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Purpose – This is a case study paper. A major research goal of this study is to extend the existing theories of learning organization put forth in the 4I model by adding more complicated ideas to it. One minor goal of this research is to show that the first stage of organizational learning, "intuiting", is the hardest to implement when starting a learning organization. Particular attention should be paid to this step, and with the addition of adult learning theory, the possibility of facing a negative situation should be reduced. A second less important goal is to explain how to assess organizational learning, and how the flow of single- and double-loop learning takes place within a learning organization. Design/methodology/approach – This study adopted a combination of qualitative and quantitative survey methods to study the effectiveness of the new mode of transformational activity practiced in Firm A. Findings – Statistical evidence showed that the practice was successful. It solved the issue that expertise and top managers mostly protest against learning. Originality/value – This paper brings a new and more adaptive perspective for building a learning organization upon existing organizational learning theories. Through this case study, the integration and transformation from tacit knowledge to explicit knowledge, intuition to institution (the 4i model), and individual level to organizational level are illustrated. The practices of single-loop and double-loop learning are also well depicted by this study. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether insulin resistance and beta-cell dysfunction are both related to diabetic retinopathy (DR) in type II diabetics by using a community-based study in Kinmen, Taiwan. Methods: A screening program for DR was performed by a panel of ophthalmologists who used ophthalmoscopy and 45° color retinal photographs on dilated pupils to determine a consensus grade of diabetic retinopathy. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type II diabetes. The Homeostatis Model Assessment (HOMA) method was used to determine insulin resistance and beta-cell dysfunction. Results: Seven hundred twenty-five diabetics who attended ophthalmological fundus checkups were studied. The overall response rate was 75%. After excluding 10 insulin-treated diabetics, diabetic retinopathy at first eye screening among the remaining 715 diabetics was 18.5%. Based on the multiple logistic regression, DR was found to be strongly related to both baseline insulin resistance (IR) and beta-cell dysfunction regardless of duration of diabetes. The strength of the relationships was maintained after adjustment for confounders. Those who were in the 2nd, 3rd, and 4th quartile of HOMA IR had 1.38 times (95% CI: 0.62-3.05), 2.37 times (95% CI: 1.19-4.69), and 4.16 times (95% CI: 2.15-8.06) the risk for DR compared to that in the 1st quartile, respectively. A reduced risk for DR in relation to HOMA beta-cell dysfunction for the 2nd, 3rd, and 4th quartile were 64% (95% CI: 27%-82%), 82% (95% CI: 58%-92%), and 82% (95% CI: 60%-92%) compared to that in the 1st quartile, respectively. Conclusions: Insulin resistance and beta-cell dysfunction are both associated with diabetic retinopathy in type II diabetes. [ABSTRACT FROM AUTHOR]

In the context of global advocacy for sustainable development, how to reduce the consumption of resources through sustainable use of goods is an important issue. Although people can get what they need through the exchange of second-hand goods, the pre- and perceptual processes that trigger the willingness to exchange need to be clarified. This study found that perceived depreciation leads to a decrease in exchange reference prices and perceived transaction costs, while product scarcity increases exchange reference prices and perceived transaction costs. Second, the exchange reference prices and psychological premiums help to increase the traders' willingness to exchange. Finally, when barterers have higher perceived transaction costs, they are more likely to engage in exchanges without being affected by transaction costs. However, for traders in platform industry, it is necessary to provide commodity information to meet the needs of the barter, and to provide a product scarcity identification mechanism to help the barter to set the transaction reference price. Moreover, it is necessary to provide a communication platform for both parties to further determine the value of the goods, so as to facilitate the exchange of goods between the two parties. (The research findings are based on the conclusions of this paper). • Perceived depreciation results in reduced exchange reference prices and perceived transaction costs. • Perceived depreciation has a different effect on psychological premium. • Product rarity increases exchange reference prices and perceived transaction costs. • Reference prices impacts on consumer's willingness to exchange second-hand commodities. • Psychological premium impacts on consumer's willingness to exchange second-hand commodities. • High perceived transaction costs enhance barterers engage in exchange behavior. [ABSTRACT FROM AUTHOR]

Purpose: To explore the natural course of diabetic retinopathy among type 2 diabetics using the indirect ophthalmoscope and single-field fundus photographs in Kinmen, Taiwan. Methods: A screening program for diabetic retinopathy was carried out by a panel of ophthalmologists, who employed the ophthalmoscope and 45-degree retinal color photographs to examine the fundus after pupil dilation. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type 2 diabetes. A multi-state Markov model was used to assess the natural course of diabetic retinopathy among type 2 diabetics. Results: Among the 725 diabetes patients who attended at least two ophthalmological fundus check-ups and were screened, the overall response rate was about 75%. The mean duration of the disease states mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy were 4.05 [95% confidence interval (CI): 3.28–5.32], 4.18 (95% CI: 3.18–6.06), 2.52 (95% CI: 1.78–4.27), and 4.22 (95% CI: 2.88–7.81) years, respectively. Compared to controls, the incidence of blindness reduction for annual, biennial, 3-year, 4-year, and 5-year screenings of diabetic retinopathy were approximately 94.4% (95% CI: 91.6%–96.3%), 83.9% (95% CI: 83.6%–84.2%), 70.2% (95% CI: 69.8%–70.7%), 57.2% (95% CI: 56.7%–57.7%), and 45.6% (95% CI: 45.0%–46.1%), respectively. Conclusions: In conclusion, the average time for the development of diabetic retinopathy from nonexistence to blindness was approximately 26.5 years. The present recommendation for annual screening in type 2 diabetics with nonproliferative diabetic retinopathy should be retained only for the mild form, not for the moderate or severe forms. [ABSTRACT FROM AUTHOR]