Human Sigma: What, Why and Why Not

The high levels of employee disengagement at the global and national levels, pressures of the rising consumer empowerment, especially, on sales and service organizations, and growing need to ensure the delivery of high quality customer experience—all three, collectively, require a business solution to avoid their negative impact on the financial efficiency of organizations. Human Sigma, such a solution, is a philosophy as well as a strategy that focuses on strengthening the interactions of two most important Human system assets of a sales and service organization, namely, employees and customers. Accordingly, the nature and significance of Human Sigma are explained. A simplified alternative to Human Sigma— Net Promoter Score—is also suggested

Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians

Aim: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation. Methods: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confi rmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profi le of this group was studied. Results: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m2 respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) infl ammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fi brosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5, P = 0.002) and AST/ALT ratio > 1 (OR = 14.3; 95% CI: 1.4-678.5, P = 0.008) were associated with high grades of inflammation and none was associated with advanced fibrosis. On multivariate logistic regression analysis, hypertriglyceridemia >150 mg% was the only factor independently associated with presence of high grade of infl ammation (OR = 1.6; 95% CI: 1.3-22.7, P = 0.02), while none was associated with advanced fi brosis. Triglyceride levels correlated positively with infl ammatory grade (r = 0.412; P = 0.003). Conclusion: NAFLD in North Indian patients is a disease of young over-weight males, most of whom are insulin resistant and they tend to have a mild histological disease at presentation

Optical coherence tomography for the diagnosis of skin cancer in adults

Background: Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised, with potential to infiltrate and damage surrounding tissue. Anxiety around missing early cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Optical coherence tomography (OCT) is a microscopic imaging technique, which magnifies the surface of a skin lesion using near-infrared light. Used in conjunction with clinical or dermoscopic examination of suspected skin cancer, or both, OCT may offer additional diagnostic information compared to other technologies. Objectives: To determine the diagnostic accuracy of OCT for the detection of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, basal cell carcinoma (BCC), or cutaneous squamous cell carcinoma (cSCC) in adults. Search methods: We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; EMBASE; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. Selection criteria: Studies evaluating OCT in adults with lesions suspicious for invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC, compared with a reference standard of histological confirmation or clinical follow-up. Data collection and analysis: Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). Our unit of analysis was lesions. Where possible, we estimated summary sensitivities and specificities using the bivariate hierarchical model. Main results: Five studies including 529 cutaneous lesions (273 malignant lesions) were included, providing nine datasets for OCT, two for visual inspection alone, and two for visual inspection plus dermoscopy. Studies were of moderate to poor quality using data driven thresholds for test positivity and giving poor accounts of reference standard interpretation and blinding. Studies may not be representative of populations eligible for OCT in practice, for example due to high disease prevalence in study populations, and may not reflect how OCT is used in practice, for example by using previously acquired OCT images. It is not possible to make summary statements regarding accuracy of detection of melanoma or of cSCC because of the paucity of studies, small sample sizes, and for melanoma differences in the OCT technologies used (high-definition versus conventional resolution OCT), and differences in the degree of testing performed prior to OCT (i.e. visual inspection alone or visual inspection plus dermoscopy). Pooled data from two studies using conventional swept-source OCT alongside visual inspection and dermoscopy for the detection of BCC estimated the sensitivity and specificity of OCT as 95% (95% CI: 91, 97%) and 77% (95% CI: 69, 83%), respectively. When applied to a hypothetical population of 1000 lesions at the mean observed BCC prevalence of 60%, OCT would miss 31 BCCs (91 fewer than would be missed by visual inspection alone and 53 fewer than would be missed by visual inspection and dermoscopy), and OCT would lead to 93 false positive results for BCC (a reduction in unnecessary excisions of 159 compared to using visual inspection alone and of 87 compared to visual inspection and dermoscopy). Authors' conclusions: Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggests conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection and dermoscopy. However the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn. Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and indeed other similar diagnostic aids such as reflectance confocal microscopy

Factors influencing consumers' behaviour towards organic food purchase in Denmark and Tanzania

