Type 2 diabetes:assessing the relative risks and benefits of glucose-lowering medications

The selection of appropriate pharmacologic therapy for any disease requires a careful assessment of benefit and risk. In the case of type 2 diabetes, this decision typically balances the benefits accrued from improved glycemic control with the risks inherent in glucose-lowering medications. This review is intended to assist therapeutic decision-making by carefully assessing the potential benefit from improved metabolic control relative to the potential risks of a wide array of currently prescribed glucose-lowering agents. Wherever possible, risks and benefits have been expressed in terms of absolute rates (events per 1000 patient-years) to facilitate cross-study comparisons. The review incorporates data from new studies (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation, Action to Control Cardiovascular Risk in Diabetes, and the Veterans Affairs Diabetes Trial), as well as safety issues associated with newer glucose-lowering medications. © 2010 Elsevier Inc. All rights reserved.

Capital markets and the market structure of foreign investments

Contrary to the long-received theory of FDI, interest rates or rates of return can motivate foreign direct investment (FDI) in concert with the benefits of direct ownership. Thus, access to investor capital and capital markets is a vital component of the multinational’s competitive market structure. Moreover, multinationals can use their superior financial capacity as a competitive advantage in exploiting FDI opportunities in dynamic markets. They can also mitigate higher levels of foreign business risks under dynamic conditions by shifting more financial risk to creditors in the host economy. Furthermore, the investor’s expectation of foreign business risk necessarily commands a risk premium for exposing their equity to foreign market risk. Multinationals can modify the profit maximization strategy of their foreign subsidiaries to maximize growth or profits to generate this risk premium. In this context, we investigate how foreign subsidiaries manage their capital funding, business risk, and profit strategies with a diverse sample of 8,000 matched parents and foreign subsidiary accounts from multiple industries in 38 countries.We find that interest rates, asset prices, and expectations in capital markets have a significant effect on the capital movements of foreign subsidiaries. We also find that foreign subsidiaries mitigate their exposure to foreign business risk by modifying their capital structure and debt maturity. Further, we show how the operating strategy of foreign subsidiaries affects their preference for growth or profit maximization. We further show that superior shareholder value, which is a vital link for access to capital for funding foreign expansion in open market economies, is achieved through maintaining stability in the rate of growth and good asset utilization.

Workers' understanding of chemical risks: electroplating case study

BACKGROUND: There is limited research concerning how small companies in particular, respond to health and safety messages. AIMS: To understand individuals' knowledge and beliefs about chemical risks and to compare these with those of experts. METHODS: The use of chromic acid in particular, and also other chemicals associated with chrome plating were studied. All chromium plating firms were based in the West Midlands. The methodology involved initial face to face interviews (n = 21) with chromium platers, structured questionnaires (n = 84) to test the prevalence of beliefs identified in the interviews, an expert questionnaire, and a workshop to discuss findings. The responses of platers were compared with those of occupational health and safety experts. RESULTS: Although chromium platers appeared to understand the short term adverse effects of the chemicals to which they are exposed, their understanding of long term, or chronic effects appeared to be incomplete. They had good knowledge of acute effects based primarily on experience. Platers were aware of the hazardous nature of the chemicals with which they work, but did not draw distinction between the terms "hazards" and "risks". They had difficulties articulating the effects of the chemicals and how exposure might occur; although it is inappropriate to equate this with lack of knowledge. A significant minority of platers displayed deficiencies in understanding key technical terms used in Safety Data Sheets. CONCLUSIONS: This study provides a method which can be used to gain some understanding of workers' knowledge and beliefs about risks that they are exposed to in the workplace. The study also identifies gaps between the platers' knowledge and beliefs and those of experts. New risk information needs to be designed which addresses the information needs of platers using language that they understand.

