Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom

Objective: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. Setting TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Methods: Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Main outcome measures: Quality-adjusted life-years (QALYs). Results: In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGITIORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses. Conclusions: TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain

Role of “reduced-size” liver/bowel grafts in the “abdominal wall transplantation” era

The evolution of multi-visceral and isolated intestinal transplant techniques over the last 3 decades has highlighted the technical challenges related to the closure of the abdomen at the end of the procedure. Two key factors that contribute to this challenge include: (1) Volume/edema of donor graft; and (2) loss of abdominal domain in the recipient. Not being able to close the abdominal wall leads to a variety of complications and morbidity that range from complex ventral hernias to bowel perforation. At the end of the 90's this challenge was overcome by graft reduction during the donor operation or bench table procedure (especially reducing liver and small intestine), as well as techniques to increase the volume of abdominal cavity by pre-operative expansion devices. Recent reports from a few groups have demonstrated the ability of transplanting a full-thickness, vascularized abdominal wall from the same donor. Thus, a spectrum of techniques have co-evolved with multi-visceral and intestinal transplantation, ranging from graft reduction to enlarging the volume of the abdominal cavity. None of these techniques are free from complications, however in large-volume centers the combinations of both (graft reduction and abdominal widening, sometimes used in the same patient) could decrease the adverse events related to recipient's closure, allowing a faster recovery. The quest for a solution to this unique challenge has led to the proposal and implementation of innovative solutions to enlarge the abdominal cavity

Technology Strategy Formulation for Global Corporations

Most global companies operate in multiple countries and locations all around the world. The focus on technology and economics is not enough as the global corporations have affiliates and subsidiaries that carry social and political undertones stemming from cultural and geographical diversity. The execution of digitalization/technology strategy is governed by the interplay of social structures and technology. Orlikowski, Sabatier and other researchers found that social aspects significantly contribute to strategy execution success. Lindbolm, Dunshire and others have brought into limelight the bipartisan politics, mutual adjustment etc. This chapter discusses major elements of technology strategy viz. Technological considerations, Operational considerations, Economic aspects, Social aspects and Political issues. Converging, the chapter presents aspects of technology strategy of national companies and multinational companies, specifically focusing on social and political angles of a multinational companies. Third part focuses on technology strategy formulation process, concluding that it is the strength of the process of strategy formulation that will help the companies in the changing dynamic environment business scenario. The model offered here is titled IPCRC model adapted from Vaidya that addresses meeting socio-political challenges of a multinational company. Conceptually this model may be used in any business or functional strategy formulation

A Study on Causes of Stress among the Employees and Its Effect on the Employee Performance at the Workplace in an International Agricultural Research Institute, Hyderabad, Telangana, India

The stress has significant psychological, physiological and performance effects on human resources of an organization. The contribution of the researchers on stress was significant due to the dynamic social factors and life style changes. Though, the stress has some ill health effects not all the stresses are destructive in nature. The good stress – eustress creates positive reaction to stress that generates within person a desire to achieve and overcome a challenge and allows to perform best of his/her ability. The most of the studies carried out and reported the effects of stress on human resources and organizations are limited to either Information Technology or Banking sector. The work stress is found in all the sectors. The focus of this paper is to throw a light on the wide spread silent issue the “Stress” and its effects on employees in an International Agricultural Research Institute, Hyderabad, Telangana, India and suggest appropriate coping strategies. A survey of 200 employees of the institute carried out to assess the job related, organization related, individual related and physiological reactions to stress and its effect on employees’ performance. We have applied the descriptive analysis, correlation techniques and regression analysis to arrive the conclusions. To measure the reliability of the scale used for this research, and internal consistencies of the survey questionnaire, the reliability static Cronbach's alpha is used. The study concluded that the occupational stress is having moderate impact on the employees’ performance of the institute, the job related stress in general and the stress factor job security in particular. The employees’ reaction to the stress – physiological factors also has moderate effect the performance of an employee. Health-wise, some employees had developed chronic neck and back pain, an effect of long sitting hours at work. Keywords: Job related stress, Individual related stress, performance, Cronbach’s alpha, stres

The implications of organizational context for Information Systems and Technology strategy formulation. A study of socio-political factors in global corporations.

