte’s text reveals a specific form of racism that insists on biology and nature. Fichte’s racism is a species of “hypophysics,” a consecration of nature as value. His theory of language is simultaneously biological and spiritual, these two aspects flowing from a single geistige (...) Naturgesetz (spiritual-natural-law) and determining the hypophysical unity of language, community and “philosophy” (as he defined it). The logic of such a hypophysics is misrecognized and left unaddressed in the conventional categories of “naturalism” and “biologism.” Further, hypophysical-logic is not onto-theo-logic (in Heidegger’s definition). This imposes new questions for the history and future of philosophy: how does hypophysics enter philosophy; can there be philosophy without hypophysics and its attendant racisms? (shrink)

Freud’s late works established the schema of a more or less inexorable civilizational course built around one drive—the death drive—despite his emphatic insistence on a dual structure of two drives. This schema became influential for Critical Theory and in a more subterranean way, also for decolonial thought, and has been widely invoked during the pandemic. It indicates the extent to which drive, destruction, and mastery have consolidated into a, which not only fails to be dislodged by but even informs Derrida’s (...) readings of Freud. Instead, we have to be attentive to the play of homology in Freud as of life, psyche, and civilization, as archaic inheritance. Freudian homology distinguishes itself from what Derrida called “genealogical drive.” The Freudian assumptions in this regard need to be addressed in a step beyond which works with a concept of origin—as its own interruption—that can neither comprehend nor deconstruct the concept of origin as a single and perpetually active homological power as is to be found in Freud. (shrink)

The authors of this insightful and urgent collection both use the metaphor of evil as a virus or contagion and conceptualize the COVID-19 virus as a manifestation of evil to reconsider the purpose of philosophy in and for a pandemic.

The emphasis in human pluripotent stem cell (hPSC) technologies has shifted from cell therapy to in vitro disease modelling and drug screening. This review examines why this shift has occurred, and how current technological limitations might be overcome to fully realise the potential of hPSCs. Details are provided for all disease‐specific human induced pluripotent stem cell lines spanning a dozen dysfunctional organ systems. Phenotype and pharmacology have been examined in only 17 of 63 lines, primarily those that model neurological and (...) cardiac conditions. Drug screening is most advanced in hPSC‐cardiomyocytes. Responses for almost 60 agents include examples of how careful tests in hPSC‐cardiomyocytes have improved on existing in vitro assays, and how these cells have been integrated into high throughput imaging and electrophysiology industrial platforms. Such successes will provide an incentive to overcome bottlenecks in hPSC technology such as improving cell maturity and industrial scalability whilst reducing cost. (shrink)

The role of various organizational pressures in influencing performance of firms has been an interesting research topic in a variety of fields and has received the attention of researchers working in the field of environmental strategy. Although there are previous studies that have looked at the influence of various pressures in influencing firms’ environmental strategies, our study provides a more holistic analysis considering a variety of such pressures in a single framework. We discuss a research study to analyze how pressures (...) from internal and external stakeholders of a firm, economic pressures, environmental regulations, and pressures of environmental compliance have affected environmental performance of firms using data collected from manufacturing firms in the United Kingdom. We have found that internal stakeholders provide the greatest impact in shaping environmental performance of firms, closely followed by economic pressures, environmental regulations, and external stakeholders in that order. Fears of penalties due to environmental compliance have the least impact, although this pressure also has a positive and significant impact on environmental performance. (shrink)

Purpose The purpose of this paper is to understand the dark side of blockchain technology (BCT) adoption in small and mid-size enterprises. The focus of the authors is to decode the intricate relationship among the selected variables missing in the existing literature. Design/methodology/approach A focused group approach is initiated by the authors to identify the barriers. Total interpretive structural modeling, Matrice d'impacts croisés multiplication appliquée á un classment, that is, matrix multiplication applied to classification and decision-making trial and evaluation laboratory (...) are used to analyze the complex relationships among identified barriers. Findings This study finds that implementation of BCT reduces maintenance cost by withdrawing manual effort, as BCT has better capability to quantify the internal status of the system (observability characteristic). The observability characteristic of BCT provides high compatibility to the system. This study also finds that the compatibility of BCT with the organization reduces implementation cost and facilitates project management. The findings of this study recommend analyzing maintenance cost and compatibility of BCT before implementing it. Small and mid-size enterprises can select complex BCT depending on the sophistication level of IT usage and IT project management capabilities. Research limitations/implications This study comes with various limitations, where the model developed by the authors may not be conclusive, as it is based exclusively on expert opinion. The samples collected may not help in validating the model statistically. Though the model has its limitations, it can still be considered as a nascent initiative for further investigation using structural equation modeling. Originality/value The outcomes of the theoretical and managerial contributions of the study can be categorized into three levels. This study can be used both by the industrialists and researchers to understand the barriers and the recovery methods thereafter. Suggestions that serve as future directives are also discussed by the authors. (shrink)

In her article, around the vision of Obiora Ike, the author presents how multicultural education is made possible, in a world where, as university education functions as a fantastic bridge builder, it is a good catalyst for social reforms and equality. University is a place for dynamical leadership at all levels and for a peaceful engagement along the advancement of the digital revolution and reliance on information technology.

