bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovations in financing of agri-food value chains in China and India
Authors: Chen Kevin Z , Joshi Pramod K , Cheng Enjiang , Birthal Pratap S
Published: November 2015

Purpose

– The purpose of this paper is to synthesize lessons from the agricultural value chain models and their associated financing mechanisms in China and India as to provide policy recommendations on how best to facilitate development of efficient and inclusive value chains.

Design/methodology/approach

– The paper builds on a review of the existing literature on agricultural value chains and their financing mechanisms, and draws lessons from it for strengthening interface between product and financial markets in order to enable smallholders capture benefits of the value addition.

Findings

– From the comparative review of value chain financing mechanisms and current policy contexts the authors find dominance of internal financing of value chains (in terms of provision of inputs, technology and services) in both the countries. Value chain finance from commercial banks and other financial institutions is limited and mainly through tripartite agreements among the financing institutions, lead firms and farmers.

Practical implications

– The lessons drawn from various value chain models and their financing mechanisms provide feedback to financial institutions and policymakers to take measures to strengthen value chain finance in smallholder agriculture.

Originality/value

– The paper undertakes a rigorous review of the existing value chain models and their financing mechanisms in light of the most recent research on emerging innovations and development strategies, in order to glean key lessons for policy recommendations on strengthening linkages between financial and product markets.
A comparative analysis of agricultural research and extension reforms in China and India
Authors: Babu Suresh Chandra , Huang Jikun , Venkatesh P. , Zhang Yumei
Published: November 2015

Purpose

– There is growing interest from the global development community in the role of agricultural research and extension (AR & E) systems to achieve development targets. Despite this interest, many smallholders in developing countries continue to lack access to updated agricultural information and reliable services. In an effort to increase the effectiveness, impact, and reach of AR & E programs, many governments have attempted to reform their national systems. The paper aims to discuss these issues.

Design/methodology/approach

– This paper systematically compares the systems and reforms of AR & E in China and India in order to draw out lessons applicable to developing countries. This paper first reviews the existing literature on AR & E systems and their role in agricultural and economic development. The authors then provide a detailed review and comparative analysis of the reforms and approaches implemented in the AR & E systems of China and India. The authors apply this comparative analysis to draw out lessons that can be applied to inform the reformation of AR & E systems in developing countries.

Findings

– The authors find that although both countries face similar agricultural development challenges, each took a different approach in the reformation of AR & E to address these challenges. Each country’s approaches had different impacts on the effectiveness of the system. Lessons from the reformation of the AR & E systems in China and India can be used to inform and improve the impact of AR & E in developing countries.

Originality/value

– The paper examines two systems together using a set of common indicators and factors. The paper’s value comes from its usefulness in informing future AR & E reforms in other developing countries in order to increase the impact of these reforms on development outcomes.
Linkages between poverty, food security and undernutrition: evidence from China and India
Authors: de Brauw Alan , Suryanarayana MH
Published: November 2015

Purpose

– China and India are two of the fastest growing economies in the world, and poverty reduction has been substantial in both countries through the past few decades. Yet they have very different profiles in terms of food security and undernutrition – while at the micro-level China has performed well in terms of undernutrition, India has not. The purpose of this paper is to examine linkages between poverty, food security, and undernutrition in both countries.

Design/methodology/approach

– In this paper, the authors discuss the linkages between poverty, food security, and undernutrition at the micro level, describe the literature, and make inferences for targeting the remaining poor, food insecure, or undernourished in both countries.

Findings

– In China, there is a need for better tools for targeting the poor or malnourished. In India, more effective state-level policies should be better understood by the central government and disseminated to less successful states.

Originality/value

– In this paper, the authors describe data sources on poverty, food security, and undernutrition in both China and India, and correlates with changes in all three. The authors try to understand what factors appear to lead to reductions in all three, pointing out data gaps in both countries.
Integrating knowledge and aerospace
Authors: Foo Check Teck , Wu Weiwei , Yu Bo
Published: November 2015

Purpose

– The purpose of this paper is to answer the question “will China overtake the USA in the space race?” This paper reviews China’s recent progress in aerospace while developing a wind theory of change to underline the geographic spread of various empires over the past thousand years, a topic studied by one of China’s most prestigious historians, Sima Qian, with a specific interest in 2,500 years of the rise and fall of Chinese kingdoms. Based on the wind theory, China is geared to overtake the USA in the twenty-first century space race. Historically, Chinese have always been fascinated with outer space, and it is felt by many Chinese that the USA, despite its current lead in the field, should work with China to explore outer space.

Design/methodology/approach

– This paper introduces the philosophy and methodology of Sima Qian for Chinese management, in particular his analytical approach and drawing of lessons from past cases (dynasties) for managing the future which can be considered clearly reminiscent of the Harvard case approach. Evolving from this broad study of patterns by Sima Qian, a wind theory methodology is suggested using an overview of patterns over vast stretches of time, in this case from the Tang dynasty. Etymological analyses are embarked upon to illustrate how the ancient Chinese were interested in learning more about the outer space. Conceptual models are developed to map the current nascent space industry.

