Endometrial and vaginal effects of low-dose estradiol delivered by vaginal ring or vaginal tablet

Aims The major aims of the study were to compare the safety of a continuous low-dose estradiol-releasing vaginal ring (ESTring) to that of a vaginal estradiol tablet (Vagifem®) on the endometrium and the relief of subjective symptoms and signs of urogenital estrogen deficiency. Quality of life and acceptability of treatment delivery were also assessed. Study design A prospective, randomized study in which women were assigned in a 2: 1 ratio to ESTring and Vagifem and followed for 12 months. The primary endpoint was endometrial safety, based on the results of ultrasound measurement of endometrial thickness and a progestogen challenge test at baseline and week 48. Efficacy was determined by subjective assessment of urogenital estrogen deficiency symptoms at baseline and weeks 3, 12, 24, 36 and 48 and assessment of signs of vaginal epithelial atrophy by the clinician at baseline, 12 and 48 weeks. In addition, pelvic floor strength, vaginal cytological evaluation and pH, bacteruria and patient acceptability were assessed. Quality of life was assessed using a menopause-specific quality-of-life questionnire and a 2-day bladder diary at baseline and 12 and 48 weeks. The comparability of the two groups was assessed using ANOVA, χ(2) or Fisher's exact tests. Results A total of 126 women were randomized to ESTring and 59 to Vagifem. There was no statistical difference between the groups in the alleviation of symptoms and signs of urogenital estrogen deficiency. Maturation indices increased in both groups, from generally atrophic at baseline to proliferative or highly proliferative at 48 weeks. After 48 weeks of treatment, there was no statistically significant difference in endometrial thickness between the two groups. A statistically smaller proportion of bleeding/spotting occurred in the ESTring group (n = 0) compared to the Vagifem users (n = 4). Estradiol and total estrone serum levels increased during treatment in both groups but remained within the normal postmenopausal range. General health status in both groups was unchanged but the urogenital component of health burden was significantly improved in both groups. Bladder diary variables showed no differences between treatment groups. Conclusion Equivalent endometrial safety and efficacy in the relief of the symptoms and signs of urogenital estrogen deficiency were demonstrated for the 12 months' use of a low-dose estradiol-releasing vaginal ring and a vaginal estradiol tablet.

Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis

Most people presenting with rheumatoid arthritis today can expect to achieve disease suppression, can avoid or substantially delay joint damage and deformities, and can maintain a good quality of life. Optimal management requires early diagnosis and treatment, usually with combinations of conventional disease modifying antirheumatic drugs (DMARDs). If these do not effect remission, biological DMARDs may be beneficial. Lack of recognition of the early signs of rheumatoid arthritis, ignorance of the benefits of early application of modern treatment regimens, and avoidable delays in securing specialist appointments may hinder achievement of best outcomes for many patients. Triage for recognising possible early rheumatoid arthritis must begin in primary care settings with the following pattern of presentation as a guide: involvement of three or more joints; early-morning joint stiffness of greater than 30 minutes; or bilateral squeeze tenderness at metacarpophalangeal or metatarsophalangeal joints.

Leflunomide improves psoriasis in patients with psoriatic arthritis: An in-depth analysis of data from the TOPAS study

Background: Leflunomide has shown promise in the treatment of psoriasis. Objective: To provide an in-depth analysis of the effect of leflunomide on psoriasis in patients with psoriatic arthritis (PsA). Methods: 190 patients with plaque psoriasis (at least 3% skin involvement) and active PsA were randomized to double-blind treatment with leflunomide (100 mg/day loading dose for 3 days followed by 20 mg/day orally) or placebo for 24 weeks. Results: As previously reported, leflunomide resulted in a significantly higher Psoriatic Arthritis Response Criteria response rate than placebo (58.9 vs. 29.7%; p < 0.0001). Significant differences in favor of leflunomide were also observed in the Psoriasis Area and Severity Index (PASI 50 in 30.4% of patients vs. 18.9% for placebo; p = 0.05), target lesion response (46.4 vs. 25.3%; p = 0.0048), combined skin and joint response (27.2 vs. 8.9%; p < 0.0001), Dermatology Life Quality Index (improvement of 1.9 points vs. 0.2; p = 0.0173) and certain SF-36 subdomains. Dermatological responses were observed at the earliest examination (4 weeks) and increased throughout the 24-week study. Conclusion: Once-daily oral leflunomide is an effective and convenient treatment for PsA and plaque psoriasis. Copyright (c) 2006 S. Karger AG, Basel.

