Elevated serum free light chains predict cardiovascular events in type 2 diabetes

OBJECTIVE: Elevated polyclonal serum immunoglobulin free light chains (FLCs; combined FLCκ+FLCλ [cFLC]) are associated with adverse clinical outcomes and increased mortality; we investigated cFLC and cardiovascular disease (CVD) events in type 2 diabetes. RESEARCH DESIGN AND METHODS: In a cohort study of 352 south Asian patients with type 2 diabetes, serum cFLC, high-sensitivity C-reactive protein (hsCRP), and standard biochemistry were measured. CVD events over 2 years were recorded and assessed usingmultiple logistic regression. RESULTS: cFLC levels were elevated significantly in 29 of 352 (8%) patients with CVD events during 2 years of follow-up (50.7 vs. 42.8mg/L; P = 0.004). Inmultivariate analysis, elevated cFLC (>57.2 mg/L) was associated with CVD outcomes (odds ratio 3.3 [95% CI 1.3-8.2]; P = 0.012) and remained significant after adjusting for age, albumin-to-creatinine ratio, diabetes duration, or treatment. CONCLUSIONS: cFLC elevation is a novel marker for CVD outcomes in type 2 diabetes that warrants further investigation. © 2014 by the American Diabetes Association.

Extreme weather events and construction SMEs:vulnerability, impacts and responses

Purpose – The UK experienced a number of Extreme Weather Events (EWEs) during recent years and a significant number of businesses were affected as a result. With the intensity and frequency of weather extremes predicted in the future, enhancing the resilience of businesses, especially of Small and Medium-sized Enterprises (SMEs), who are considered as highly vulnerable, has become a necessity. However, little research has been undertaken on how construction SMEs respond to the risk of EWEs. In seeking to help address this dearth of research, this investigation sought to identify how construction SMEs were being affected by EWEs and the coping strategies being used. Design/methodology/approach – A mixed methods research design was adopted to elicit information from construction SMEs, involving a questionnaire survey and case study approach. Findings – Results indicate a lack of coping strategies among the construction SMEs studied. Where the coping strategies have been implemented, these were found to be extensions of their existing risk management strategies rather than radical measures specifically addressing EWEs. Research limitations/implications – The exploratory survey focused on the Greater London area and was limited to a relatively small sample size. This limitation is overcome by conducting detailed case studies utilising two SMEs whose projects were located in EWE prone localities. The mixed method research design adopted benefits the research by presenting more robust findings. Practical implications – A better way of integrating the potential of EWEs into the initial project planning stage is required by the SMEs. This could possibly be achieved through a better risk assessment model supported by better EWE prediction data. Originality/value – The paper provides an original contribution towards the overarching agenda of resilience of SMEs and policy making in the area of EWE risk management. It informs both policy makers and practitioners on issues of planning and preparedness against EWEs.

The implementation of supply chain management theory in practice:an empirical investigation

Purpose: The purpose of the research described in this paper is to disentangle the rhetoric from the reality in relation to supply chain management (SCM) adoption in practice. There is significant evidence of a divergence between theory and practice in the field of SCM. Design/methodology/approach: Based on a review of extant theory, the authors posit a new definitional construct for SCM – the Four Fundamentals – and investigated four research questions (RQs) that emerged from the theoretical review. The empirical work comprised three main phases: focussed interviews, focus groups and a questionnaire survey. Each phase used the authors’ definitional construct as its basis. While the context of the paper’s empirical work is Ireland, the insights and results are generalisable to other geographical contexts. Findings: The data collected during the various stages of the empirical research supported the essence of the definitional construct and allowed it to be further developed and refined. In addition, the findings suggest that, while levels of SCM understanding are generally quite high, there is room for improvement in relation to how this understanding is translated into practice. Research limitations/implications: Expansion of the research design to incorporate case studies, grounded theory and action research has the potential to generate new SCM theory that builds on the Four Fundamentals construct, thus facilitating a deeper and richer understanding of SCM phenomena. The use of longitudinal studies would enable a barometer of progress to be developed over time. Practical implications: The authors’ definitional construct supports improvement in the cohesion of SCM practices, thereby promoting the effective implementation of supply chain strategies. A number of critical success factors and/or barriers to implementation of SCM theory in practice are identified, as are a number of practical measures that could be implemented at policy/supply chain/firm level to improve the level of effective SCM adoption. Originality/value: The authors’ robust definitional construct supports a more cohesive approach to the development of a unified theory of SCM. In addition to a profile of SCM understanding and adoption by firms in Ireland, the related critical success factors and/or inhibitors to success, as well as possible interventions, are identified.