Findings

– After outlining the current developments made by China in aerospace, the overall analysis suggests the following: based on the wind theory of change, China will overtake the USA even in race into space. Given their historical fascination with outer space, Chinese are likely to enter the business of space at the opportune time. When will that be? Most likely when appropriate technologies have been developed, in particular developing safe moon tours for tourists.

Practical implications

– Suggests a futuristic look at the space industry that China can enter the market at the opportune time. With their long-term fascination with outer space, China may potentially be the largest market for those in space business.

Originality/value

– Introduces a new idea of looking into the future possibilities as embedded in the wind theory of change: the geographical patterns in the rise and fall of empires. If this pattern holds, China will overtake the USA including in the race for outer space. For the first time, this paper draws the relevance of Sima Qian’s analytical, case-based methods for management.
Yes Bank: bringing sustainability in agriculture through Public-Private Partnerships (PPPs)
Authors: Jaisinghani Dinesh , Tandon Deepak
Published: November 2015

Structured abstract

Subject Area: Strategy – dealing with a particular type of strategic alliance (Public Private Partnership) as a strategy to enter a new business segment.

Study level/applicability

MBA and other similar programs at the postgraduation level.

Case overview

The current case deals with Yes Bank, one of the largest private sector banks in India. The main objective of the case is to help the students to understand the banking industry, and the structure and implementation of Public–Private Partnership (PPP) at a large Indian Bank. The case also intends to highlight the cost and revenue drivers for a particular industry. Yes Bank is contemplating entering into the Indian Agricultural financing sector that has huge potential. The case describes how to analyze the sector using Porter's five force model. Also, there are several modes of entering the sector, including joint-ventures, mergers, direct investments and PPPs. The case describes the benefits and issues associated with each of the mentioned strategies. Further, the case also describes the challenges and benefits of PPPs as a mode of generating growth opportunities.

Expected learning outcomes

The case can be a part of a banking course as well as a strategy course. The current case allows the students to make decisions while dealing with situations pertaining to sustainable development and implementation of PPPs. The major expected learning outcomes of the current case are: to be able to understand industry structure, using the banking sector as an example; to be able to list down the revenue and cost drivers for Indian banks; to be able to identify investment drivers for a particular industry, such as agriculture; to be able to analyze the agricultural financing industry using the Porter's five force model; to be able to analyze different modes of entering a new sector and the challenges associated with each one of them; and to be able to comprehend the role of PPPs in entering new areas of business.

Supplementary materials

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.
Critical design characteristics for online retail stores in India
Authors: Prakash Gyan , Sahney Sangeeta , Kavdia Divyan
Published: November 2015

Subject area

E-commerce.

Study level/applicability

The case study is specific to the marketing demographics of online Indian shoppers and therefore, the inter-relationship between certain customer requirements and design elements and the relative importance of items in the latter may not follow the same pattern elsewhere.

Case overview

At a time when e-commerce is booming in India and when online retailers are posting multifold year-on-year growth, it becomes increasingly important to identify the factors pertaining to online stores which can influence the buying behavior of consumers. This case aims to explore such factors relevant to businesses as well as consumers so as to enable the next generation of leaders in online retail business to gain maximally. It deals with critical design characteristics of online retail stores in India which can prove crucial to their success. These characteristics are manifestations of various customer requirements. Two surveys are conducted to establish a hierarchy of design elements and quantify the inter-relationships between customer requirements and design characteristics. This is followed by leads as to which factors may or may not have contributed toward the declining sales volume of an e-commerce start-up, namely, E-Bazaar.

Expected learning outcomes

The learning objectives of the case include: the study of design characteristics with respect to their relative importance; the analysis of the degree of relationships between the design characteristics and customer requirements; and the interpretation of real-life signs in taking strategic business decisions in the field of e-commerce. The case aims to prepare a new breed of leaders in the e-commerce sector with a good level of relevant business acumen to help them make informed strategic choices.

Supplementary materials

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.
Strategizing business in times of crisis: the story of Sarawak layered cake
Authors: Latip Hamrila A. , Md Yusoff Irma Yazreen , Hanapi Sapiee
Published: November 2015

Subject area

Management, business studies, entrepreneurship, public relations or communications.

Study level/applicability

This case study is suitable for certificate, diploma and degree programmes in management, business studies, entrepreneurship, public relations or communications.

Case overview

In this case study, there are three issues related to the halal controversy with the Sarawak layered cake that aimed at business competitiveness, namely, business perseverance during turbulent times; creativity and innovation for business growth; and expansion strategy. The halal controversy of an imported butter affected Di Wannie's business to a great extent. The “Imported X” butter was then declared to be halal after further investigation by the Islamic Advisory Committee, but the business impacts from the controversy took longer to vanish.