Loan loss provisions, bank valuations and discretion : a comparative study between conventional and Islamic banks

This study investigates the use of reported loan loss provisions (LLP) by investors in their valuations of banks within the Middle East and North Africa region between the years 2006 and 2011. We decompose LLP into discretionary and non-discretionary components to test for differential valuations in the two banking sectors. We use alternative criteria to define the components of LLP in banks: loan quality/size and earnings management/ manipulation incentives. We employ a price-level valuation model estimated using two-stage analyses. We find that LLP has positive value relevance to investors in both banking sectors. Investors in Islamic banks price the discretionary component relatively lower than their conventional counterparts. We attribute this result to differences in product and governance structures as well as to the religious perception of Islamic banking. In both banking sectors, investors construe an increase in the non-discretionary component as irrelevant valuation information. Our results are relevant to bank regulators in showing the signalling effect of LLP to bank value and stability.

Loan loss provisions, bank valuations and discretion:a comparative study between conventional and Islamic banks

This study investigates the use of reported loan loss provisions (LLP) by investors in their valuations of banks within the Middle East and North Africa region between the years 2006 and 2011. We decompose LLP into discretionary and non-discretionary components to test for differential valuations in the two banking sectors. We use alternative criteria to define the components of LLP in banks: loan quality/size and earnings management/manipulation incentives. We employ a price-level valuation model estimated using two-stage analyses. We find that LLP has positive value relevance to investors in both banking sectors. Investors in Islamic banks price the discretionary component relatively lower than their conventional counterparts. We attribute this result to differences in product and governance structures as well as to the religious perception of Islamic banking. In both banking sectors, investors construe an increase in the non-discretionary component as irrelevant valuation information. Our results are relevant to bank regulators in showing the signalling effect of LLP to bank value and stability. © 2013 Elsevier B.V.

Combining an enterprise resource planning system and informality:a study of efficiency and flexibility complmentarity [sic]

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT One of the current research trends in Enterprise Resource Planning (ERP) involves examining the critical factors for its successful implementation. However, such research is limited to system implementation, not focusing on the flexibility of ERP to respond to changes in business. Therefore, this study explores a combination system, made up of an ERP and informality, intended to provide organisations with efficient and flexible performance simultaneously. In addition, this research analyses the benefits and challenges of using the system. The research was based on socio-technical system (STS) theory which contains two dimensions: 1) a technical dimension which evaluates the performance of the system; and 2) a social dimension which examines the impact of the system on an organisation. A mixed method approach has been followed in this research. The qualitative part aims to understand the constraints of using a single ERP system, and to define a new system corresponding to these problems. To achieve this goal, four Chinese companies operating in different industries were studied, all of which faced challenges in using an ERP system due to complexity and uncertainty in their business environments. The quantitative part contains a discrete-event simulation study that is intended to examine the impact of operational performance when a company implements the hybrid system in a real-life situation. Moreover, this research conducts a further qualitative case study, the better to understand the influence of the system in an organisation. The empirical aspect of the study reveals that an ERP with pre-determined business activities cannot react promptly to unanticipated changes in a business. Incorporating informality into an ERP can react to different situations by using different procedures that are based on the practical knowledge of frontline employees. Furthermore, the simulation study shows that the combination system can achieve a balance between efficiency and flexibility. Unlike existing research, which emphasises a continuous improvement in the IT functions of an enterprise system, this research contributes to providing a definition of a new system in theory, which has mixed performance and contains both the formal practices embedded in an ERP and informal activities based on human knowledge. It supports both cost-efficiency in executing business transactions and flexibility in coping with business uncertainty.This research also indicates risks of using the system, such as using an ERP with limited functions; a high cost for performing informally; and a low system acceptance, owing to a shift in organisational culture. With respect to practical contribution, this research suggests that companies can choose the most suitable enterprise system approach in accordance with their operational strategies. The combination system can be implemented in a company that needs to operate a medium amount of volume and variety. By contrast, the traditional ERP system is better suited in a company that operates a high-level volume market, while an informal system is more suitable for a firm with a requirement for a high level of variety.

