Purpose – This paper aims to focus on two main and related issues: evaluating whether the required entrepreneurial capabilities are present according to Gladwell’s law of the few in the Western Negev region of Israel and identifying the economic development model that can generate a viral development. Design/methodology/approach – In this paper, McClelland’s classification was used to evaluate the level of motivation in the region and Gladwell’s law of the few classification was used to understand the potentially positive effect of each entrepreneur on the others and on economic development in general. To evaluate the personal and business capabilities of each entrepreneur, two groups of parameters, one describing the personal profile and the other describing the business behavior of the entrepreneurs, were used. Findings – Most entrepreneurs are ready to cooperate with the open incubator and to contribute to generating common business interest, but mavens and connectors have few of the required personal characteristics and business attitudes. Only the salesmen have the required personal profile, but they lack the necessary business attitude. Highly motivated entrepreneurs, at need-for-power level, have both the required personal profile and business attitude. They are the ones who could generate growth, and a portion of them have the characteristics to become mavens, connectors and salesmen. Practical implications – The willingness to cooperate with a neutral organization and generate common economic interest is present in the Western Negev, but the following actions are required to achieve viral development: persuade and support entrepreneurs at the highest level of motivation to be a part of the few, i.e. mavens, connectors and salesmen; improve the business attitude of mavens, connectors and salesmen; and plan the work program of the open incubator in cooperation with entrepreneurs at the need-for-power level: mavens, connectors and salesmen. Originality/value – Viral economic development can occur if the few mavens, connectors and salesmen in a given sector or region have the required positive personal profile and business attitude, and if most of the entrepreneurs are ready to cooperate with a neutral organization, the open incubator and join efforts with others to generate new common business interests.

Opioid consumption by countries and health care organizations can be regarded as a marker of the quality of pain management. However, there are only limited data on opioid consumption in hospital settings. Objective and reliable data can be obtained by monitoring direct opioid consumption within a hospital, and then that data can be analyzed for identifying trends and directions to assist in guiding improved pain treatment within the hospital. This article tracks opioid consumption in a tertiary hospital over an 8-year period and by comparing the data to the consumption during the previous decade, it highlights trends and tendencies in the use of opioids as a potential indicator of pain management within this facility.

Purpose: Pancreatic ductal adenocarcinoma (PDAC) is remarkably resistant to standard modalities, including radiotherapy (RT). The mechanisms of radiation resistance in general, and pancreatic cancer in particular, are poorly understood. We hypothesized that metabolic reprogramming may underlie this radioresistance, and moreover, that it would be possible to exploit these changes in metabolism for therapeutic intent. Experimental Design: We established multiple isogenic models of radioresistant PDAC cells. Metabolic profile was investigated using Nanostring technology, labeled-glucose tracing by liquid chromatography-mass spectrometry, Seahorse analysis and exposure to metabolic inhibitors. Patient-derived xenografts (PDXs) were established from patients treated with radiation and RNA sequencing performed. The PDXs were grouped according to clinical RECIST response to radiation (responsive/stable disease vs disease progression) and differential gene expression analysis was performed. Results: The radioresistant cells overexpressed pyruvate dehydrogenase kinase (PDK) and were radiosensitized by the PDK inhibitor dichloroacetate. In keeping with PDK overexpression, radioresistant cells displayed increased glycolysis and downregulated both the tricarboxylic acid cycle and oxidative phosphorylation. Metabolic flux through the pentose-phosphate pathway (PPP) was increased, as were levels of reduced glutathione; PPP inhibition dramatically potentiated radiation-induced cell death. Critically, the PPP was upregulated in PDXs derived from patients who demonstrated clinical resistance to radiotherapy. High transcription levels of 6PGD, the rate-limiting enzyme of the PPP, were associated with a poor radiological response to radiation therapy (p=0.0004) and a lower overall survival (p=0.004). Conclusions: We demonstrate that radioresistant PDAC cells divert the glycolytic flux from the tricarboxylic acid cycle and oxidative phosphorylation to the PPP, thereby increasing their antioxidant capacity and promoting nucleotide synthesis for DNA repair. Furthermore, we show that PDAC cells can be radiosensitized via PPP inhibition. Exploitation of metabolic vulnerabilities to radiosensitize tumors constitutes a novel approach to pancreatic cancer with a real potential to improve clinical outcomes. Citation Format: Ariel Shimoni-Sebag, Ifat Abramovich, Bella Agranovich, Yaarit Sirovsky, Chani Stossel, Dikla Atias, Maria Raitses-Gurevich, Yulia Glick-Gorman, Ofer Margalit, David Regev, Rotem Tal, Itay Tirosh, Talia Golan, Keren Yizhak, Eyal Gottlieb, Yaacov R. Lawrence. The pentose-phosphate pathway induces pancreatic cancer radioresistance, a preclinical study with clinical validation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2411.

Our research is focused on two main and related issues: evaluate whether the required entrepreneurial capabilities are present in the region, and how the open incubator model, a hybrid model between the Incubator and Industrial District models, must proceed in order to generate a "clusterization process." The three of the McClelland entrepreneurial levels are ready to invest in their own businesses and to cooperate with other businesses. The need for power level is even ready to seek external sources of financing. Connectors are strongly entrepreneurial, ready to take risks, and to follow new trends in business. Mavens are not ready to share their business knowhow with other businesses within the framework of a common organization. Salesmen belong to the family care entrepreneurial level and are ready to take risks in order to improve entrepreneurship in family businesses.