Expected learning outcomes

By the end of the discussion, students should have a clear concept of the various elements that constituted Di Wannie's business strategies, as well as the elements that constituted a Sarawak layered-cake industry strategy. Students should realize that the business model for a cake and pastry company is more complex because it not only involves building competency in cake production and marketing but also involves continuous innovation in recipe and baking process development, experimentation, sensitivity and ethical consumerism.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.
SADRAG: NGOs with organizational growth challenges
Authors: Awasthy Richa
Published: November 2015

Subject area

Management – NGOs and organizational growth challenges.

Study level/applicability

Undergraduate/MBA – The case can be used in an executive MBA or management development program (especially for the development sector) to discuss the importance of design in the successful transition from one phase to another in an organization.

Case overview

Social and Development Research and Action Group (SADRAG) incepted in 2004 as a registered not-for-profit organization. It was started by Dr Mala Bhandari. In 2014, Dr Bhandari estimated that SADRAG would have to expand to 7-10 employees in the Noida office and 6-8 employees in the new center in North India by the end of 2014, to manage the portfolio of projects envisaged at this time. Dr Bhandari's major challenge was how to manage the organization and meet its growing needs, and she felt burdened and stressed due to multiple demands on her due to internal issues and external interactions. People looked to her for guidance and directions. Because of the growing pressure, Bhandari decided to get an assessment done for her organization's growing needs.

Expected learning outcomes

To appreciate the challenges faced by non-governmental organizations (NGOs) in India. To diagnose the stage of organizational growth of SADRAG using Greiner's model of organizational growth. To appreciate the issues and problems faced by NGOs as organizations.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.
Tata Wiron: branding galvanized wires
Authors: Bhangale Vijay Pundalik , Dhuri Maithili Prashant
Published: November 2015

Subject area

Marketing.

Study level/applicability

MBA Marketing Class.

Case overview

The case describes the transition of a “Galvanized Wires Business of Tata Steel” into a unique identity, the'Tata Wiron' brand. It focuses on key stages in this journey, including “Understanding the Customers in Galvanized Wires Business”, “Value Chain”, “Challenges Faced”, “Need for Branding”, “Market Segmentation”, “Competition”, “Process of Branding”, “Differentiation”, “Distribution & Sales” and “Promotion”. Tata Steel Wires Business is a major player in the steel wire industry, servicing the discerning needs of its customers across global markets and the leading producer of steel wires in India. A wealth of experience and expertise in the wire industry coupled with latest technology incorporations has enabled Tata Steel Wires Division to constantly meet the most exacting specifications and requirements of its customers. It manufactures a wide range of wires catering to the needs of various industry segments, such as automobile, infrastructure, power and general engineering. The products are well established across the markets of Europe, the USA, Middle East Asia, Australasia, South Asia and Asia and the Far East.

Expected learning outcomes

The expected learning outcomes are as follows: understanding how in-depth analysis of the competition and value chain establishes the need for branding in a commodity market; understanding how consumer insights help in market segmentation and targeting; and building a brand in commodity market.

Supplementary materials

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.
School inclusion for children with mental health difficulties
Authors: Holttum Sue
Published: November 2015

Purpose

– The purpose of this paper is to highlight research on the exclusion from school of children with disabilities, and especially those identified as experiencing emotional disturbance. Two studies of schools that are inclusive are then described in order to examine how they achieve good results.

Design/methodology/approach

– Three papers are summarized. The first examines things that predict children with disabilities being excluded from school, including characteristics of children and of schools. The second is a qualitative study of four English schools involved in a national programme aimed at improving children’s mental health. The third is a case study of one American school identified for its high inclusivity and excellent educational results.

Findings

– In the first study, children with emotional disturbance, and African-American children were most likely to be excluded from school. The study of four English schools suggested that implementation of the national programme was variable but leadership and planning seemed vital, as well as whole-school commitment. The high-performing inclusive American school had whole-school commitment, high quality planning alongside flexibility, on-going further training for teachers, and close pupil tracking.

Originality/value

– The study of school exclusion was the first to examine children and schools together, as well as different disabilities and ethnicity. The study of English schools highlights the experiences of those directly involved in implementing a national programme to promote children’s mental health. The study of a high-performing inclusive school in America discovered much in common with inclusive high-performing schools in England, suggesting that some practices can be identified across the two cultures that aid successful inclusion of children with disabilities including mental health difficulties.
Remarkable lives: Christopher Fox in conversation with Jerome Carson
Authors: Fox Christopher , Carson Jerome
Published: November 2015

Purpose

– The purpose of the paper is to provide a profile of Christopher Fox.

Design/methodology/approach

– Christopher provides a short biographical account of his life thus far. He is then interviewed by Jerome. He describes how he has coped with serious depression.

Findings

– Christopher claims that he owes his own life to two things, Philosophy and his close friend Helena.

