Value of glycaemic control in diabetes

Full text: Several Lancet publications have questioned the value of glycaemic control in diabetic patients. For example, in their Comment (Sept 29, p 1103),1 John Cleland and Stephen Atkin state that “Improved glycaemic control is not a surrogate for effective care of patients who have diabetes”, and Victor Montori and colleagues (p 1104)2 claim that “HbA1c loses its validity as a surrogate marker when patients have a constellation of metabolic abnormalities”. We are concerned that the reaction against “glucocentricity” in the field of diabetes has gone too far. Even the UK's National Prescribing Centre website, carrying the National Health Service logo, includes comments that undermine the value of glycaemic control. For example, referring to the United Kingdom Prospective Diabetes Study (UKPDS), this site states that “Compared with ‘conventional control’ there was no benefit from tight control of blood glucose with sulphonylureas or insulin with regard to total mortality, diabetes-related death, macrovascular outcomes or microvascular outcomes, including all the most serious ones such as blindness or kidney failure”.3 It is well established that better glycaemic control reduces long-term microvascular complications in type 1 and type 2 diabetes.4 In type 2 diabetes, the UKPDS reported that a composite microvascular endpoint (retinopathy requiring photocoagulation, vitreous haemorrhage, and fatal or non-fatal renal failure) was reduced by 25% in patients randomised to intensive glucose control (p=0·0099).4 To imply that these are not patient-relevant outcomes is to distort the evidence. Many studies have also found that improved glycaemic control reduces macrovascular complications.5 Do not be misled: glycaemic control remains a crucial component in the care of people with diabetes. The authors have received research support and undertaken ad hoc consultancies and speaker engagements for several pharmaceutical companies.

Managing risk in enterprise resource planning projects

Enterprise Resource Planning (ERP) projects are strategic and capital intensive, so failure may be costly and even cause bankruptcy of companies. Previous studies have proposed ways for improving implementation, but they are mostly generic and follow standardized project management practices as specified in various standards (e.g. the “project management body of knowledge” of the Project Management Institute). Because ERP is interdisciplinary (involving change management, project management and information technology management), it warrants a customized approach to managing risks throughout the life cycle of implementation and operation. Through a practical case study, this paper demonstrates a qualitative, user friendly approach to ERP project risk management. Firstly, through a literature review it identifies various risk factors in ERP implementation. Secondly, the risk management practices of a UK-based multinational consulting company in one of its clients are evaluated. The risk factors from the case study organization and literature are then compared and discussed.

Creative self-efficacy and individual creativity in teams:cross-level interactions with team informational resources

We propose a cross-level perspective on the relation between creative self-efficacy and individual creativity in which team informational resources, comprising both shared “knowledge of who knows what” (KWKW) and functional background diversity, benefit the creativity of individuals more with higher creative self-efficacy. To test our hypotheses, we conducted a multi-level study with 176 employees working in 34 research and development teams of a multinational company in 4 countries. In support of our hypotheses, the link between creative self-efficacy and individual creativity was more positive with greater shared KWKW, and this interactive effect was pronounced for teams of high rather than low functional background diversity. We discuss implications for the study of creative self-efficacy in team contexts. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Managing customer relationship management projects:the case of a large French telecommunication company

Customer relationship management (CRM) implementation projects reflect a growing conceptual shift from the traditional engineering view of projects. Such projects are complex and risky because they call for both organisational and technological changes. This requires effective project management across various phases of the implementation process. However, few empirical researches have dealt with these project management issues. The aim of this research is to investigate how a “project team” manages CRM implementation projects successfully, across the different phases of the implementation process. We conducted an in-depth case study of the “Firm-Clients Branch” of a large telecommunications company in France. The findings show that, to manage CRM implementation projects successfully, an integrated and balanced approach is required. This involves appropriate system selection, effective process re-engineering and further development of organizational structures. We highlight the need for a “technochange approach” to achieve successful organisational transition and effective CRM implementation. The study reveals that the project team plays a central role throughout the implementation phases. Furthermore the effectiveness of technochange depends on project team performance, technology efficiency and close coordination with stakeholders.

