A medical management of interstitial ectopic pregnancy: A 5-year clinical study

Background: Medical treatment of the rare interstitial ectopic pregnancy with methotrexate has been considered an alternative to surgical resection. Aim: To determine the treatment success rate with a single-dose intravenous methotrexate/folinic acid regimen and to identify predictors of treatment outcome. Methods: A 5-year audit (April 2000-August 2005) was carried out, collecting clinical imaging data and serum beta-human chorionic gonadotrophin (beta-hCG). Time taken for complete beta-hCG resolution was recorded, and a negative beta-hCG result was used as an endpoint of successful outcome. Results: Of the 13 cases, two required urgent surgery for rupture on presentation. In the remaining 11 cases, intravenous methotrexate (300 mg) was used, with oral folinic acid rescue (15 mg x 4 doses). There were no side-effects. Complete beta-hCG resolution was achieved in 10 of the 11 medically treated cases (91% success rate), requiring 21-129 days. Successful outcome was seen with initial beta-hCG level as high as 106 634 IU/L and gestation sac as large as 6 cm and a live fetus. Conclusion: The methotrexate/folinic acid regimen used as a one-dose treatment is safe and effective for unruptured interstitial pregnancy, with no side-effects and the advantage of avoiding invasive surgery. Subsequent tubal patency and reproductive function are yet to be ascertained.

An investigation into the similarities and differences governing the cryopreservation success of koala (Phascolarctos cinereus: goldfuss) and common wombat (Vombatus ursinus: shaw) spermatozoa

The aim of this study was to determine the relative cryopreservation success of koala and wombat spermatozoa and to investigate reasons for their respective post-thaw survival by examining the sperm's response to a range of osmotic media and determining the presence and distribution of F-actin. An hypothesis was proposed that F-actin may be imparting a degree of structural inflexibility to the koala sperm plasma membrane; hence, exposure of spermatozoa to cytochalasin D (5 mu M), a F-actin depolymerisation agent, should result in increased plasticisation of the membrane and greater tolerance of cell volume changes that typically occur during cryopreservation. In experiment 1, koala (n = 4) and wombat (n = 4) spermatozoa packaged in 0.25 mL straws were cryopreserved using two freezing rates (fast-3 cm above liquid N2 interface; slow-6 degrees C/min in a freezing chamber) and two glycerol concentrations (8 and 14% v/v) in a tris-citrate glucose buffer with 15% (v/v) egg yolk. Wombat spermatozoa showed better (P < 0.01) post-thaw survival (% motile, % intact plasma membranes, % decondensed sperm heads) than koala spermatozoa. When exposed to media of varying osmolality, koala spermatozoa were less tolerant (% intact plasma membrane) of hyper-osmotic conditions (920 and 1410mOsmol/kg) than wombat spermatozoa. F-actin was localised using a monoclonal antibody but only found in the wombat sperm head. When koala and wombat spermatozoa were exposed to media of varying osmolality, cytochalasin D had no beneficial effect on sperm survival (% intact plasma membranes). This study has demonstrated that wombat spermatozoa are highly tolerant of cryopreservation when compared to koala sperm but that spermatozoa from both species show greatest post-thaw survival when frozen slowly in 14% glycerol. Koala sperm are also particularly susceptible to hyper-osmotic environments but lack of detectable F-actin in the koala spermatozoan suggests that poor cryopreservation success in this species is unlikely to be associated with F-actin induced plasma membrane inflexibility. (c) 2006 Elsevier Inc. All rights reserved.

Factors affecting female reproductive success and the survival of pouch young in the threatened brush-tailed rock-wallaby, Petrogale penicillata

Knowledge of factors affecting the survival of individuals and their reproductive success is essential for threatened species management, but studies assessing these factors are lacking for many threatened rock-wallaby species. In this study we investigated the factors influencing the breeding performance of females and the survival of pouch young in a wild colony of the threatened brush-tailed rock-wallaby. Individuals were trapped between October 2000 and April 2004. More than 50% of the females in the colony were breeding below their full potential and giving birth to only one offspring per year. Most females within the colony bred in synchrony, with a substantial birth peak evident during autumn. Pouch young born in autumn left the pouch during spring and were weaned during summer and autumn when forage was most abundant. Pouch young born during the autumn birth peak or in winter had a substantially higher probability of surviving through to pouch emergence than those born during spring or summer. This study provides demographic parameters that may be used in population models and for comparison with other populations, particularly those that are small and declining. To optimise reproductive success in reintroduction programs, females in good condition and with small pouch young should be released at the end of the wettest season.