Research limitations/implications

– The wide diversity of first person accounts shows the necessity of collecting them as they reflect the lived experience of people battling with serious mental health problems. The personal is often lost in the quantitative world of p values and statistical tests.

Practical implications

– Christopher mentions being helped by numerous informal chats with peers rather than medication and focused psychological therapies.

Social implications

– While Christopher drew much sustenance from the works of Nietzsche, he was most helped by a friend who had been his learning mentor at school. Friendship can be critical in maintaining hope.

Originality/value

– Like many before him, Christopher says he “learnt more about himself in the days where I sat in the garden (with peer survivors) than in the collective sessions of therapy, CBT or hospital visits”.
Reforming Labour: The Leadership of Jeremy Corbyn
Authors: Crines Andrew S.
Published: November 2015

Jeremy Corbyn's election as leader has shaken Labour to its core. Yet the Party's current divisions should not be surprising given its historical origins. Meanwhile, the new leader has an opportunity to fashion an interpretation of socialism for the 21st century, writes Andrew Crines.
Europe's Migration Crisis
Authors: Hampshire James
Published: November 2015

There has been a huge increase in the numbers of migrants seeking refuge in Europe. James Hampshire examines the development of a humanitarian and a political crisis within the European Union and assesses the chances of a long-term solution.
Radicalism or Retreat? The Conservative Party under Cameron
Authors: McEnhill Libby
Published: November 2015

A decade into his leadership has David Cameron fundamentally changed the Conservative Party, or has he simply re-framed Thatcherism for the 21st century? Libby McEnhill investigates.
Countering Twenty-First Century Terrorism
Authors: English Richard
Published: November 2015

It is time that politicians recognised that minimising the threat from groups such as Islamic State and the new IRA is far more realistic than pretending terrorism can be completely defeated, writes Richard English.
Greece's Ongoing Tragedy
Authors: Gerodimos Roman
Published: November 2015

From Syriza's two election victories to the seemingly endless negotiations with the international community, Greece has rarely been out of the headlines in 2015. Roman Gerodimos looks back on another turbulent year in Greek politics.
Rubidium marking reveals different patterns of movement in four ground beetle species (Col., Carabidae) between adjacent alfalfa and maize
Authors: Madeira Filipe , Pons Xavier
Published: November 2015

In the north‐east Iberian Peninsula, in summer, arable crop landscapes are characterized by a mosaic of alfalfa and maize. Although carabids are among the main predators in both crops, crop management can affect their movement.

The main aim of the present study was to measure the movement of the four most abundant carabid species (Calathus fuscipes, Poecilus cupreus, Bembidion lampros and Pseudoophonus rufipes) between adjacent alfalfa and maize before and after alfalfa cutting, using rubidium as a marker. Movement of predators into the herbaceous margin between alfalfa and maize was also assessed.

The four carabid species showed bidirectional movements between crops, although the pattern of movement differed between species and was affected by alfalfa cutting. After cutting, the movement of C. fuscipes, P. cupreus and P. rufipes from alfalfa towards maize was higher than in the opposite direction. Bembidion lampros showed a greater degree of movement towards alfalfa than in the opposite direction before cutting and only moved to the margin after cutting.

Maize and herbaceous field margins can therefore act as both refuge and donor habitat for carabids, and can help to recolonize alfalfa after cuttings. Growing maize near alfalfa and providing an intercrop refuge habitat may conserve and enhance carabid populations.
Radiotherapy in well‐differentiated thyroid cancer: is it underutilized?
Authors: So Kevin , Smith Robin E. , Davis Sidney R.
Published: November 2015

Background

The usual management of thyroid cancer is surgery and radioactive iodine. The role of external beam radiotherapy (EBRT) in well‐differentiated thyroid carcinoma remains controversial. Indications for the use of EBRT, contained within both the American and British Thyroid Association published guidelines, include unresectable or non‐iodine avid disease, extra‐thyroidal extension or distant metastatic disease.

Methods

A retrospective review of prospectively collected data from a single Australian institution was conducted, analysing patients referred and treated with EBRT for well‐differentiated thyroid carcinoma between November 1992 and July 2013.

Results

Of 36 patients referred, 32 were treated with EBRT. Sixteen patients in total received locoregional treatment (six radical, 10 palliative), of whom 81% (13/16) had gross disease and 88% (14/16) had recurrent disease (eight with multiple recurrences). Additionally, 63% (10/16) had multiple surgical resections and 50% (8/16) had previously received multiple courses of radioactive iodine. Overall, 67% (4/6) of patients treated with radical intent had no locoregional recurrence or progression. Thirteen of the 16 patients who received locoregional EBRT remained asymptomatic from their locoregional disease at the time of last follow‐up or death. The most commonly treated distant metastatic disease site was bone, with a total of 45 sites irradiated. Of these patients, 93% and 78% were symptom‐free at two and four years, respectively.