Purpose Google commands approximately 70 per cent of search market share worldwide, resulting in businesses investing heavily in search engine advertising on Google to target potential customers. Recently, Google changed the way in which content and ads were displayed on the search engine results page. This reshuffling of content and ads is expected to affect the advertisers who advertise on Google and/or use it to drive traffic to their websites. The purpose of this study is to analyze the impact of (...) these changes on various stakeholders. Design/methodology/approach Data have been collected from various sources on the internet including blogs and discussion forums. Netnography has been used as it allows a detailed evaluation of the consumers’ needs, wants and choices in a virtual space. Findings The average cost-per-click for ads on the top positions is expected to increase. Advertisers whose ads usually occupy the lower positions would be adversely affected. To counter this, more emphasis should be placed on ad extensions and on product listing ads. In addition, organizations would benefit from increased efforts on search engine optimization. Practical implications A variety of coping strategies have been developed that can help marketers to successfully navigate through the change, including the use of ad extensions and the use of product listing ads. Originality/value This practice-focused paper offers guidelines for digital marketers to use sponsored search more effectively as part of their arsenal in light of some important changes recently made by Google. The potential of netnography as a research methodology has also been expanded by using it in a novel setting and in drawing up actionable insights. (shrink)

“Humble” and “business school” are not two words you might associate together, but we can address grand challenges only if business school education instills epistemic humility through reflexivity. We hope that this call-to-action challenges educators to consider how we develop future business leaders who are sensitized to the communities around them, open to tackling the range of challenges that the Sustainable Development Goals (SDGs) present to all of society.

This volume, an important contribution to dialogic and Bakhtin studies, shows the natural fit between Bakhtin’s ideas and the pluralistic culture of India to a global academic audience. It is premised on the fact that long before principles of dialogism took shape in the Western world, these ideas, though not labelled as such, were an integral part of intellectual histories in India. Bakhtin’s ideas and intellectual traditions of India stand under the same banner of plurality, open-endedness and diversity of languages (...) and social speech types and, therefore, the affinity between the thinker and the culture seems natural. Rather than being a mechanical import of Bakhtin’s ideas, it is an occasion to reclaim, reactivate and reenergize inherent dialogicality in the Indian cultural, historical and philosophical histories. Bakhtin is not an incidental figure, for he offers precise analytical tools to make sense of the incredibly complex differences at every level in the cultural life of India. Indian heterodoxy lends well to a Bakhtinian reading and analysis and the papers herein attest to this. The papers range from how ideas from Indo-European philology reached Bakhtin through a circuitous route, to responses to Bakhtin’s thought on the carnival from the philosophical perspectives of Abhinavagupta, to a Bakhtinian reading of literary texts from India. The volume also includes an essay on ‘translation as dialogue’ – an issue central to multilingual cultures – and on inherent dialogicality in the long intellectual traditions in India. (shrink)

Derek Parfit, who died in 2017, is widely believed to have been the best moral philosopher in well over a century. The twenty new essays in this book were written in his honour and have all been inspired by his work - in particular, his work in an area of moral philosophy known as 'population ethics', which is concerned with moral issues raised by causing people to exist. Until Parfit began writing about these issues in the 1970s, there was almost (...) no discussion of them in the entire history of philosophy. But his monumental book 'Reasons and Persons' (1984) revealed that population ethics abounds in deep and intractable problems and paradoxes that not only challenge all the major moral theories but also threaten to undermine many important common-sense moral beliefs. (shrink)

Many targets of the Wnt/β-catenin signaling pathway are regulated by TCF transcription factors, which play important roles in animal development, stem cell biology, and oncogenesis. TCFs can regulate Wnt targets through a “transcriptional switch,” repressing gene expression in unstimulated cells and promoting transcription upon Wnt signaling. However, it is not clear whether this switch mechanism is a general feature of Wnt gene regulation or limited to a subset of Wnt targets. Co-repressors of the TLE family are known to contribute to (...) the repression of Wnt targets in the absence of signaling, but how they are inactivated or displaced by Wnt signaling is poorly understood. In this mini-review, we discuss several recent reports that address the prevalence and molecular mechanisms of the Wnt transcription switch, including the finding of Wnt-dependent ubiquitination/inactivation of TLEs. Together, these findings highlight the growing complexity of the regulation of gene expression by the Wnt pathway. Wnt targets are regulated by a “switch” where TLE co-repressors are displaced from TCFs by β-catenin, leading to activation of transcription. Recent reports challenge this view and suggest that additional processes, including exchange of specific TCF proteins and Wnt-dependent ubiquitination of TLEs, play important roles in the Wnt transcriptional switch. (shrink)