Effects of grain size and microstructure on threshold values and near threshold crack growth in powder-formed Ni-base superalloy

Threshold stress intensity values, ranging from ∼6 to 16 MN m −3/2 can be obtained in powder-formed Nimonic AP1 by changing the microstructure. The threshold and low crack growth rate behaviour at room temperature of a number of widely differing API microstructures, with both ‘necklace’ and fully recrystallized grain structures of various sizes and uniform and bimodal γ′-distributions, have been investigated. The results indicate that grain size is an important microstructural parameter which can control threshold behaviour, with the value of threshold stress intensity increasing with increasing grain size, but that the γ′-distribution is also important. In this Ni-base alloy, as in many others, near threshold fatigue crack growth occurs in a crystallographic manner along {111} planes. This is due to the development of a dislocation structure involving persistent slip bands on {111} planes in the plastic zone, caused by the presence of ordered shearable precipitates in the microstructure. However, as the stress intensity range is increased, a striated growth mode takes over. The results presented show that this transition from faceted to striated growth is associated with a sudden increase in crack propagation rate and occurs when the size of the reverse plastic zone at the crack tip becomes equal to the grain size, independent of any other microstructural variables.

An investigation of management accounting control systems in the palm oil industry:a sociomaterial approach to practice change

The primary aim of this research is to understand what constitutes management accounting and control (MACs) practice and how these control processes are implicated in the day to day work practices and operations of the organisation. It also examines the changes that happen in MACs practices over time as multiple actors within organisational settings interact with each other. I adopt a distinctive practice theory approach (i.e. sociomateriality) and the concept of imbrication in this research to show that MACs practices emerge from the entanglement between human/social agency and material/technological agency within an organisation. Changes in the pattern of MACs practices happens in imbrication processes which are produced as the two agencies entangle. The theoretical approach employed in this research offers an interesting and valuable lens which seeks to reveal the depth of these interactions and uncover the way in which the social and material imbricate. The theoretical framework helps to reveal how these constructions impact on and produce modifications of MACs practices. The exploration of the control practices at different hierarchical levels (i.e. from the operational to middle management and senior level management) using the concept of imbrication process also maps the dynamic flow of controls from operational to top management and vice versa in the organisation. The empirical data which is the focus of this research has been gathered from a case study of an organisation involved in a large vertically integrated palm oil industry company in Malaysia specifically the refinery sector. The palm oil industry is a significant industry in Malaysia as it contributed an average of 4.5% of Malaysian Gross Domestic Product, over the period 1990 -2010. The Malaysian palm oil industry also has a significant presence in global food oil supply where it contributed 26% of the total oils and fats global trade in 2010. The case organisation is a significant contributor to the Malaysian palm oil industry. The research access has provided an interesting opportunity to explore the interactions between different groups of people and material/technology in a relatively heavy process food industry setting. My research examines how these interactions shape and are shaped by control practices in a dynamic cycle of imbrications over both short and medium time periods.

A techno-economic comparison of power production by biomass fast pyrolysis with gasification and combustion

This paper presents an assessment of the technical and economic performance of thermal processes to generate electricity from a wood chip feedstock by combustion, gasification and fast pyrolysis. The scope of the work begins with the delivery of a wood chip feedstock at a conversion plant and ends with the supply of electricity to the grid, incorporating wood chip preparation, thermal conversion, and electricity generation in dual fuel diesel engines. Net generating capacities of 1–20 MWe are evaluated. The techno-economic assessment is achieved through the development of a suite of models that are combined to give cost and performance data for the integrated system. The models include feed pretreatment, combustion, atmospheric and pressure gasification, fast pyrolysis with pyrolysis liquid storage and transport (an optional step in de-coupled systems) and diesel engine or turbine power generation. The models calculate system efficiencies, capital costs and production costs. An identical methodology is applied in the development of all the models so that all of the results are directly comparable. The electricity production costs have been calculated for 10th plant systems, indicating the costs that are achievable in the medium term after the high initial costs associated with novel technologies have reduced. The costs converge at the larger scale with the mean electricity price paid in the EU by a large consumer, and there is therefore potential for fast pyrolysis and diesel engine systems to sell electricity directly to large consumers or for on-site generation. However, competition will be fierce at all capacities since electricity production costs vary only slightly between the four biomass to electricity systems that are evaluated. Systems de-coupling is one way that the fast pyrolysis and diesel engine system can distinguish itself from the other conversion technologies. Evaluations in this work show that situations requiring several remote generators are much better served by a large fast pyrolysis plant that supplies fuel to de-coupled diesel engines than by constructing an entire close-coupled system at each generating site. Another advantage of de-coupling is that the fast pyrolysis conversion step and the diesel engine generation step can operate independently, with intermediate storage of the fast pyrolysis liquid fuel, increasing overall reliability. Peak load or seasonal power requirements would also benefit from de-coupling since a small fast pyrolysis plant could operate continuously to produce fuel that is stored for use in the engine on demand. Current electricity production costs for a fast pyrolysis and diesel engine system are 0.091/kWh at 1 MWe when learning effects are included. These systems are handicapped by the typical characteristics of a novel technology: high capital cost, high labour, and low reliability. As such the more established combustion and steam cycle produces lower cost electricity under current conditions. The fast pyrolysis and diesel engine system is a low capital cost option but it also suffers from relatively low system efficiency particularly at high capacities. This low efficiency is the result of a low conversion efficiency of feed energy into the pyrolysis liquid, because of the energy in the char by-product. A sensitivity analysis has highlighted the high impact on electricity production costs of the fast pyrolysis liquids yield. The liquids yield should be set realistically during design, and it should be maintained in practice by careful attention to plant operation and feed quality. Another problem is the high power consumption during feedstock grinding. Efficiencies may be enhanced in ablative fast pyrolysis which can tolerate a chipped feedstock. This has yet to be demonstrated at commercial scale. In summary, the fast pyrolysis and diesel engine system has great potential to generate electricity at a profit in the long term, and at a lower cost than any other biomass to electricity system at small scale. This future viability can only be achieved through the construction of early plant that could, in the short term, be more expensive than the combustion alternative. Profitability in the short term can best be achieved by exploiting niches in the market place and specific features of fast pyrolysis. These include: •countries or regions with fiscal incentives for renewable energy such as premium electricity prices or capital grants; •locations with high electricity prices so that electricity can be sold direct to large consumers or generated on-site by companies who wish to reduce their consumption from the grid; •waste disposal opportunities where feedstocks can attract a gate fee rather than incur a cost; •the ability to store fast pyrolysis liquids as a buffer against shutdowns or as a fuel for peak-load generating plant; •de-coupling opportunities where a large, single pyrolysis plant supplies fuel to several small and remote generators; •small-scale combined heat and power opportunities; •sales of the excess char, although a market has yet to be established for this by-product; and •potential co-production of speciality chemicals and fuel for power generation in fast pyrolysis systems.

