Non-invasive ventilation for cystic fibrosis.

Non-invasive ventilation may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis. To compare the effect of non-invasive ventilation versus no non-invasive ventilation in people with cystic fibrosis. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials.Most recent search: 22 February 2013. Randomised controlled trials comparing a form of pressure preset or volume preset non-invasive ventilation to no non-invasive ventilation in people with acute or chronic respiratory failure in cystic fibrosis. Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data. Fifteen trials were identified; seven trials met the inclusion criteria with a total of 106 participants. Six trials evaluated single treatment sessions and one evaluated a six-week intervention.Four trials (79 participants) evaluated non-invasive ventilation for airway clearance compared with an alternative chest physiotherapy method and showed that airway clearance may be easier with non-invasive ventilation and people with cystic fibrosis may prefer it. We were unable to find any evidence that NIV increases sputum expectoration, but it did improve some lung function parameters.Three trials (27 participants) evaluated non-invasive ventilation for overnight ventilatory support, measuring lung function, validated quality of life scores and nocturnal transcutaneous carbon dioxide. Due to the small numbers of participants and statistical issues, there were discrepancies in the results between the RevMan and the original trial analyses. No clear differences were found between non-invasive ventilation compared with oxygen or room air except for exercise performance, which significantly improved with non-invasive ventilation compared to room air over six weeks. Non-invasive ventilation may be a useful adjunct to other airway clearance techniques, particularly in people with cystic fibrosis who have difficulty expectorating sputum. Non-invasive ventilation, used in addition to oxygen, may improve gas exchange during sleep to a greater extent than oxygen therapy alone in moderate to severe disease. These benefits of non-invasive ventilation have largely been demonstrated in single treatment sessions with small numbers of participants. The impact of this therapy on pulmonary exacerbations and disease progression remain unclear. There is a need for long-term randomised controlled trials which are adequately powered to determine the clinical effects of non-invasive ventilation in cystic fibrosis airway clearance and exercise.

Waste Not, Want Not: Managing Perishables in Small and Medium Retail Enterprises

Purpose of this paper:
Recent literature indicates that around one third of perishable products finish as waste (Mena et al., 2014): 60% of this waste can be classified as avoidable (EC, 2010) suggesting logistics and operational inefficiencies along the supply chain. In developed countries perishable products are predominantly wasted in wholesale and retail (Gustavsson et al., 2011) due to customer demand uncertainty the errors and delays in the supply chain (Fernie and Sparks, 2014). While research on logistics of large retail supply chains is well documented, research on retail small and medium enterprises’ (SMEs) capabilities to prevent and manage waste of perishable products is in its infancy (c.f. Ellegaard, 2008) and needs further exploration. In our study, we investigate the retail logistics practice of small food retailers, the factors that contribute to perishable products waste and the barriers and opportunities of SMEs in retail logistics to preserve product quality and participate in reverse logistics flows.

Design/methodology/approach:
As research on waste of perishable products for SMEs is scattered, we focus on identifying key variables that contribute to the creation of avoidable waste. Secondly we identify patterns of waste creation at the retail level and its possibilities for value added recovery. We use explorative case studies (Eisenhardt, 1989) and compare four SMEs and one large retailer that operate in a developed market. To get insights into specificities of SMEs that affect retail logistics practice, we select two types of food retailers: specialised (e.g. greengrocers and bakers) and general (e.g. convenience store that sells perishable products as a part of the assortment)

Findings:
Our preliminary findings indicate that there is a difference between large retailers and SME retailers in factors that contribute to the waste creation, as well as opportunities for value added recovery of products. While more factors appear to affect waste creation and management at large retailers, a small number of specific factors appears to affect SMEs. Similarly, large retailers utilise a range of practices to reduce risks of product perishability and short shelf life, manage demand, and manage reverse logistics practices. Retail SMEs on the other hand have limited options to address waste creation and value added recovery. However, our findings show that specialist SMEs could successfully minimize waste and even create possibilities for value added recovery of perishable products. Data indicates that business orientation of the SME, the buyersupplier relationship, and an extent of adoption of lean principles in retail coupled with SME resources, product specific regulations and support from local authorities for waste management or partnerships with other organizations determine extent of successful preservation of a product quality and value added recovery.

Value:
Our contribution to the SCM academic literature is threefold: first, we identify major factors that contribute to the generation waste of perishable products in retail environment; second, we identify possibilities for value added recovery for perishable products and third, we present opportunities and challenges for SME retailers to manage or participate in activities of value added recovery. Our findings contribute to theory by filling a gap in the literature that considers product quality preservation and value added recovery in the context of retail logistics and SMEs.

Research limitations/implications:
Our findings are limited to insights from five case studies of retail companies that operate within a developed market. To improve on generalisability, we intend to increase the number of cases and include data obtained from the suppliers and organizations involved in reverse logistics flows (e.g. local authorities, charities, etc.).

Practical implications:
With this paper, we contribute to the improvement of retail logistics and operations in SMEs which constitute over 99% of business activities in UK (Rhodes, 2015). Our findings will help retail managers and owners to better understand the possibilities for value added recovery, investigate a range of logistics and retail strategies suitable for the specificities of SME environment and, ultimately, improve their profitability and sustainability.

MMSET deregulation affects cell cycle progression and adhesion regulons in t(4;14) myeloma plasma cells

BackgroundThe recurrent immunoglobulin translocation, t(4;14)(p16;q32) occurs in 15% of multiple myeloma patients and is associated with poor prognosis, through an unknown mechanism. The t(4;14) up-regulates fibroblast growth factor receptor 3 (FGFR3) and multiple myeloma SET domain (MMSET) genes. The involvement of MMSET in the pathogenesis of t(4;14) multiple myeloma and the mechanism or genes deregulated by MMSET upregulation are still unclear.Design and MethodsThe expression of MMSET was analyzed using a novel antibody. The involvement of MMSET in t(4;14) myelomagenesis was assessed by small interfering RNA mediated knockdown combined with several biological assays. In addition, the differential gene expression of MMSET-induced knockdown was analyzed with expression microarrays. MMSET gene targets in primary patient material was analyzed by expression microarrays.ResultsWe found that MMSET isoforms are expressed in multiple myeloma cell lines, being exclusively up-regulated in t(4;14)-positive cells. Suppression of MMSET expression affected cell proliferation by both decreasing cell viability and cell cycle progression of cells with the t(4;14) translocation. These findings were associated with reduced expression of genes involved in the regulation of cell cycle progression (e.g. CCND2, CCNG1, BRCA1, AURKA and CHEK1), apoptosis (CASP1, CASP4 and FOXO3A) and cell adhesion (ADAM9 and DSG2). Furthermore, we identified genes involved in the latter processes that were differentially expressed in t(4;14) multiple myeloma patient samples.ConclusionsIn conclusion, dysregulation of MMSET affects the expression of several genes involved in the regulation of cell cycle progression, cell adhesion and survival.