Trisomy 13 and 18 are rare chromosomal abnormalities associated with high morbidity and mortality. Improved survival rates and increased prevalence of aggressive medical intervention have resulted in families and physicians holding different perspectives regarding the appropriate management of children with T 13/18. Families were invited for open-ended interviews regarding their experiences with the medical care of a child with T 13/18 over the past 5 years. Seven of 33 invited families were surveyed; those who had spent more than 40 days (...) in the hospital were most likely to accept the invitation. Grounded theory technique was used to analyze the interviews. This method elicited four key themes regarding family perspectives on children with T 13/18: they are unique and significant, they transform the lives of others, their families can feel overwhelmed and powerless in the medical setting, their families are motivated to “carry the torch” and tell their story. Families also emphasized ways in which Internet support groups can provide both positive and negative perspectives. The ensuing discussion explores the difficulties of parents and physicians in forecasting the impact that T 13/18 will have on families and emphasizes a narrative approach to elicit a map of the things that matter to them. The paper concludes that while over-reliance on dire prognostic data can alienate families, examining the voice, character and plot of patient stories can be a powerful way for physicians to foster shared decision-making with families. (shrink)

Niranjan Ramakrishnan examines the surprising extent to which Gandhi's writings still provide insight into current global tensions and the assumptions that drive them. This book explores how ideas Gandhi expressed over a century ago can be applied today to issues from terrorism to the environment, globalization to the 'Clash of Civilizations.' In particular it looks at Gandhi's emphasis on the small, the local, and the human – an emphasis that today begins to appear practical, attractive, and even inescapable. Written (...) in an accessible style invoking examples from everyday happenings familiar to all, this concise volume reintroduces Gandhi to today's audiences in relevant terms. (shrink)

We show, for various classes of totally ordered structures, including o‐minimal and weakly o‐minimal structures, that every definable partial order on a subset of extends definably in to a total order. This extends the result proved in for and o‐minimal.

To understand the variations in the financial characteristics, we examine the dynamical behaviors by considering the chaotic financial model with external force. First, the dynamical characteristics are analyzed by introducing the external driven force in the price index with commodity demand. We discover that the presence of an external force causes the alternate occurrence of oscillatory and steady states as a function of time. Interestingly, we find the existence of bifurcation delay during the transition from oscillatory to steady state or (...) vice versa. Bifurcation delay is a phenomenon in which the bifurcation does not occur at the actual bifurcation point but rather at a later time, which is referred to as bifurcation delay. To confirm the delay in bifurcation, we estimate the actual bifurcation point and compare it to the observed bifurcation transition. Furthermore, to understand the variations in the bifurcation delay, we estimate the delay time between each consecutive cycle and find random fluctuations in the BD. Following that, the BD is virtualized via a transformed phase portrait. In addition, we show decreasing the value of average BD while increasing the frequency of external forcing. Second, the presence of BD is explored by incorporating external forces into the investment demand with unit investment cost. We discover the existence of a similar phenomenon with a constant bifurcation delay. (shrink)

A proper elementary extension of a model is called small if it realizes no new types over any finite set in the base model. We answer a question of Marker, and show that it is possible to have an o-minimal structure with a maximal small extension. Our construction yields such a structure for any cardinality. We show that in some cases, notably when the base structure is countable, the maximal small extension has maximal possible cardinality.

Dynamical analysis, chaos suppression and electronic implementation of the synchronous reluctance motor without external inputs are investigated in this paper. The different dynamical behaviors found in the SynRM without external inputs are illustrated in the two parameters largest Lyapunov exponent diagrams, one parameter bifurcation diagram, and phase portraits. The three single controllers are designed to suppress the chaotic behaviors found in SynRM without external inputs. The three proposed single controllers are simple and easy to implement. Numerical simulation results show that (...) the three proposed single controllers are effective. Finally, the dynamical behaviors found in the SynRM without external inputs and the physical feasibility of the three proposed single controllers are validated through circuit implementation on OrCAD-PSpice software. (shrink)

We prove that a function definable with parameters in an o-minimal structure is bounded away from ∞ as its argument goes to ∞ by a function definable without parameters, and that this new function can be chosen independently of the parameters in the original function. This generalizes a result in [1]. Moreover, this remains true if the argument is taken to approach any element of the structure , and the function has limit any element of the structure.

The nature of the relationship between environmental performance and firm performance of corporations is a long standing and contentious issue in the literature. This study is intended to advance this debate by arguing for the existence of curvilinear relationship and empirically testing the same using survey data on UK manufacturing firms. FP is captured in terms of growth in sales and market share. Our results show evidence for a quadratic relationship—as firms improve their EP, they seem to achieve much higher (...) levels of FP. These results are consistent with the resource-based view of a firm; as firms engage in EP activities, they are able to gain inimitable knowledge that helps in further learning to further improve performance. Based on our results, we suggest that new studies focus on strategies to extend the period of increasing returns and maximizing the benefits of the positive association between EP and FP. (shrink)