What can higher education contribute to improving social mobility in the UK?

At a time when the UK may slowly be emerging out of what, for many in higher education, has been a period of ‘unprecedented change’ (Universities UK, 2012) in which institutions have found themselves having to balance increases in student expectations and demands against decreases in funding and resources, this special edition focuses on an issue that is becoming ever-more important – that of the relationship between social mobility and higher education. Drawing upon the findings of the Higher Education Academy’s March 2013 Conference: What can higher education contribute to improving social mobility in the UK?, the six papers gathered here give between them a clear indication of the proactive and synergetic manner in which the sector is responding to the resource and funding challenges which it currently faces.

Multiple criteria optimization of contemporary logistics distribution network problems

In the contemporary customer-driven supply chain, maximization of customer service plays an equally important role as minimization of costs for a company to retain and increase its competitiveness. This article develops a multiple-criteria optimization approach, combining the analytic hierarchy process (AHP) and an integer linear programming (ILP) model, to aid the design of an optimal logistics distribution network. The proposed approach outperforms traditional cost-based optimization techniques because it considers both quantitative and qualitative factors and also aims at maximizing the benefits of deliverer and customers. In the approach, the AHP is used to determine the relative importance weightings or priorities of alternative warehouses with respect to some critical customer-oriented criteria. The results of AHP prioritization are utilized as the input of the ILP model, the objective of which is to select the best warehouses at the lowest possible cost. In this article, two commercial packages are used: including Expert Choice and LINDO.

Upper and Lower Bounds in Relator Spaces

2000 Mathematics Subject Classification: 06A06, 54E15

100-Gb/s point-to-point solutions for long-reach passive optical networks in sparse rural and urban areas

Long reach-passive optical networks (LR-PON) are being proposed as a means of enabling ubiquitous fiber-to-the-home (FTTH) by massive sharing of network resources and therefore reducing per customer costs to affordable levels. In this paper, we analyze the chain solutions for LR-PON deployment in urban and rural areas at 100-Gb/s point-to-point transmission using dual polarization-quaternary phase shift-keying (DP-QPSK) modulation. The numerical analysis shows that with appropriate finite impulse response (FIR) filter designs, 100-Gb/s transmission can be achieved with at least 512 way split and up to 160 km total distance, which is sufficient for many of the optical paths in a practical situation, for point-to-point link from one LR-PON to another LR-PON through the optical switch at the metro nodes and across a core light path through the core network without regeneration.