Island diasporas: Perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States

Mentoring is defined as an "intense caring relationship in which persons with more experience work with less experienced persons to promote both professional and personal development" (Caffarella, 1992, p. 38). It is "a powerful emotional, and passionate interaction whereby the mentor and protégé experience...intellectual growth and development" (Galbraith & Zelenak, 1991, p. 126). In cross-cultural mentoring, mentors and protégés from different cultures confront social and cultural identities, goals, expectations, values, and beliefs (Cross & Lincoln, 2005) to "achieve a higher level of potency in education and society" (Mullen, 2005, p. 6). Cross-cultural mentoring research explores attitudes, behaviors, linguistics and motivators of the more visible racial and ethnic groups in the U.S. (Elmer, 1986, Ulmer, 2008). The cross-cultural mentoring experiences of Indo-Caribbeans in the U.S. are obscured from the research despite their rich socio-historic culture. The purpose of this phenomenological study was to explore the perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States. Phenomenology is "the systematic attempt to uncover and describe...the internal meaning structures, of lived experience [by studying the] particulars or instances as they are encountered" (Van Manen, 1990, p. 10). Criterion and snowball sampling were used to recruit 15 participants. A semi-structured interview guide was used to gather data and Creswell's (2007) simplified version of Moustakas's (1994) Modification of the Stevick-Colaizzi-Keen Method of Analysis of Phenomenological Data was used to analyze the data. Three themes emerged: (a) "Sitting at the feet of gurus" taught protégés how to accept guidance, (b) Guru-Shishya: Learning and Discipleship, ways that protégés perceived mentors' guidance related to work, skill acquisition, and social or emotional support, and (c) Samavartan sanskar: Building Coherence, helped protégés understand, manage and find meaning. Protégés' goals and professional expectations determined what they wanted from cross-cultural mentoring relationships and what they were willing to endure within those relationships. Since participants valued achievement and continuous improvement, mentor support was integral to making meaning and developing a sense of coherence in their lives. Implications regarding cross-cultural mentoring relationships together with recommendations for future research conclude the study.

Customer Perception of Drive-Thru Service

The rapid growth of off-premise dining and, consequently, drive- thru service, presents the challenge of building customer loyalty in a highly competitive marketplace. In this study, customer perceptions of drive-thru service associated with quick service restaurants were examined. Results suggest that service time appears to differ among quick service restaurants, even those within the same chain. Employee courtesy was rated positively at all restaurants, as was food quality. The implications of these results for restaurateurs who offer drive-thru service are discussed.

Fish Community Responses to the Combined Effects of Decreased Hydroperiod and Nonnative Fish Invasions in a Karst Wetland: Are Everglades Solution Holes Sinks for Native Fishes?

Short-hydroperiod Everglades wetlands have been disproportionately affected by reductions in freshwater inflows, land conversion and biotic invasions. Severe hydroperiod reductions in these habitats, including the Rocky Glades, coupled with proximity to canals that act as sources of invasions, may limit their ability to support high levels of aquatic production. We examined whether karst solution holes function as dry-down refuges for fishes, providing a source of marsh colonists upon reflooding, by tracking fish abundance, nonnative composition, and survival in solution holes throughout the dry season. We paired field surveys with an in situ nonnative predation experiment that tested the effects of predation by the recent invader, African jewelfish (Hemichromis letourneuxi) on native fishes. Over the 3 years surveyed, a large number of the solution holes dried before the onset of the wet season, while those retaining water had low survivorship and were dominated by nonnatives. In the experiment, mortality of eastern mosquitofish (Gambusia holbrooki) in the presence of African jewelfish was greater than that associated with deteriorating water quality. Under current water management, findings suggest that solution holes are largely sinks for native fishes, given the high frequency of drydown, extensive period of fish residence, and predation by nonnative fishes.

Real-time scheduling of embedded applications on multi-core platforms

For the past several decades, we have experienced the tremendous growth, in both scale and scope, of real-time embedded systems, thanks largely to the advances in IC technology. However, the traditional approach to get performance boost by increasing CPU frequency has been a way of past. Researchers from both industry and academia are turning their focus to multi-core architectures for continuous improvement of computing performance. In our research, we seek to develop efficient scheduling algorithms and analysis methods in the design of real-time embedded systems on multi-core platforms. Real-time systems are the ones with the response time as critical as the logical correctness of computational results. In addition, a variety of stringent constraints such as power/energy consumption, peak temperature and reliability are also imposed to these systems. Therefore, real-time scheduling plays a critical role in design of such computing systems at the system level. We started our research by addressing timing constraints for real-time applications on multi-core platforms, and developed both partitioned and semi-partitioned scheduling algorithms to schedule fixed priority, periodic, and hard real-time tasks on multi-core platforms. Then we extended our research by taking temperature constraints into consideration. We developed a closed-form solution to capture temperature dynamics for a given periodic voltage schedule on multi-core platforms, and also developed three methods to check the feasibility of a periodic real-time schedule under peak temperature constraint. We further extended our research by incorporating the power/energy constraint with thermal awareness into our research problem. We investigated the energy estimation problem on multi-core platforms, and developed a computation efficient method to calculate the energy consumption for a given voltage schedule on a multi-core platform. In this dissertation, we present our research in details and demonstrate the effectiveness and efficiency of our approaches with extensive experimental results.