The efficacy and safety of imeglimin as add-on therapy in patients with type 2 diabetes inadequately controlled with sitagliptin monotherapy

OBJECTIVE: This 12-week study assessed the efficacy and tolerability of imeglimin as add-on therapy to the dipeptidyl peptidase-4 inhibitor sitagliptin in patients with type 2 diabetes inadequately controlled with sitagliptin monotherapy. RESEARCH DESIGN AND METHODS: In a multicenter, randomized, double-blind, placebo-controlled, parallel-group study, imeglimin (1,500 mg b.i.d.) or placebo was added to sitagliptin (100 mg q.d.) over 12weeks in 170 patientswith type 2 diabetes (mean age 56.8 years; BMI 32.2 kg/m2) that was inadequately controlled with sitagliptin alone (A1C ≥7.5%) during a 12-week run-in period. The primary ef ficacy end point was the change in A1C from baseline versus placebo; secondary end points included corresponding changes in fasting plasma glucose (FPG) levels, strati fication by baseline A1C, and percentage of A1C responders. RESULTS: Imeglimin reduced A1C levels (least-squares mean difference) from baseline (8.5%) by 0.60% compared with an increase of 0.12% with placebo (between-group difference 0.72%, P < 0.001). The corresponding changes in FPG were -0.93 mmol/L with imeglimin vs. -0.11 mmol/L with placebo (P = 0.014). With imeglimin, the A1C level decreased by ≥0.5% in 54.3% of subjects vs. 21.6% with placebo (P < 0.001), and 19.8%of subjects receiving imeglimin achieved a decrease in A1C level of ≤7% compared with subjects receiving placebo (1.1%) (P = 0.004). Imeglimin was generally well tolerated, with a safety pro file comparable to placebo and no related treatment-emergent adverse events. CONCLUSIONS: Imeglimin demonstrated incremental efficacy benefits as add-on therapy to sitagliptin, with comparable tolerability to placebo, highlighting the potential for imeglimin to complement other oral antihyperglycemic therapies. © 2014 by the American Diabetes Association.

Does anticholinergics drug burden relate to global neuro-disability outcome measures and length of hospital stay?

Primary objective: To assess the relationship between disability, length of stay (LOS) and anticholinergic burden (ACB) with people following acquired brain or spinal cord injury. Research design: A retrospective case note review assessed total rehabilitation unit admission. Methods and procedures: Assessment of 52 consecutive patients with acquired brain/spinal injury and neuropathy in an in-patient neuro-rehabilitation unit of a UK university hospital. Data analysed included: Northwick Park Dependency Score (NPDS), Rehabilitation complexity Scale (RCS), Functional Independence Measure and Functional Assessment Measure FIM-FAM (UK version 2.2), LOS and ACB. Outcome was different in RCS, NPDS and FIM-FAM between admission and discharge. Main outcomes and results: A positive change was reported in ACB results in a positive change in NPDS, with no significant effect on FIM-FAM, either Motor or Cognitive, or on the RCS. Change in ACB correlated to the length of hospital stay (regression correlation = −6.64; SE = 3.89). There was a significant harmful impact of increase in ACB score during hospital stay, from low to high ACB on NPDS (OR = 9.65; 95% CI = 1.36–68.64) and FIM-FAM Total scores (OR = 0.03; 95% CI = 0.002–0.35). Conclusions: There was a statistically significant correlation of ACB and neuro-disability measures and LOS amongst this patient cohort.