Using "war stories" to train for adaptive performance: Is it better to learn from error or success?

The study examines whether error exposure training can enhance adaptive performance. Fifty-nine experienced fire-fighters undergoing training for incident command participated in the study. War stories were developed based on real events to illustrate successful and unsuccessful incident command decisions. Two training methodologies were compared and evaluated. One group was trained using case studies that depicted incidents containing errors of management with severe consequences in fire-fighting outcomes (error-story training) while a second group was exposed to the same set of case studies except that the case studies depicted the incidents being managed without errors and their consequences (errorless-story training). The results provide some support for the hypothesis that it is better to learn from other people's errors than from their successes. Implications for training are discussed.

Identification of success and failure factors for technology transfer in biotechnology: case studies and surveys from Academic Sinica in Taiwan

Academia Sinica is the leading research institute in Taiwan founded in 1928. Its Office of Technology Transfer (OTT) was established in 1998. It made great efforts to dramatically turn around the technology transfer activity of Academia Sinica, especially in biotechnology. Academia Sinica has more than 80 cases of experience in biotechnology transfer with companies in Taiwanese industry in the past five years. The purpose of this study is to identify potential success and failure factors for biotechnology transfer in Taiwan. Eight cases were studied through in-depth interview. The results of the analysis were used to design two surveys to further investigate 81 cases (48 successful and 33 failure cases) of biotechnology transfer in Academia Sinica from 1999–2003. The results indicated that 10 of the 14 success factors were cited in more than 40% of the cases as contributing to the success of technology transfer. By contrast, only 5 out of 16 key factors were present in more than 30% of the failure cases.

Encounter success of free-ranging marine predator movements across a dynamic prey landscape

Movements of wide-ranging top predators can now be studied effectively using satellite and archival telemetry. However, the motivations underlying movements remain difficult to determine because trajectories are seldom related to key biological gradients, such as changing prey distributions. Here, we use a dynamic prey landscape of zooplankton biomass in the north-east Atlantic Ocean to examine active habitat selection in the plankton-feeding basking shark Cetorhinus maximus. The relative success of shark searches across this landscape was examined by comparing prey biomass encountered by sharks with encounters by random-walk simulations of ‘model’ sharks. Movements of transmitter-tagged sharks monitored for 964 days (16754km estimated minimum distance) were concentrated on the European continental shelf in areas characterized by high seasonal productivity and complex prey distributions. We show movements by adult and sub-adult sharks yielded consistently higher prey encounter rates than 90% of random-walk simulations. Behavioural patterns were consistent with basking sharks using search tactics structured across multiple scales to exploit the richest prey areas available in preferred habitats. Simple behavioural rules based on learned responses to previously encountered prey distributions may explain the high performances. This study highlights how dynamic prey landscapes enable active habitat selection in large predators to be investigated from a trophic perspective, an approach that may inform conservation by identifying critical habitat of vulnerable species.

A study of large-bowel volvulus in urban Australia

Background: Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001. Methods: A retrospective chart study was carried out. Results: Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum. Conclusions: Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized.

