Foreign Venture Capital Firms in a Cross-Border Context: Empirical Insights from India

Syndication or co-investment is a potent way of pooling resources among peer Venture Capital (VC) firms. This is even more vital for Foreign VC firms (FVCFs) when investing in destinations that are geographically distant from their countries of origin. Although FVCFs are relatively abundantly endowed in terms of financial capital, they are distinctly disadvantaged in terms of their social capital when investing in geographies that are distinctly different in terms of their institutions, norms, and culture from their own. One of the ways in which FVCFs overcome this impediment is by investing in human resources that serve as a bridge between their financial and social capital. Accordingly, the primary aim of this study is to investigate the relationship between the resources of FVCFs and their syndication intensity. Using the technique of logistic regression, we arrive at several interesting findings. FVCFs with a greater proportion of investment executives with prior founding experience in India and those with lower proportions of professionals of Indian origin demonstrate lower syndication intensity. Similarly, the syndication intensity diminishes with the increase in size of the investing team. FVCFs with greater fund size demonstrate a lower need for syndication. Greater endowment of social capital as proxied by the age of the VC firm is seen to enhance the syndication intensity

Sources, blood concentrations, and approaches for reducing exposure to lead: A critical appraisal on lead poisoning

Lead, a non-essential metal, enters the body in various ways, making it a major public health issue. Painters and smelters report lead poisoning in children and staff. Mining and battery workers risk lead exposure. Traditional and cultural remedies may include dangerous quantities of lead, producing lead poisoning. These drugs must be properly understood and regulated to avoid toxicity. Lead poisoning symptoms vary by duration and severity. Lead first impairs cognition, development, and behaviour by damaging the neural system. Time degrades reproductive and haematological systems. Lead's quiet entry into the body makes it deadly. Acute lead nephropathy damages kidneys at 100mg/dL. Lead levels exceeding 150mg/dL may induce encephalopathy. Blood lead levels indicate lead poisoning severity. Lead levels over 10g/dL in children and 40g/dL in adults are hazardous. Lead toxicity affects various organs. Lead may induce hypertension and cardiovascular disease. It may also cause chronic kidney disease and renal failure. Lead exposure may impede fertility, cause miscarriages, and alter foetal development; hence the reproductive system is vulnerable. Symptoms and lead levels may be treated with different approaches. Lead chelation treatment is frequent. Other vitamins and medications may enhance organ function and treat lead poisoning. Lead poisoning prevention requires widespread awareness. Strict standards and education regarding lead-contaminated products and conventional remedies should reduce occupational lead exposure. Regular blood lead level monitoring, especially in youngsters and lead workers, may help detect and treat lead poisoning early. Lead poisoning has serious health consequences. Understanding lead exposure pathways, identifying symptoms, and preventing lead poisoning is essential to public health and organ system protection

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

Background and purpose: Prospectively collected data comparing the safety and effectiveness of individual non-vitamin K antagonists (NOACs) are lacking. Our objective was to directly compare the effectiveness and safety of NOACs in patients with newly diagnosed atrial fibrillation (AF). Methods: In GLORIA-AF, a large, prospective, global registry program, consecutive patients with newly diagnosed AF were followed for 3 years. The comparative analyses for (1) dabigatran vs rivaroxaban or apixaban and (2) rivaroxaban vs apixaban were performed on propensity score (PS)-matched patient sets. Proportional hazards regression was used to estimate hazard ratios (HRs) for outcomes of interest. Results: The GLORIA-AF Phase III registry enrolled 21,300 patients between January 2014 and December 2016. Of these, 3839 were prescribed dabigatran, 4015 rivaroxaban and 4505 apixaban, with median ages of 71.0, 71.0, and 73.0 years, respectively. In the PS-matched set, the adjusted HRs and 95% confidence intervals (CIs) for dabigatran vs rivaroxaban were, for stroke: 1.27 (0.79–2.03), major bleeding 0.59 (0.40–0.88), myocardial infarction 0.68 (0.40–1.16), and all-cause death 0.86 (0.67–1.10). For the comparison of dabigatran vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 1.16 (0.76–1.78), myocardial infarction 0.84 (0.48–1.46), major bleeding 0.98 (0.63–1.52) and all-cause death 1.01 (0.79–1.29). For the comparison of rivaroxaban vs apixaban, in the PS-matched set, the adjusted HRs were, for stroke 0.78 (0.52–1.19), myocardial infarction 0.96 (0.63–1.45), major bleeding 1.54 (1.14–2.08), and all-cause death 0.97 (0.80–1.19). Conclusions: Patients treated with dabigatran had a 41% lower risk of major bleeding compared with rivaroxaban, but similar risks of stroke, MI, and death. Relative to apixaban, patients treated with dabigatran had similar risks of stroke, major bleeding, MI, and death. Rivaroxaban relative to apixaban had increased risk for major bleeding, but similar risks for stroke, MI, and death. Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01468701, NCT01671007. Date of registration: September 2013