The role of wisdom in organisational leadership

This thesis begins with a review of the literature on wisdom models, theories of wise leadership, and existing wisdom measures. It continues with a review of how the concept of wisdom may add value to existing leadership models, highlighting the need to empirically identify the characteristics of wise leaders and develop a wise leadership measure. A nomological framework for wise leadership is then presented. Based on a review of the wisdom and leadership paradigms, a mixed-methods research design is described for three studies to define the characteristics of wise leadership in organisations; identify specific leadership challenges that might require wise responses; and to develop the wise leadership measure comprising of vignettes. The first study involves critical incident interviews with 26 nominated wise leaders and 23 of their nominators, which led to the identification of nine wise leadership dimensions which include Strong Ethical Code, Strong Judgement, Optimising Positive Outcomes, Managing Uncertainty, Strong Legacy, Leading with Purpose, Humanity, Humility, and Self-Awareness. The second study includes critical incident interviews with 20 leaders about organisational challenges associated with the nine dimensions, to elucidate the wise leadership measure. The third study includes the design of 45 vignettes based on organisational challenges that measure the nine wise leadership dimensions. The measure is then administered to 250 organisational leaders to establish its construct validity, leading to the selection of 18 vignettes forming the final wise leadership measure. Theoretical, methodological and practical implications of this research are then discussed with recommendations for future research.

Antecedents and consequences of percieved effective managerial coaching:an individual, team-level and cross-level examination

The major contribution of the study is the identification of a positive link between perceived effective managerial coaching (PEMC) and team task performance and also, the examination of PEMC adopting a multilevel research design and incorporating dual-source data. Specifically, drawing on social psychology, the thesis aims at developing and testing a comprehensive conceptual framework of the antecedents and consequences of PEMC for knowledge workers. The model takes into consideration intrapersonal, interpersonal and team-level characteristics, which relate to PEMC and, subsequently associate with important work outcomes. In this regard, the thesis identifies PEMC as a practice of dual nature in that it may be experienced not only as a one-on-one workplace developmental interaction, but also as a managerial practice that is experienced by each member of a team for co-ordination purposes. Adopting a cross-sectional survey research design, the hypotheses are tested in three organisations in Greece and the UK. In particular, hierarchical linear modelling of 191 employees nested in 60 teams yields that employees’ learning goal orientation (LGO) and high-quality exchanges between an employee and a manager (LMX) are positively related to effective MC, while a manager’s LGO moderates the relationship between employees’ LGO and PEMC. In turn, PEMC, as a one-on-one practice, is related to cognitive outcomes, such as information sharing, while as a shared team practice is related also to behavioural outcomes, including individual and team performance. Overall, the study contributes to a growing body of coaching and management literature that acknowledges PEMC as a core managerial practice.

Disaster risk reduction infrastructure requirements for South-Western Bangladesh:perspectives of local communities

Purpose: Development of effective disaster risk reduction (DRR) strategies for communities at risk of being affected by natural disasters is considered essential, especially in the wake of devastating disaster events reported worldwide. As part of a wider research study investigating community perspectives on existing and potential strategies for enhancing resilience to natural disasters, community perspectives on infrastructure and structural protection requirements were investigated. The paper aims to discuss these issues. Design/methodology/approach: Patuakhali region in South-Western Bangladesh is a region significantly at risk of multiple natural hazards. In order to engage local communities and obtain their perspectives, focus group discussions were held with local community leaders and policy makers of at-risk communities in Patuakhali region, South-Western Bangladesh. Findings: Infrastructure and structural protection requirements highlighted included multi-purpose cyclone shelters, permanent embankments and improved transport infrastructure. Much of the discussions of focus group interviews were focused on cyclone shelters and embankments, suggesting their critical importance in reducing disaster risk and also dependence of coastal communities on those two measures. Originality/value: The research design adopted sought to answer the research questions raised and also to inform local policy makers on community perspectives. Local policy makers involved in DRR initiatives in the region were informed of community perspectives and requirements, thus contributing to community engagement in implementing DRR activities.