Dilution versus dialysis - A quantitative study of the oxidative refolding of recombinant human alpha-fetoprotein

Alpha-fetoprotein (AFP) is a commercially important polypeptide with important diagnostic. physiological and immunomodulatory functions. Previous studies into the refolding of this macromolecule are contradictory. and variously suggest that AFP denaturation may be irreversible or that refolding may be achieved by reducing denaturant concentration through dilution but not dialysis. Importantly, these same previous studies do not provide quantitative metrics by which the Success of refolding, and the potential for bioprocess development. can be assessed. Moreover, these same studies do not optimize and control refolding redox potential - an important factor considering that AFP contains 32 cysteines which form 16 disulfide bonds. In this current study, a quantitative comparison of recombinant human AFP (rhAFP) refolding by dilution and dialysis is conducted under optimized redox conditions. rhAFP refolding yields were > 35% (dialysis refolding) and > 75% (dilution refolding) as assessed by RP-HPLC and ELISA, with structural Similarity to the native state confirmed by UV spectroscopy. Dialysis refolding yield was believed to be lower because the gradual reduction in denaturant concentration allowed extended conformational searching. enabling more time for undesirable interaction with other protein molecules and/or the dialysis membrane, leading to a Sub-optimal process outcome. Significant yield sensitivity to redox environment was also observed, emphasizing the importance of physicochemical optimization. This study demonstrates that very high refolding yields can be obtained, for a physiologically relevant protein, with optimized dilution refolding. The study also highlights the quantitative metrics and macromolecular physical spectroscopic 'fingerprints' required to facilitate transition from laboratory to process scale.

A D-optimal designed population pharmacokinetic study of itraconazole capsules and solution in adults with cystic fibrosis

Background: Oral itraconazole (ITRA) is used for the treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis (CF) because of its antifungal activity against Aspergillus species. ITRA has an active hydroxy-metabolite (OH-ITRA) which has similar antifungal activity. ITRA is a highly lipophilic drug which is available in two different oral formulations, a capsule and an oral solution. It is reported that the oral solution has a 60% higher relative bioavailability. The influence of altered gastric physiology associated with CF on the pharmacokinetics (PK) of ITRA and its metabolite has not been previously evaluated. Objectives: 1) To estimate the population (pop) PK parameters for ITRA and its active metabolite OH-ITRA including relative bioavailability of the parent after administration of the parent by both capsule and solution and 2) to assess the performance of the optimal design. Methods: The study was a cross-over design in which 30 patients received the capsule on the first occasion and 3 days later the solution formulation. The design was constrained to have a maximum of 4 blood samples per occasion for estimation of the popPK of both ITRA and OH-ITRA. The sampling times for the population model were optimized previously using POPT v.2.0.[1] POPT is a series of applications that run under MATLAB and provide an evaluation of the information matrix for a nonlinear mixed effects model given a particular design. In addition it can be used to optimize the design based on evaluation of the determinant of the information matrix. The model details for the design were based on prior information obtained from the literature, which suggested that ITRA may have either linear or non-linear elimination. The optimal sampling times were evaluated to provide information for both competing models for the parent and metabolite and for both capsule and solution simultaneously. Blood samples were assayed by validated HPLC.[2] PopPK modelling was performed using FOCE with interaction under NONMEM, version 5 (level 1.1; GloboMax LLC, Hanover, MD, USA). The PK of ITRA and OH‑ITRA was modelled simultaneously using ADVAN 5. Subsequently three methods were assessed for modelling concentrations less than the LOD (limit of detection). These methods (corresponding to methods 5, 6 & 4 from Beal[3], respectively) were (a) where all values less than LOD were assigned to half of LOD, (b) where the closest missing value that is less than LOD was assigned to half the LOD and all previous (if during absorption) or subsequent (if during elimination) missing samples were deleted, and (c) where the contribution of the expectation of each missing concentration to the likelihood is estimated. The LOD was 0.04 mg/L. The final model evaluation was performed via bootstrap with re-sampling and a visual predictive check. The optimal design and the sampling windows of the study were evaluated for execution errors and for agreement between the observed and predicted standard errors. Dosing regimens were simulated for the capsules and the oral solution to assess their ability to achieve ITRA target trough concentration (Cmin,ss of 0.5-2 mg/L) or a combined Cmin,ss for ITRA and OH-ITRA above 1.5mg/L. Results and Discussion: A total of 241 blood samples were collected and analysed, 94% of them were taken within the defined optimal sampling windows, of which 31% where taken within 5 min of the exact optimal times. Forty six per cent of the ITRA values and 28% of the OH-ITRA values were below LOD. The entire profile after administration of the capsule for five patients was below LOD and therefore the data from this occasion was omitted from estimation. A 2-compartment model with 1st order absorption and elimination best described ITRA PK, with 1st order metabolism of the parent to OH-ITRA. For ITRA the clearance (ClItra/F) was 31.5 L/h; apparent volumes of central and peripheral compartments were 56.7 L and 2090 L, respectively. Absorption rate constants for capsule (kacap) and solution (kasol) were 0.0315 h-1 and 0.125 h-1, respectively. Comparative bioavailability of the capsule was 0.82. There was no evidence of nonlinearity in the popPK of ITRA. No screened covariate significantly improved the fit to the data. The results of the parameter estimates from the final model were comparable between the different methods for accounting for missing data, (M4,5,6)[3] and provided similar parameter estimates. The prospective application of an optimal design was found to be successful. Due to the sampling windows, most of the samples could be collected within the daily hospital routine, but still at times that were near optimal for estimating the popPK parameters. The final model was one of the potential competing models considered in the original design. The asymptotic standard errors provided by NONMEM for the final model and empirical values from bootstrap were similar in magnitude to those predicted from the Fisher Information matrix associated with the D-optimal design. Simulations from the final model showed that the current dosing regimen of 200 mg twice daily (bd) would provide a target Cmin,ss (0.5-2 mg/L) for only 35% of patients when administered as the solution and 31% when administered as capsules. The optimal dosing schedule was 500mg bd for both formulations. The target success for this dosing regimen was 87% for the solution with an NNT=4 compared to capsules. This means, for every 4 patients treated with the solution one additional patient will achieve a target success compared to capsule but at an additional cost of AUD $220 per day. The therapeutic target however is still doubtful and potential risks of these dosing schedules need to be assessed on an individual basis. Conclusion: A model was developed which described the popPK of ITRA and its main active metabolite OH-ITRA in adult CF after administration of both capsule and solution. The relative bioavailability of ITRA from the capsule was 82% that of the solution, but considerably more variable. To incorporate missing data, using the simple Beal method 5 (using half LOD for all samples below LOD) provided comparable results to the more complex but theoretically better Beal method 4 (integration method). The optimal sparse design performed well for estimation of model parameters and provided a good fit to the data.