Conclusion

Our study suggests that in a select group of patients with well‐differentiated thyroid carcinoma, EBRT treatment appears to provide durable tumour and symptom control.
Myostatin in relation to physical activity and dysglycaemia and its effect on energy metabolism in human skeletal muscle cells
Authors: Hjorth M. , Pourteymour S. , Görgens S. W. , Langleite T. M. , Lee S. , Holen T. , Gulseth H. L. , Birkeland K. I. , Jensen J. , Drevon C. A. , Norheim F.
Published: November 2015

Aim

Some health benefits of exercise may be explained by an altered secretion of myokines. Because previous focus has been on upregulated myokines, we screened for downregulated myokines and identified myostatin. We studied the expression of myostatin in relation to exercise and dysglycaemia in skeletal muscle, adipose tissue and plasma. We further examined some effects of myostatin on energy metabolism in primary human muscle cells and Simpson–Golabi–Behmel syndrome (SGBS) adipocytes.

Methods

Sedentary men with or without dysglycaemia underwent a 45‐min acute bicycle test before and after 12 weeks of combined endurance and strength training. Blood samples and biopsies from m. vastus lateralis and adipose tissue were collected.

Results

Myostatin mRNA expression was reduced in skeletal muscle after acute as well as long‐term exercise and was even further downregulated by acute exercise on top of 12‐week training. Furthermore, the expression of myostatin at baseline correlated negatively with insulin sensitivity. Myostatin expression in the adipose tissue increased after 12 weeks of training and correlated positively with insulin sensitivity markers. In cultured muscle cells but not in SGBS cells, myostatin promoted an insulin‐independent increase in glucose uptake. Furthermore, muscle cells incubated with myostatin had an enhanced rate of glucose oxidation and lactate production.

Conclusion

Myostatin was differentially expressed in the muscle and adipose tissue in relation to physical activity and dysglycaemia. Recombinant myostatin increased the consumption of glucose in human skeletal muscle cells, suggesting a complex regulatory role of myostatin in skeletal muscle homeostasis.
Structural Studies of Nicotinic Acetylcholine Receptors: Using Acetylcholine‐Binding Protein as a Structural Surrogate
Authors: Shahsavar Azadeh , Gajhede Michael , Kastrup Jette S. , Balle Thomas
Published: November 2015

Nicotinic acetylcholine receptors (nAChRs) are members of the pentameric ligand‐gated ion channel superfamily that play important roles in the control of neurotransmitter release in the central and peripheral nervous system. These receptors are important therapeutic targets for the development of drugs against a number of mental health disorders and for marketed smoking cessation aids. Unfortunately, drug discovery has been hampered by difficulties in obtaining sufficiently selective compounds. Together with functional complexity of the receptors, this has made it difficult to obtain drugs with sufficiently high‐target to off‐target affinity ratios. The recent and ongoing progress in structural studies holds promise to help understand structure–function relationships of nAChR drugs at the atomic level. This will undoubtedly lead to the design of more efficient drugs with fewer side effects. As a high‐resolution structure of a nAChR is yet to be determined, structural studies are to a large extent based on acetylcholine‐binding proteins (AChBPs) that despite low overall sequence identity display a high degree of conservation of overall structure and amino acids at the ligand‐binding site. Further, AChBPs reproduce relative binding affinities of ligands at nAChRs. Over the past decade, AChBPs have been used extensively as models for nAChRs and have aided the understanding of drug receptor interactions at nAChRs significantly.
Omeprazole and Semen Quality
Authors: Banihani Saleem A.
Published: November 2015

A number of studies have linked omeprazole, a commonly used acid reducer under the brand name Prilosec, with semen quality. This MiniReview systematically addresses and summarizes the effect of omeprazole on semen quality, and male infertility. We searched the MEDLINE electronic database for English‐language articles using the keywords ‘omeprazole’ versus ‘sperm’ and ‘testosterone’ and the references from selected articles were reviewed, if relevant. In summary, omeprazole does not appear to change semen quality. This may be because, at least in part, it does not alter the basal levels of pituitary–gonadal hormones; in addition, it counteracts the damaging effect of reactive oxygen species. However, further research is still required to confirm this effect.
An Empirically Adjusted Approach to Reproductive Number Estimation for Stochastic Compartmental Models: A Case Study of Two Ebola Outbreaks
Authors: Brown Grant D. , Oleson Jacob J. , Porter Aaron T.
Published: November 2015

The various thresholding quantities grouped under the “Basic Reproductive Number” umbrella are often confused, but represent distinct approaches to estimating epidemic spread potential, and address different modeling needs. Here, we contrast several common reproduction measures applied to stochastic compartmental models, and introduce a new quantity dubbed the “empirically adjusted reproductive number” with several advantages. These include: more complete use of the underlying compartmental dynamics than common alternatives, use as a potential diagnostic tool to detect the presence and causes of intensity process underfitting, and the ability to provide timely feedback on disease spread. Conceptual connections between traditional reproduction measures and our approach are explored, and the behavior of our method is examined under simulation. Two illustrative examples are developed: First, the single location applications of our method are established using data from the 1995 Ebola outbreak in the Democratic Republic of the Congo and a traditional stochastic SEIR model. Second, a spatial formulation of this technique is explored in the context of the ongoing Ebola outbreak in West Africa with particular emphasis on potential use in model selection, diagnosis, and the resulting applications to estimation and prediction. Both analyses are placed in the context of a newly developed spatial analogue of the traditional SEIR modeling approach.
Tolerance Bands for Functional Data
Authors: Rathnayake Lasitha N. , Choudhary Pankaj K.
Published: November 2015