Anticoagulant selection in relation to the SAMe-TT2R2 score in patients with atrial fibrillation. the GLORIA-AF registry

Aim: The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT2R2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and ≥1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT2R2 score >2 and ≤ 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT2R2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT2R2 scores >2 and 27.5% in those with scores ≤2. Conclusions: The lack of a clear association between the SAMe-TT2R2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT2R2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial. Clinical trial registration: URL: https://www.clinicaltrials.gov//Unique identifier: NCT01937377, NCT01468701, and NCT01671007

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Robust and fault-tolerant scheduling for scientific workflows in cloud computing environments

© 2015 Dr. Deepak Poola ChandrashekarCloud environments offer low-cost computing resources as a subscription-based service. These resources are elastically scalable and dynamically provisioned. Furthermore, new pricing models have been pioneered by cloud providers that allow users to provision resources and to use them in an efficient manner with significant cost reductions. As a result, scientific workflows are increasingly adopting cloud computing. Scientific workflows are used to model applications of high throughput computation and complex large scale data analysis. However, existing works on workflow scheduling in the context of clouds are either on deadline or cost optimization, ignoring the necessity for robustness. Cloud is not a utopian environment. Failures are inevitable in such large complex distributed systems. It is also well studied that cloud resources experience fluctuations in the delivered performance. Therefore, robust and fault-tolerant scheduling that handles performance variations of cloud resources and failures in the environment is essential in the context of clouds. This thesis presents novel workflow scheduling heuristics that are robust against performance variations and fault-tolerant towards failures. Here, we have presented and evaluated static and just-in-time heuristics using multiple fault-tolerant techniques. We have used different pricing models offered by the cloud providers and proposed schedules that are fault-tolerant and at the same time minimize time and cost. We have also proposed resource selection policies and bidding strategies for spot instances. The proposed heuristics are constrained by either deadline and budget or both. These heuristics are evaluated with the prominent state-of-the art workflows. Finally, we have also developed a multi-cloud framework for the Cloudbus workflow management system, which has matured with years of research and development at the CLOUDS Lab in the University of Melbourne. This multi-cloud framework is demonstrated with a private and a public cloud using an astronomy workflow that creates a mosaic of astronomic images. In summary, this thesis provides effective fault-tolerant scheduling heuristics for workflows on cloud computing platforms, such that performance variations and failures can be mitigated whilst minimizing cost and time

High-order finite-difference entropy stable schemes for two-fluid relativistic plasma flow equations

In this article, we propose high-order finite-difference entropy stable schemes for the two-fluid relativistic plasma flow equations. This is achieved by exploiting the structure of the equations, which consists of three independent flux components. The first two components describe the ion and electron flows, which are modeled using the relativistic hydrodynamics equation. The third component is Maxwell's equations, which are linear systems. The coupling of the ion and electron flows, and electromagnetic fields is via source terms only. Furthermore, we also show that the source terms do not affect the entropy evolution. To design semi-discrete entropy stable schemes, we extend the RHD entropy stable schemes in Bhoriya et al. to three dimensions. This is then coupled with entropy stable discretization of the Maxwell's equations. Finally, we use SSP-RK schemes to discretize in time. We also propose ARK-IMEX schemes to treat the stiff source terms; the resulting nonlinear set of algebraic equations is local (at each discretization point). These equations are solved using the Newton's Method, which results in an efficient method. The proposed schemes are then tested using various test problems to demonstrate their stability, accuracy and efficiency