Technology transfer to developing countries : the case of physical asset management in South Africa

This research investigates technology transfer (TT) to developing countries, with specific reference to South Africa. Particular attention is paid to physical asset management, which includes the maintenance of plant, equipment and facilities. The research is case based, comprising a main case study (the South African electricity utility, Eskom) and four mini-cases. A five level framework adapted from Salami and Reavill (1997) is used as the methodological basis for the formulation of the research questions. This deals with technology selection, and management issues including implementation and maintenance and evaluation and modifications. The findings suggest the Salami and Reavill (1997) framework is a useful guide for TT. The case organisations did not introduce technology for strategic advantage, but to achieve operational efficiencies through cost reduction, higher quality and the ability to meet customer demand. Acquirers favour standardised technologies with which they are familiar. Cost-benefit evaluations have limited use in technology acquisition decisions. Users rely on supplier expertise to compensate for poor education and technical training in South Africa. The impact of political and economic factors is more evident in Eskom than in the mini-cases. Physical asset management follows traditional preventive maintenance practices, with limited use of new maintenance management thinking. Few modifications of the technology or R&D innovations take place. Little use is made of explicit knowledge from computerised maintenance management systems. Low operating and maintenance skills are not conducive to the transfer of high-technology equipment. South African organisations acquire technology as items of plant, equipment and systems, but limited transfer of technology takes place. This suggests that operators and maintainers frequently do not understand the underlying technology, and like workers elsewhere, are not always inclined towards adopting technology in the workplace.

Social and scientific issues in the acceptibility of radiation risks

Ionising radiation hazards are perhaps the most documented and regulated occupational and environmental hazard. In the radiological protection field a single expert advisory organisation has had an unusually large influence on the international standard setting process. This is the International Commission on Radiological Protection (ICRP). Two common, and opposing views, exist over the formulation of protection recommendations by the ICRP. The first, and most widely accepted, is that its recommendations are scientifically determined. The second view, is that its recommendations are politically or socially determined. Neither of these analyses adequately accounts for the complex process in which protection recommendations are formulated. A third view, provided by studies of the origins of scientific controversy, suggests that both science and social factors are important in the assessment and limitation of risk. The aim of this thesis is not simply to examine the origin of controversy. Issues of equal, if not more, importance are the resolution of controversy, the formation of consensus and the maintenance of expert authority and influence. These issues form the central focus of this thesis. The aim is to assess the process through which the ICRP formulates its radiological protection recommendations and comment on the extent that these are influenced by the affiliations of its members. This thesis concludes that the ICRP's recommendations have been shaped by a complex relationship of scientific and social considerations, in which a socio-technical commitment to nuclear energy has played a key role. The Commission has responded to new scientific data by making complex changes to its philosophy and methods of describing risk. Where reductions in numerical limits have been applied they have been accompanied by practical measures designed to limit the impact of the change and provide continuity with the old limits and flexibility in the application of the new recommendations.

Mathematical modelling of patient risks in a hospital environment, using multiple regression analysis

The aim of this research work was primarily to examine the relevance of patient parameters, ward structures, procedures and practices, in respect of the potential hazards of wound cross-infection and nasal colonisation with multiple resistant strains of Staphylococcus aureus, which it is thought might provide a useful indication of a patient's general susceptibility to wound infection. Information from a large cross-sectional survey involving 12,000 patients from some 41 hospitals and 375 wards was collected over a five-year period from 1967-72, and its validity checked before any subsequent analysis was carried out. Many environmental factors and procedures which had previously been thought (but never conclusively proved) to have an influence on wound infection or nasal colonisation rates, were assessed, and subsequently dismissed as not being significant, provided that the standard of the current range of practices and procedures is maintained and not allowed to deteriorate. Retrospective analysis revealed that the probability of wound infection was influenced by the patient's age, duration of pre-operative hospitalisation, sex, type of wound, presence and type of drain, number of patients in ward, and other special risk factors, whilst nasal colonisation was found to be influenced by the patient's age, total duration of hospitalisation, sex, antibiotics, proportion of occupied beds in the ward, average distance between bed centres and special risk factors. A multi-variate regression analysis technique was used to develop statistical models, consisting of variable patient and environmental factors which were found to have a significant influence on the risks pertaining to wound infection and nasal colonisation. A relationship between wound infection and nasal colonisation was then established and this led to the development of a more advanced model for predicting wound infections, taking advantage of the additional knowledge of the patient's state of nasal colonisation prior to operation.

Accountability, organisational learning and risks to patient safety in England: conflict or compromise?