Often the object of inference in biomedical applications is a range that brackets a given fraction of individual observations in a population. A classical estimate of this range for univariate measurements is a “tolerance interval.” This article develops its natural extension for functional measurements, a “tolerance band,” and proposes a methodology for constructing its pointwise and simultaneous versions that incorporates both sparse and dense functional data. Assuming that the measurements are observed with noise, the methodology uses functional principal component analysis in a mixed model framework to represent the measurements and employs bootstrapping to approximate the tolerance factors needed for the bands. The proposed bands also account for uncertainty in the principal components decomposition. Simulations show that the methodology has, generally, acceptable performance unless the data are quite sparse and unbalanced, in which case the bands may be somewhat liberal. The methodology is illustrated using two real datasets, a sparse dataset involving CD4 cell counts and a dense dataset involving core body temperatures.
Instrumental variable method for time‐to‐event data using a pseudo‐observation approach
Authors: Kjaersgaard Maiken I. S. , Parner Erik T.
Published: November 2015

Observational studies are often in peril of unmeasured confounding. Instrumental variable analysis is a method for controlling for unmeasured confounding. As yet, theory on instrumental variable analysis of censored time‐to‐event data is scarce. We propose a pseudo‐observation approach to instrumental variable analysis of the survival function, the restricted mean, and the cumulative incidence function in competing risks with right‐censored data using generalized method of moments estimation. For the purpose of illustrating our proposed method, we study antidepressant exposure in pregnancy and risk of autism spectrum disorder in offspring, and the performance of the method is assessed through simulation studies.
Outcomes of unselected patients with metastatic clear‐cell renal cell carcinoma treated with first‐line pazopanib therapy followed by vascular endothelial growth factor receptor tyrosine kinase inhibitors or mammalian target of rapamycin inhibitors: a single institution experience
Authors: Matrana Marc R. , Bathala Tharakeswara , Campbell Matthew T. , Duran Cihan , Shetty Aditya , Teegavarapu Purnima , Kalra Sarathi , Xiao Lianchun , Atkinson Bradley , Corn Paul , Jonasch Eric , Tannir Nizar M.
Published: November 2015

Objective

To explore the efficacy and safety of pazopanib in a ‘real‐world’ setting in unselected patients, as data regarding unselected patients with metastatic clear‐cell renal cell carcinoma (ccRCC) treated with first‐line pazopanib are limited.

Patients and Methods

We reviewed records of patients with metastatic ccRCC treated with first‐line pazopanib from 1 November 2009 through to 1 November 2012. Cox models were fitted to evaluate the association of progression‐free survival (PFS) and overall survival (OS) with patient co‐variables.

Results

In all, 88 patients were identified; 74 were evaluable for response: two (3%) had a complete response, 27 (36%) a partial response, 36 (49%) had stable disease and nine (12%) had progressive disease. The median PFS was 13.7 months [95% confidence interval (CI) 8.7–18.3]. PFS was correlated with a Karnofsky Performance Status score of <80 [hazard ratio (HR) 3.26, P < 0.001] and serum lactate dehydrogenase of >1.5 × upper limit of normal (HR 3.25, P = 0.014). The median OS was 29.1 months (95% CI 20.2–not reached). The OS was correlated with brain metastasis (HR 2.55, P = 0.009), neutrophilia (HR 1.179, P = 0.018), and anaemia (HR 3.51, P < 0.001). There were no treatment‐related deaths. In all, 53 patients received second‐line therapy [vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR‐TKI) in 22 patients, mammalian target of rapamycin inhibitors (mTORi) in 22 patients, and other therapy in nine patients]; the median PFS was 8.6 months (95% CI 3.3–25.7) with VEGFR‐TKI and 5 months (95% CI 3.5–15.2) with mTORi (P = 0.41); the median OS was 19.9 months (95% CI 12.9–not reached) and 14.2 months (95% CI 8.1–not reached), from initiation of second‐line VEGFR‐TKI or mTORi, respectively (P = 0.37).