In search of a sustainable success strategy in the Chinese chemical industry

The Chinese chemical industry is facing fierce competition and changing market dynamics due to the change in the country's economic policy. Its government has applied administr.ttive actions rather than simply relying on the market to address the changing dynamics. It has attempted to privatise government-owned enterprises by corporatisation coupled with industrial restructuring. This paper uses a case study of Peony Printing Ink Co Ltd, a state-owned chemical enterprise, to illustrate the effectiveness of developing internal competences to improve long-term operational performance rather than the adoption of a privatisation approach.

Managing risk in software development projects:a case study

Purpose - The main objective of the paper is to develop a risk management framework for software development projects from developers' perspective. Design/methodology/approach - This study uses a combined qualitative and quantitative technique with the active involvement of stakeholders in order to identify, analyze and respond to risks. The entire methodology has been explained using a case study on software development project in a public sector organization in Barbados. Findings - Analytical approach to managing risk in software development ensures effective delivery of projects to clients. Research limitations/implications - The proposed risk management framework has been applied to a single case. Practical implications - Software development projects are characterized by technical complexity, market and financial uncertainties and competent manpower availability. Therefore, successful project accomplishment depends on addressing those issues throughout the project phases. Effective risk management ensures the success of projects. Originality/value - There are several studies on managing risks in software development and information technology (IT) projects. Most of the studies identify and prioritize risks through empirical research in order to suggest mitigating measures. Although they are important to clients for future projects, these studies fail to provide any framework for risk management from software developers' perspective. Although a few studies introduced framework of risk management in software development, most of them are presented from clients' perspectives and very little effort has been made to integrate this with the software development cycle. As software developers absorb considerable amount of risks, an integrated framework for managing risks in software development from developers' perspective is needed. © Emerald Group Publishing Limited.