Methicillin-resistant Staphylococcus aureus bacteremia:epidemiology, outcome, and laboratory characteristics in a tertiary referral center in the UK

Objective: To analyze the recent epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in a UK tertiary referral center. Methods: We collected epidemiological and laboratory data on all cases of MRSA bacteremia from September 1, 2005 to December 31, 2007. Results: There were 195 clinically significant episodes. Most were hospital-acquired. Only one episode occurred in patients without a history of hospital admission in the previous 12 months. An intravascular device was the most common focus of infection (37%), with no identifiable source found in 35% of episodes. Twenty-eight percent of patients died within 30 days of bacteremia. Mortality was significantly higher in the absence of an identifiable focus. Failure to include an antibiotic active against MRSA in the empirical treatment was only significantly associated with death in patients showing signs of hemodynamic instability (p < 0.001). No isolates had a minimum inhibitory concentration to vancomycin above 1.5. mg/l and no heteroresistance to glycopeptide antibiotics (heteroresistant vancomycin-intermediate Staphylococcus aureus; hVISA) was detected. All isolates were sensitive to daptomycin, tigecycline, and linezolid. Conclusions: Despite improvement in infection control measures, medical devices remain the most common source of infection. Inappropriate empirical antibiotic usage is associated with a poor outcome in patients with signs of severe sepsis. Susceptibility to glycopeptides and newer antibiotics remains good. © 2010 International Society for Infectious Diseases.

Accounting and the 'insoluble' problem of health care costs

Health service accounting reforms are frequently promoted, explained or justified with reference to ageing populations, expensive medical technologies and their purported implications for the cost of health care. Drawing on Foucault’s genealogical method, we examine the emergence of concerns regarding health expenditure in the wake of the creation of the British National Health Service in 1948, and their relationship with health service accounting practices. We argue that concerns regarding the cost of health care are historically contingent rather than inescapable consequences of demographic and technological change, and that health service accounting practices are both constitutive and reflective of such concerns. We conclude by relating our analysis to current attempts to control costs and increase efficiency in the health services.

Stokes waves revisited:exact solutions in the asymptotic limit

The Stokes perturbative solution of the nonlinear (boundary value dependent) surface gravity wave problem is known to provide results of reasonable accuracy to engineers in estimating the phase speed and amplitudes of such nonlinear waves. The weakling in this structure though is the presence of aperiodic “secular variation” in the solution that does not agree with the known periodic propagation of surface waves. This has historically necessitated increasingly higher-ordered (perturbative) approximations in the representation of the velocity profile. The present article ameliorates this long-standing theoretical insufficiency by invoking a compact exact n-ordered solution in the asymptotic infinite depth limit, primarily based on a representation structured around the third-ordered perturbative solution, that leads to a seamless extension to higher-order (e.g., fifth-order) forms existing in the literature. The result from this study is expected to improve phenomenological engineering estimates, now that any desired higher-ordered expansion may be compacted within the same representation, but without any aperiodicity in the spectral pattern of the wave guides.

Elemzés vagy megérzés: a stratégiai döntéshozatal gyakorlata Californiában és Magyarországon = Analysis or Intuition: Strategic decision making in California and Hungary

Stratégiai döntéseket jellemzően a vállalatok felsővezetői, vezérigazgatók és elnökök hoznak. Ennek szellemében 40 felsővezetőt kérdeztünk két nagyon különböző régióban (Kaliforniában és Magyarországon) egy összehasonlító kutatás keretében. A két országban tizenkét válaszadó vezérigazgató, elnök, alelnök, vagy felelős vezető volt (rájuk, mint Vezetőkre hivatkoztunk), miközben nyolcan alapítói és többségi tulajdonosai voltak saját vállalkozásuknak (őket nevezzük Vállalkozóknak). A kutatás három területre irányult: 1) Hogyan hoznak döntéseket a felsővezetők a valóságban a világ e két különböző táján; 2) Mennyiben különböznek - ha egyáltalán különböznek - a Vállalkozók és a Vezetők az alkalmazott döntéshozatali közelítésmódot tekintve, amikor az analitikus gondolkodást az intuícióikkal kombinálják; 3) Mik a hasonlóságok és a különbségek a menedzsment képességekben és a döntéshozatali rutinokban a Vállalkozók és a Vezetők között a vizsgált menedzsment kultúrákban. = Strategic decision making is usually conducted by a firm’s top management, led by the CEO or the President of the company. In keeping with this, 40 top level managers in two very different regions (California, USA and Hungary) were targeted in a comparative research study. In the two countries, twelve of the managers were CEOs, Presidents, Vice Presidents or Chief Officers (hereafter referred to as Executives) while eight were founders and majority owners of their own enterprises (hereafter referred to as Entrepreneurs). The research focused on the following 3 areas: 1) How top level managers really make strategic decisions in these two different parts of the world; 2) How Entrepreneurs and Executives differ, if at all, in their approach to strategic decision making when they combine analytical thinking with their intuition; 3) The similarities and differences in management skills and decision making routines between Entrepreneurs and Executives within the investigated management cultures.