Conclusions

In this retrospective study, first‐line pazopanib confirmed its efficacy in metastatic ccRCC. Trends for longer PFS and OS were seen with VEGFR‐TKI compared with mTORi after first‐line pazopanib.
Adherent perinephric fat at minimally invasive partial nephrectomy is associated with adverse peri‐operative outcomes and malignant renal histology
Authors: Kocher Neil J. , Kunchala Sudhir , Reynolds Christopher , Lehman Erik , Nie Sarah , Raman Jay D.
Published: November 2015

Objectives

To predict adherent perinephric fat (APF) at minimally invasive partial nephrectomy (MIPN) using the Mayo adhesive probability (MAP) score and to determine the impact of MAP score and APF on MIPN outcomes.

Patients and Methods

A total of 245 patients undergoing MIPN were included in the study. The presence of APF was determined through keywords in operating notes, and radiographic data were obtained from preoperative cross‐sectional imaging. Posterior fat thickness was measured between the renal capsule and the posterior abdominal wall at the level of the renal vein. Perinephric stranding was graded on a 0–3 severity scale.

Results

The study included 123 men and 122 women, with a median age of 55 years, body mass index of 31.7, tumour size of 2.7 cm and nephrometry score of 6. The median posterior fat thickness was 1.79 cm and MAP score 2.63. In all, 26 patients (10.6%) had evidence of APF at the time of renal surgery. Factors predictive of APF included increasing age (P = 0.001), male gender (P = 0.045), perinephric stranding (P = 0.002), posterior fat thickness (P < 0.001) and MAP score (P < 0.001). APF was associated with adverse pathological and peri‐operative outcomes including malignant renal histology (P = 0.04), longer operating time (P = 0.005) and greater estimated blood loss (EBL; P = 0.025).

Conclusions

Specific clinical and radiographic factors predict APF at MIPN. The presence of APF is associated with adverse peri‐operative outcomes including longer operating time and greater EBL. APF was also associated with renal malignancy on final pathology, but further studies are necessary to elucidate the precise underlying mechanism.
JP–HHT phenotype in Danish patients with SMAD4 mutations
Authors: Jelsig A. M. , Tørring P. M. , Kjeldsen A. D. , Qvist N. , Bojesen A. , Jensen U. B. , Andersen M. K. , Gerdes A. M. , Brusgaard K. , Ousager L. B.
Published: November 2015

Patients with germline mutations in SMAD4 can present symptoms of both juvenile polyposis syndrome (JPS) and hereditary hemorrhagic telangiectasia (HHT): the JP‐HHT syndrome. The complete phenotypic picture of this syndrome is only just emerging. We describe the clinical characteristics of 14 patients with SMAD4‐mutations. The study was a retrospective, register‐based study. SMAD4 mutations carriers were identified through the Danish HHT‐registry, the genetic laboratories – and the genetic departments in Denmark. The medical files from relevant departments were reviewed and symptoms of HHT, JPS, aortopathy and family history were noted. We detected 14 patients with SMAD4 mutations. All patients had polyps removed and 11 of 14 fulfilled the diagnostic criteria for JPS. Eight patients were screened for HHT‐symptoms and seven of these fulfilled the Curaçao criteria. One patient had aortic root dilation. Our findings support that SMAD4 mutations carriers have symptoms of both HHT and JPS and that the frequency of PAVM and gastric involvement with polyps is higher than in patients with HHT or JPS not caused by a SMAD4 mutation. Out of eight patients screened for aortopathy, one had aortic root dilatation, highlighting the need for additional screening for aortopathy.
Quality of life questionnaires in otorhinolaryngology: a systematic overview
Authors: Koenraads S.P.C. , Aarts M.C.J. , van der Veen E.L. , Grolman W. , Stegeman I.
Published: November 2015

Background

The importance of quality of life (QOL) as an endpoint and the use of validatedQOLquestionnaires have increased over time.

Objectives

To evaluate health‐related quality of life (HR‐QOL) measurement instruments used in patients in otorhinolaryngology (ORL). We aimed to establish the use ofQOLquestionnaires inORLover a period of time, establish the use ofQOLquestionnaires within different domains and determine the use of validatedQOLquestionnaires.

Main out come measures

We performed a comprehensive search in PubMed up to 1 January 2014. Articles were included that measuredHR‐QOLquestionnaires in clinical practice in children, adolescents or adults in 42 journals ofORL. Multiple uniqueQOLquestionnaires, organised according to domain, time and survey of validation, were extracted from reported articles.

Results

Of 2442 articles, we utilised 1196 publications with a total of 2103QOLquestionnaires regardingORL. We evaluated a variety of 363 uniqueQOLquestionnaires in which 60% (n= 220)QOLquestionnaires had been validated. We found a continuing increase in the amount of articles which usedQOLquestionnaires since the beginning of the 20th century, while the percentage of validatedQOLquestionnaires remained the same (76%). MostQOLquestionnaires were used in the domains oncology (35%), otology (21%) and rhinology (20%). The domain otology had the largest amount of uniqueQOLquestionnaires (n= 122).