This paper adds to the debate about factors influencing consumer behaviours that lead to the actual purchase of organic food in both developed and developing countries. Accordingly, authors seek to understand how consumers' knowledge about organic food and consumers' overall health consciousness play out as mechanisms for consumers' behaviours leading to actual purchase. Samples from Tanzania as a developing country and Denmark as a developed country are used. A total of 1393 consumers filled the questionnaire. The study found that consumer knowledge and health consciousness function as underlying mechanisms in the relationship of attitude and subjective norms for actual purchase of organic food behaviour in Tanzania. In addition, consumer knowledge and health consciousness function as an underlying mechanism in the relationship of attitude and perceived behaviour control for actual purchase of organic food in Denmark. The study argues for enhancing consumers' knowledge of organic food as the latter has been championed for its perceived health benefits in both developed and less developed countries

EXTENSIVE ROLE OF FOREIGN DIRECT INVESTMENT IN DEVELOPMENT OF INDIAN ECONOMY

Since 2001, the extensive growth in domestic economy were potentially associated with the scale of foreign direct inflows that were largely interconnected with industrial growth, re-shuffling investment policies, and availability of large market size in India. However, the government remained much restrictive earlier in these issues to protect the domestic entrepreneurs along with to promote the self-efficacy among individuals. Within this framework, this paper is being prepared to observe the degree of effect of foreign direct investment inflow over successive economic parameters such as gross domestic product and Export. Moreover, to define such interconnection, the generalized linear model econometric model has been developed to analyze the overall effect and uni-variate effect over three categorical factors i.e. country, year and foreign direct investment itself. Finally, the results shown, the consistent foreign direct investment inflows is the result of successive years that led to increase the prestige of gross domestic products and Export in many folds during a period from 2000 to 2012

2'-hydroxychalcone inhibits nuclear factor-κB and blocks tumor necrosis Factor-α- and lipopolysaccharide-induced adhesion of neutrophils to human umbilical vein endothelial cells

Inhibition of expression of cell adhesion molecules (CAM), including intercellular CAM-1 (ICAM-1), vascular CAM-1 (VCAM-1), and E-selectin, has been shown to be important in controlling various inflammatory diseases. The cell adhesion proteins are induced by various inflammatory cytokines, such as tumor necrosis factor-α, interleukin-1, and bacterial lipopolysaccharide. The induction process primarily takes place at the level of transcription, where nuclear factor-κB (NF-κB) plays a major role. We demonstrate here that 2'-hydroxychalcone inhibits the adhesion of peripheral neutrophils to the endothelial cell monolayers by inhibiting the expression of ICAM-1, VCAM-1, and E-selectin in a concentration-dependent manner. The inhibition by 2'-hydroxychalcone is reversible. 2'-Hydroxychalcone inhibits the induction of steady-state transcript levels of ICAM-1, VCAM-1, and E-selectin by tumor necrosis factor-α as determined by reverse transcription-polymerase chain reaction, and therefore it may interfere with the transcription of their genes. Because NF-κB is a major transcription factor involved in CAM expression, we studied its status in the 2'-hydroxychalcone treated cells. We demonstrate that 2'-hydroxychalcone inhibits the activation of NF-κB. These results have implications for using NF-κB inhibitors for the treatment of various inflammatory diseases

Patterns of responses to alternative medicines in controlling allergic conjunctivitis

This analysis identifies the various patterns of the responses of the medicines in controlling allergic conjunctivitis. The mean S Deviation coefficient of variation, correlation matrix and loading of factors are worked out as stated in the tables. In the present case the Eigen values greater than 1.50 are retained. The four factors retained explain 68% of the total variations of the 16 responses. The first factor shows 23.38% of variations in total responses while first two and first three factors show 42.39% and 58.64% respectively. Thus medicine affective in controlling the symptoms are given In the descending order: oxymetazoline and sodium salicylate and Sodium cromoglycate, Oxymetazoline and Disodium CCromoglycate & Sodium Salicylate and disodium Cromoglycate