Information systems and technology strategy has been discussed by many researchers and authors over last three decades. The concepts of business alignment, competitive advantage, value generation etc. have been elaborated and still similar discussions continue. While the advances in IS/IT strategy formulation were being made, the businesses were changing their operating models. More specifically they became global businesses active in multiple geographies at the same time. This research aims to provide deeper understanding of IT developments in global organizations as manifested in the changing social and political environment of the organization and the reciprocal effect of social and political changes on IT strategies. Further it aims to investigate whether the relevant theories and concepts can be integrated to develop a new model that can incorporate the socio-political aspects into IS/IT strategy formulation. To achieve this objective the literature survey was conducted to explore available published papers in the sphere of IS/IT strategy formulation. Considering that the applicability of information systems and technology falls into the sphere of social sciences, the research design focused on the qualitative approach. The primary method of data collection was through semi-structured interviews with IT managers. This was complemented by interviews with business managers and consultants. Further the experiences of the researcher in the earlier role of practitioner were taken into account. Using grounded theory approach the information collected through interviews, own experiences and the data gathered from literature survey were used to develop a new model of IT strategy formulation. The model addresses the context part of IT strategy formulation process. This model development is aimed to counter and account for the political and social aspects of strategy development and deployment in global corporations characterised by diversity of cultures, attitudes and behaviours

FORMULATION DEVELOPMENT AND CHARACTERIZATION OF LYOPHILIZED FEBUXOSTAT NANOSUSPENSION

Objective: The study aims to prepare and evaluate febuxostat nanosuspension to improve oral bioavailability. Methods: Febuxostat nanosuspension was prepared by the solvent-antisolvent method, followed by a lyophilization technique using PVP K-30 as a stabilizer and sodium lauryl sulfate as a surfactant. Drug content, differential scanning calorimetry, powder x-ray diffraction, Fourier transform infrared spectroscopy, and in vitro dissolution studies were used to characterize the nanosuspension. Results: The results of the characterization studies indicated the formation of nanosuspension. The lyophilized FXT NS particle size is 2170.2 nm, the PDI value is 0.63, the negative zeta potential is 1.6 mV, and the drug content is 19.02%. Functional characterization studies demonstrated that the particle size reduced due to the interaction between the stabilizer and surfactant. Conclusion: It can be concluded that the prepared febuxostat nanosuspension enhances the aqueous solubility of FXT and improves its oral bioavailability

A Comparative Analysis on the Causes of Occupational Stress among Men and Women Employees and its Effect on Performance at the workplace of Information Technology Sector, Hyderabad

The research study presents the outcome of a comparative analysis on causes of occupational stress among the Men and Women employees and its effect on the employee performance at the workplace of Information Technology Sector (ITS), Hyderabad. A survey of 200 employees consisting 110 Men and 90 Women working in the IT sector was carried out to assess the six independent stress causing factors Job related, Organizational Related, Career, Physiological, Behavioral and Individual factors and its effect on employees’ Performance a dependent factor. The descriptive analysis, correlation techniques and parametric statistics like t-test, F-test and multiple regression analysis carried out to arrive at the conclusions. To measure the reliability of the scale used for this study, and internal consistencies of the survey questionnaire, the reliability static Cronbach’s alpha (C-alpha) and Spearman-Brown split-half reliability statistics were estimated. The overall C-alpha is 0.89 whereas the Spearman-Brown split half statistic is 0.83. The C-alpha values ranged from 0.62 to 0.76 for Men and 0.60 to 0.74 for Women, for all the 6 independent and one dependent factor. The results of the study indicate that the medium level occupational stress exists at the workplace in general, effecting the performance moderately. Health-wise, some employees developed chronic neck and back pain, an effect of long sitting hours at work. The study confirms that Women will have more stress than Men, however the factors causing the stress among the Men and Women are not similar

Postharvest Management and Value Addition of Ginger (Zingiber Officinale Roscoe): A Review

Ginger is an important spice crop and India is one of the leading producer and exporter of ginger in the world. Ginger is widely used around the world in food as a spice both in fresh and dried form which adds flavour to the meal by creating spicy pungent taste. The chemical components of the ginger rhizome vary considerably depending on the location of cultivation and postharvest treatments. Ginger contains polyphenol compounds such as gingerol and its derivatives like zingiberone, bisabolene, camphene, geranial, linalool, borneol and oleoresin (combination of volatile oils and resin) that accounts for its characteristic aroma and therapeutic properties. Fresh ginger are perishable in nature and are spoiled due to improper handling, growth of spoilage microorganisms, susceptibility to rhizome rot, wilting and sprouting, action of naturally occurring enzymes, chemical reactions and structural changes during storage. Keeping in mind the low shelf-life of fresh ginger and inadequate facility for their modern storage leading to distress sale, value addition could be a viable alternative which will fetch remunerative price to the growers. The present scenario, nutritional importance, postharvest management, value added products of ginger have been discussed in detail in the review