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Imam-Sadeque v Bluebay Asset Management 2012

Case law report - online

Risks and benefits of selective (re)presentation of interviewees' talk:some insights from discourse analysis

Purpose: The purpose of this paper is to examine the quality of evidence collected during interview. Current UK national guidance on the interviewing of victims and witnesses recommends a phased approach, allowing the interviewee to deliver their free report before any questioning takes place, and stipulating that during this free report the interviewee should not be interrupted. Interviewers, therefore, often find it necessary during questioning to reactivate parts of the interviewee's free report for further elaboration. Design/methodology/approach: The first section of this paper draws on a collection of police interviews with women reporting rape, and discusses one method by which this is achieved - the indirect quotation of the interviewee by the interviewer - exploring the potential implications for the quality of evidence collected during this type of interview. The second section of the paper draws on the same data set and concerns itself with a particular method by which information provided by an interviewee has its meaning "fixed" by the interviewer. Findings: It is found that "formulating" is a recurrent practice arising from the need to clarify elements of the account for the benefit of what is termed the "overhearing audience" - in this context, the police scribe, CPS, and potentially the Court. Since the means by which this "fixing" is achieved necessarily involves the foregrounding of elements of the account deemed to be particularly salient at the expense of other elements which may be entirely deleted, formulations are rarely entirely neutral. Their production, therefore, has the potential to exert undue interviewer influence over the negotiated "final version" of interviewees' accounts. Originality/value: The paper highlights the fact that accurate re-presentations of interviewees' accounts are a crucial tool in ensuring smooth progression of interviews and that re-stated speech and formulation often have implications for the quality of evidence collected during significant witness interviews. © Emerald Group Publishing Limited.

Perceived risks in cross-border transactions in agri-food chains

Nowadays, agri-food chains are more global than ever and are characterized by increased imports and exports and global sourcing of products, resulting in increased cross-border transaction risks. The objective of this paper is to identify the typical risks regarding agri-food supply chains involved in cross-border transactions and to assess their importance as perceived by agri-food managers. The analysis takes into consideration four different agrifood value chains (meat, grain, olive oil, fresh vegetables and fruits). Following an explorative approach and a qualitative technique, a series of face to face in-depth interviews was conducted. Results indicate that risk perception may be quite different across countries, value chains, tiers of the supply chain, as well as across respondents. The prevalence of Market dynamics risks was pointed out in most of the interviews, yielding the impression that many operators identify the market as the most difficult environment. Differences in risk perception between fresh produce (fruit/vegetables and meat) and processed food chains (grain and olive oil) are probably interrelated to the different degree of integration within these supply chains, the different level of standardization achieved and the different causes of risks that are inherent to the nature of the product.

Innovation and policy networks:the social shaping of BSE-related technologies and the inadequate assessmant of related risks

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR CONSULTATION

Capital and asset structures and their influence on the performance of Egyptian nationalised industries:an application of financial statement analysis and survey

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Intellectual property asset management:how to identify, protect, manage and exploit intellectual property within the business environment

In the new ‘knowledge-intensive economies’ Intellectual assets increasingly play a key part on balance sheets. There is an increasing global awareness that in order to promote innovation and the growth of the economy, businesses must fully recognise and exploit their intellectual assets. A company’s ability to innovate rapidly and successfully is now regarded as essential and most breakthroughs are made by Small and Medium-sized Enterprises (SMEs), usually with no in-house legal professionals to help them. It is essential that those working with or creating intellectual property rights (IPR) are aware of the basics of Intellectual Property Law. Intellectual Property Asset Management provides business and management students at all levels with an accessible-straight-forward explanation of what the main Intellectual Property rights are and how these rights are protected. Locating the subject squarely in a business context and using case studies and examples throughout drawn from a wide range of business organisations, it explains how an organisation can exploit their rights through licensing, franchising and other means in order to make the best possible use of their IP assets. This book will provide students with: • the basic Intellectual Property law knowledge needed to identify a potential IP issue • the tools and understanding to assess an IP breach • the ability to identify where the problem cannot be solved in house and where expert legal assistance is required • the knowledge required to work effectively with lawyers and other legal professionals to achieve the desired outcome