Conclusions

We identified and evaluated all uniqueHR‐QOLquestionnaires utilised in patients inORL. Recently, the use of validated and non‐validatedHR‐QOLquestionnaires has increased within all domains ofORL. The assessment ofQOLhas become an important outcome measure in clinical practice, in medical research and for healthcare organisations.
Evaluation of an 18‐month commercial multidisciplinary obesity treatment programme
Authors: Aller E. E. J. G. , van Baak M. A.
Published: November 2015

The treatment of obesity is an often studied subject. Although reductions in weight and improvements in cardiometabolic risk factors are important aims of obesity treatment, improvements in quality of life and eating behaviour are also relevant outcomes. In this practice‐based study, we evaluated an 18‐month commercial multidisciplinary obesity treatment programme and report on treatment results for weight, cardiometabolic risk factors, eating behaviour and quality of life. From a local commercial obesity treatment centre, 426 subjects (65% female; 45.4 ± 12.2 years; body mass index 40.0 ± 6.6 kg m−2) were recruited. Measurements of body weight, height, body composition, waist circumference and blood pressure were scheduled at baseline and every 3 months, whereas fasting blood collections were scheduled at baseline and every 6 months. At the same time points, participants were asked to fill in questionnaires on dietary intake, eating behaviour and quality of life. After 18 months of treatment programme, average weight change [mean (95% confidence interval)] was −10.9 kg (−14.8 to −7.0; P < 0.001) for the completers (n = 181) and −10.8 kg (−14.2 to −7.4; P < 0.001) for the intention‐to‐treat population (n = 426). Waist circumference (mean ± standard error of the mean) (−0.13 ± 0.01 cm; P < 0.001), fat mass (−7.8 ± 1.3 kg; P < 0.001) systolic (−11.4 ± 2.0; P < 0.001) and diastolic (−7.0 ± 1.3; P < 0.001) blood pressure, triglycerides (−0.4 ± 0.1; P = 0.004) and plasma glucose (−0.6 ± 0.2; P = 0.001) were significantly reduced. The PCS scale of the SF‐36 and all three scales of the three‐factor eating questionnaire improved significantly over the 18‐month treatment period. All collected data in this study provide evidence that a multidisciplinary treatment programme based on lifestyle modification results in significant weight loss and improvements in cardiometabolic risk factors, quality of life and eating behaviour.
Bilingual enhancements have no socioeconomic boundaries
Authors: Krizman Jennifer , Skoe Erika , Kraus Nina
Published: November 2015

To understand how socioeconomic status (SES) and bilingualism simultaneously operate on cognitive and sensory function, we examined executive control, language skills, and neural processing of sound in adolescents who differed in language experience (i.e. English monolingual or Spanish‐English bilingual) and level of maternal education (a proxy for SES). We hypothesized that experience communicating in two languages provides an enriched linguistic environment that can bolster neural precision in subcortical auditory processing which, in turn, enhances cognitive and linguistic function, regardless of the adolescent's socioeconomic standing. Consistent with this, we report that adolescent bilinguals of both low and high SES demonstrate more stable neural responses, stronger phonemic decoding skills, and heightened executive control, relative to their monolingual peers. These results support the argument that bilingualism can bolster cognitive and neural function in low‐SES children and suggest that strengthened neural response consistency provides a biological mechanism through which these enhancements occur.
Gender‐related differences in elderly patients with myocardial infarction in a European Centre
Authors: Sulzgruber Patrick , Koller Lorenz , Pavo Noemi , El‐Hamid Feras , Rothgerber David‐Jonas , Forster Stefan , Maurer Gerald , Goliasch Georg , Niessner Alexander
Published: November 2015

Background

Weighing the benefit of revascularization procedures against the risk of adverse events is particularly challenging in elderly patients suffering acute myocardial infarction (AMI). Based on a general gender gap in coronary interventions, the restraint in invasive procedures may be particularly high in elderly women. We therefore investigated gender‐related differences in the frequency of coronary interventions as well as gender‐ and age‐specific outcomes after coronary interventions in patients with AMI.

Design

We included 906 AMI patients in the final analysis. Among patients ≥ 80 years (n = 453), the intention to intervention (lysis and/or coronary angiography) for women was significantly lower compared to men (65·7% vs. 80·8%; P < 0·001), whereas in patients < 80 years (n = 453), the rate was similar between both genders (94·8% vs. 95·1%, P = 0·89). However, the assessment of potential risk factors for adverse events did not explain the gender gap. When assessing the benefit of any coronary intervention (stenting and/or lysis and/or coronary artery bypass graft), elderly women benefited at least as much with a hazard ratio (HR) for cardiovascular mortality of 0·56 (95% confidence interval [CI] 0·37–0·84, P = 0·005) compared to a HR of 0·96 (95% CI 0·76–1·23, P = 0·766) in elderly men.

Conclusion

We observed a lower intention to coronary intervention in elderly women compared with men. However, the distribution of risk factors in elderly women and men who did not undergo coronary intervention was similar and therefore seemed not to be causal for the gender gap although the benefit of any coronary interventions was even higher in elderly women.