Information system planning in drug service:a case study

The development of an information system in Caribbean public sector organisations is usually seen as a matter of installing hardware and software according to a directive from senior management, without much planning. This causes huge investment in procuring hardware and software without improving overall system performance. Increasingly, Caribbean organisations are looking for assurances on information system performance before making investment decisions not only to satisfy the funding agencies, but also to be competitive in this dynamic and global business world. This study demonstrates an information system planning approach using a process-reengineering framework. Firstly, the stakeholders for the business functions are identified along with their relationships and requirements. Secondly, process reengineering is carried out to develop the system requirements. Accordingly, information technology is selected through detailed system requirement analysis. Thirdly, cost-benefit analysis, identification of critical success factors and risk analysis are carried out to strengthen the selection. The entire methodology has been demonstrated through an information system project in the Barbados drug service, a public sector organisation in the Caribbean.

An empirical study of salesperson stereotypes amongst UK students and their implications for recruitment

The success of recruitment efforts can have a major impact on sales force effectiveness. Students have long been considered a good source of potential sales recruits, but research has found students have generally negative perceptions of selling as a career. One reason for such perceptions may be negative stereotypes of salespeople held by students. However information on the content of UK sales stereotypes remains anecdotal at best. This study empirically examines UK business students' stereotypes of salespeople using a two-stage approach. Findings suggest that these stereotypes are generally negative. However, we create profiles of salespeople using our findings, and consequently uncover some positive aspects to the stereotype. The study provides instruction on how to use stereotypes in subsequent work, as well as how to utilise the profiles in recruitment efforts.

The role of market orientation in the business success of the MNC’s foreign subsidiaries

In recent discussions over the contribution of marketing to the strategy dialogue, market orientation has been singled out as being of particular importance in relation to the understanding of competitive advantage (Day et al 1992, Hunt and Lamb 2000). Research in the past has focused primarily on firms operating in domestic markets. As such, despite the recent progress, it is unclear of relevancy of market orientation as a construct in the context of multinational corporations (MNC) and their foreign subsidiaries. In this study, we set out to explore the role of market orientation in the subsidiary business performance. An investigation of a sample of 252 foreign subsidiaries in the UK revealed that except for “receptive? subsidiaries (Taggart 1998), market orientation has significant positive relationships with a number of business performance measures in all three other types of subsidiaries, suggesting that market orientation is a key driver for business performance at foreign subsidiaries.

Blood glucose self-monitoring in non-insulin-treated type 2 diabetes:a qualitative study of patients' perspectives

Background: Self-monitoring of blood glucose is controversial in the management of type 2 diabetes. Some research suggests that self-monitoring improves glycaemic control, whereas other research is sceptical about its value for people with type 2 diabetes who are not on insulin. Although blood glucose meters are widely available and used by this group, patients' own views are absent from the debate. Aim: To explore the pros and cons of glucose monitoring from the patients' perspectives. Design of study: Qualitative repeat-interview study. Setting: Patients were recruited from 16 general practices and three hospital clinics within four local healthcare cooperatives in Lothian, Scotland. Method: Interview data from 40 patients diagnosed with type 2 diabetes within the previous 6 months were analysed using thematic analysis informed by grounded theory. We report findings from round 1 and round 2 interviews. Results: Glucose monitoring can heighten patients' awareness of the impact of lifestyle; for example, dietary choices, on blood glucose levels. Glucose monitoring amplifies a sense of 'success' or 'failure' about self-management, often resulting in anxiety and self-blame if glucose readings remain consistently high. Moreover, monitoring can negatively effect patients' self-management when readings are counter-intuitive. Conclusion: Our analysis highlights the importance of understanding the meanings that newly diagnosed patients attach to glucose self-monitoring. To maximise the positive effects of self-monitoring, health professionals should ensure that patients understand the purpose of monitoring and should clarify with patients how readings should be interpreted. © British Journal of General Practice.