West Midlands English:Birmingham and the Black Country

This chapter provides an overview, discussing firstly the boundaries of the West Midlands area today within which Birmingham and the Black Country are situated, taking account of how they have changed across time. It includes a section on the demographic make-up of the region across time, before moving on to consider issues relating to language, culture and identity in section 1.5 on the theoretical underpinnings of the research upon which much of this book is based, particularly in relation to Chapters 2, 3 and 4 is also included. Section 1.6 then considers issues relating to research design, and the different methodologies adopted in research design and data collection and analysis by three separate projects which inform the chapters of this book. The Geographical Limits of the west Midlands: Where does it begin and where does it end? The Local Government Boundary Commission for England (2010: http://www.lgbce.org.uk/) gives the geographical range of the west Midlands as the five counties of Herefordshire, Shropshire, Staffordshire, Warwickshire and Worcestershire. The boundaries of these five shire counties date back to at least the twelfth century, being ancient subdivisions established by the Normans for administration purposes after the 1066 conquest. The shire counties were, in most cases, based on earlier Anglo-Saxon divisions. In 1974, as a result of population density concentrated in parts of the shire counties, a sixth county, that of the West Midlands, was carved out from parts of the three shire counties of Staffordshire, Warwickshire and Worcestershire.

Making mole-hills out of mountains:Peer Mentoring in Engineering education - A case-study

Based on the emergent findings of a pilot study which examined the issues around introducing Peer Mentoring into an Engineering School, this paper, which is very much a 'work in progress', describes and discusses results from the first year of what will be a three year exploratory study. Focusing on three distinctive concepts integral to the student experience, Relationships, Variety and Synergy, the study follows an Action Research Design in that it aims to find a realistic and workable solution to issues of attrition within the Engineering School in which the Project and Study are set. Starting with the research question "Does Peer Mentoring improve engineering students' transition into university?"', the Pilot Project and Study will run for three years, each year building on the lessons of the previous year.

Determinants of Firm Growth with respect to Exporting and Innovation Activities: Evidence from Egyptian SMEs

Small and medium-sized enterprises (SMEs) are considered to be the driving engine for employment growth, source of innovation and technological progress. Moreover, the success of small exporters is critical for economic growth and is considered as an important development stage for many SMEs. However, their competitive advantage lies within the firm’s ability to innovate. This thesis contributes to the above literature by examining two main factors believed to promote firm growth namely ‘exporting’ and ‘innovation’ activities. Growing interests on the relationship between exporting, innovation and growth have recently been tackled. However, there remains a gap in literature on the relationship between exporting, innovation and firm growth for SMEs in emerging economies. Previous studies are conducted in developed counties such as UK, Ireland, USA, Germany, and Switzerland, which leaves the gap for those developing countries. Thus, this thesis addresses the gap by examining the importance of innovation and exporting activities in the growth of SMEs in Egypt. It is also the researcher’s intent to recognise the unique contribution of innovation on firm exporting activities covering all sectors. gypt, one of the countries that were tremendously affected by the so-called ‘Arab Spring revolution’, is suffering from slow economic growth, high unemployment and poverty rate. Thus, the government must ensure economic growth and job creation. Programmes to encourage and develop SMEs should be part of inclusive growth strategy. Meanwhile, exporting is regarded as a key factor to help the economy recover from recession and stimulate economic growth. On the other hand, innovation leads to better performance in terms of growth, exporting and productivity. Therefore, SMEs and their exporting and innovation activities should be an integral part of any recovery and growth strategy for the economy. Moreover, Egypt is suffering from the so-called ‘Missing Middle’, which is problematic as medium firms tend to provide better employment growth and productivity. Therefore, more light is to shed on the importance of exporting and innovation in the growth of firms. The research design was quantitative in nature, testing the proposed hypotheses. The study was conducted in 2013 based on questionnaires of 406 Egyptians SMEs. The results of the empirical study suggest that both exporting and innovation activities are important in firm growth. However, the results show that, after controlling for endogeneity, innovation does not affect exporting activities in SMEs.