Avaliação da conformidade dos blocos cerâmicos produzidos em algumas cerâmicas no Rio Grande do Norte

The final quality of the works accomplished by the building construction industry depends directly on the quality of the materials supplied and used during all their phases of execution. The federal government participation and several state programs have established conditions to stimulate and require the increment of the quality level in the building construction industry´s product chain. These programs aim at the product conformity to the technical standards. Within this context, the evaluation program of the ceramic product conformity in Rio Grande do Norte state is assessing the conformity degree to Brazilian Technical Standards of ceramic bricks and tiles made in the ceramic production area in the state. In this work, is determine the degree of conformity of the sealing ceramic bricks made by some companies in different areas of the state, such as Assú, São Gonçalo do Amarante, Apodi, Parelhas, São José do Mipibu e Macaíba. Using the technical standards as a point of reference, we attempted to reproduce in the laboratory the experimental procedures to the analysis execution, according to the specifications. It was possible to determine that none of the evaluated samples are in strict conformity with the current technical standards, what reflects the real situation of the products available on the market.

Projeto de intervenção adaptando o Balanced Scorecard ao sistema de compras da Base Aérea de Natal

The present proposal for intervention examines the issue of public procurements carried out by a military organization on a Federal Public Administration. The main objective of this paper is to propose a model of strategic planning based on the Balanced Scorecard for the public procurement system, which contributes to increased efficiency, efficacy and effectiveness of acquisitions made in the Air Base of Natal city. Therefore, Structured interviews were used in order to make a diagnosis of the current reality of the procurement system along with the main requirement sectors of BANT, as well as the adaptation of the prospects of the BSC based on literature review. The technique used for the analysis of the interviews was the analysis of content whose results contributed to the preparation of the conceptual Strategic Map which was submitted to validation through a Focal Group. It was concluded through the analysis of the interviews, that the system of purchases of BANT is in a tactical profile because of low interaction between the system of purchases and the requirement sectors, aiming only at the “economicity” of acquisition in opposition of the effectiveness of material acquired, the lack of training of the elements which build the system and the absence of a proper planning. It is intended with thecreation of this proposal to contribute to the improvement of management with a focus on results in public administration as well as increasing efficiency, efficacy and effectiveness of public procurements. Whereas for the particular case the measurement of the results can only be performed after at least a year of its implementation, the present research constitutes a proposal of intervention.

Leanin soveltaminen haavanhoitotuotteiden valmistuksen läpimenoaikojen lyhentämiseksi

Mölnlycke Health Care valmistaa kertakäyttöisiä leikkaussali- ja haavanhoitotuotteita. Yritys on saavuttanut arvostetun aseman markkinoilla ja pitääkseen asemansa sen tulee koko ajan kehittää toimintaansa. Keväällä 2016 yritys aloitti leanin implementoinnin, minkä vuoksi nykytilanteen kartoittaminen ja sen pohjalta tuotannon kehittäminen tuli ajankohtaiseksi. Diplomityössä selvitettiin Mölnlycke Health Care Oy:lle sopiva nykytilan kartoitusmenetelmä. Sopivaksi menetelmäksi osoittautui arvovirtakuvaus. Nykytilanteen kartoitus tehtiin yrityksen kannalta tärkeälle tuoteperheelle, joka tässä tapauksessa oli edistyksellinen haavanhoitotuote ja haavasidos Mepilex Border. Nykytilanteen kartoitus antoi tuotteen läpimenoajaksi 100 päivää varaston riitto huomioituna. Tästä ajasta kuitenkin suurin osa oli hukkaa, jota pystytään poistamaan. Nykytilanteesta tehtiin kuva, jonka pohjalta pystyttiin havainnoimaan kehittävät kohteet ja tekemään ehdotukset kohteiden parantamiseksi. Kehitysehdotusten tavoitteena oli tuoda yritystä lähemmäs Lean-filosofiaa ja auttaa pitämään yllä jatkuvan parantamisen kulttuuria.