Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Islamic Banking in Australia: Challenges and Opportunities

Muslims are one of the many minorities in Australia. In this paper we report on Muslim community's reasons for discomfort with the use of the Western financial system and describe the alternative to it that has come to be known as "Islamic banking". One of the major differences between the Western and the Islamic financial systems is the use of interest (riba) which is the very foundation of the Western financial system but prohibited under the Islamic rulings governing permissible financial transactions. In this paper we will describe the activities and operations of the Islamic financial institutions and discuss why riba-free banking is likely to flourish in Australia in the future

Perceptions of firms learning and growth under knowledge management approach with linkage to balanced scorecard (BSC) : evidence from a multinational corporation of Bangladesh

The study attempts to measure organization's perception on learning and growth with the help of Balanced scorecard model in a multinational firm of Bangladesh.That is to say, in this paper it has been shown how a proper and effective knowledge management can make possible the organization's financial success that can be revealed using the Balanced Scorecard (BSC) framework. Additionally, the perception about knowledge management , its linkage to the BSC and its usage have been identified. Primary data collected for conducting this emperical research was carried out through survey method using structured questionnaire. Data were then analysed with the help of bi-variate and multi-vatiate techniques of statistics. Empirical results of our study suggest that learning and growing organization is one in which knowledge management activities are deployed and expanded with a view to leverage the creativity of all the people in the organization The result also evidenced that BSC, as a strategic performance measurement tool, helps in strategic management by linking some strategically significant, relevant, and interrelated measures or indicators with organizational emphasis on knowledge and learning initiatives.26 page(s

The Roles of degree of competition and types of business strategies in adopting multiple performance measurement practices : some reflections from Bangladesh

Aim – This empirical study explores the association between competition, business strategy, and the uses of a multiple performance measurement system in Bangladesh manufacturing firms. Design/methodology – The study uses a questionnaire survey of 50 manufacturing companies. Data were analyzed using multiple regression analysis and other descriptive statistics. Findings – The results suggest that greater emphasis on multiple measures for performance evaluation is associated with businesses that are facing high competition. The practices of multiple performance measures are also significantly related to the types of business strategy being followed. Specifically, firms pursuing a prospector strategy have relied more on multiple performance measures to rate business performance than the firms pursuing a defender strategy. Practical implications – The article notes that the designers of performance measurement systems need to consider contingent factors that affect an organizations’ control system. Originality/value – Substantiating the connection between contingent variables and the use of multiple performance measures in manufacturing firms facilitate a better acceptance of firms’ tendency toward new measurement tools. The study contributes to the performance measurement and contingency literature since it presents empirical evidence of the state of multiple performance measures with organizational contingent variables using a developing country's manufacturing sector data.32 page(s

Non-Financial Performance Measures - Organizational Performance Relationship in the Bangladeshi Firms: The Moderator Role of Environmental Uncertainty and Corporate Culture

This paper empirically examines the role of environmental uncertainty and corporate culture on the relationship between non-financial performance measures and organizational performance from manufacturing firms in Bangladesh. Specifically, it investigates the hypothesis that non-financial measures of performance lead to improved organizational performance under circumstances of increased environmental uncertainty and corporate culture.Data from a sample of 61 manufacturing firms listed on Dhaka Stock Exchange (DSE) in Bangladesh were collected. Data were then analyzed using multiple regression and factor analysis of multivariate statistical tool.Results show that there is a negative but statistically significant relationship regarding the impact of environmental uncertainty on the relationship between non-financial measures and firm performance. The results also advocate that sample Bangladeshi firms make greater use of non- financial measures with the aim of improving firm performance when environmental uncertainty is low. Conversely, the study finds positive relationship between flexibility type corporate culture and the organizational performance, and the moderating effect of this cultural type on the non-financial performance measures- organizational performance linkage.The results of this study must be interpreted with caution since it concentrates only on small sample manufacturing firms.To the best of our knowledge, the study is first to provide evidence on the environmental uncertainty and corporate culture affecting the use of non-financial performance