Determinants of firm growth with repect to exporting and innovation activities:evidence from Egyptian SMEs

Small and medium-sized enterprises (SMEs) are considered to be the driving engine for employment growth, source of innovation and technological progress. Moreover, the success of small exporters is critical for economic growth and is considered as an important development stage for many SMEs. However, their competitive advantage lies within the firm’s ability to innovate. This thesis contributes to the above literature by examining two main factors believed to promote firm growth namely ‘exporting’ and ‘innovation’ activities. Growing interests on the relationship between exporting, innovation and growth have recently been tackled. However, there remains a gap in literature on the relationship between exporting, innovation and firm growth for SMEs in emerging economies. Previous studies are conducted in developed counties such as UK, Ireland, USA, Germany, and Switzerland, which leaves the gap for those developing countries. Thus, this thesis addresses the gap by examining the importance of innovation and exporting activities in the growth of SMEs in Egypt. It is also the researcher’s intent to recognise the unique contribution of innovation on firm exporting activities covering all sectors. Egypt, one of the countries that were tremendously affected by the so-called ‘Arab Spring revolution’, is suffering from slow economic growth, high unemployment and poverty rate. Thus, the government must ensure economic growth and job creation. Programmes to encourage and develop SMEs should be part of inclusive growth strategy. Meanwhile, exporting is regarded as a key factor to help the economy recover from recession and stimulate economic growth. On the other hand, innovation leads to better performance in terms of growth, exporting and productivity. Therefore, SMEs and their exporting and innovation activities should be an integral part of any recovery and growth strategy for the economy. Moreover, Egypt is suffering from the so-called ‘Missing Middle’, which is problematic as medium firms tend to provide better employment growth and productivity. Therefore, more light is to shed on the importance of exporting and innovation in the growth of firms. The research design was quantitative in nature, testing the proposed hypotheses. The study was conducted in 2013 based on questionnaires of 406 Egyptians SMEs. The results of the empirical study suggest that both exporting and innovation activities are important in firm growth. However, the results show that, after controlling for endogeneity, innovation does not affect exporting activities in SMEs.

Implementation of supply chain management theory in practice:a questionnaire survey in the United Kingdom

Purpose: The purpose of the research described in this paper is to disentangle the rhetoric from the reality in relation to supply chain management (SCM) adoption in practice. There is significant evidence of a divergence between theory and practice in the field of SCM. Research Approach: The authors’ review of the extant SCM literature highlighted a lack of replication studies in SCM, leading to the concept of refined replication being developed. The authors conducted a refined replication of the work of Sweeney et al. (2015) where a new SCM definitional construct – the Four Fundamentals – was proposed. The work presented in this article refines the previous study but adopts the same three-phase approach: focussed interviews, a questionnaire survey, and focus groups. This article covers the second phase of the refined replication study and describes an integrated research design of a questionnaire research to be undertaken in Britain. Findings and Originality: The article presents an integrated research design of a questionnaire research with emphases on the refined replication of previous work of Sweeney et al. (2015) carried out in Ireland and adapting it to the British context. Research Impact: The authors introduce the concept of refined replication in SCM research. This allows previous research to be built upon in order to test understanding of SCM theory and its practical implementation - based on the Four Fundamentals construct - among SCM professionals in Britain. Practical Impact: The article presents the integrated research design of a questionnaire research that may be used in similar studies.