Analysis of the Strategic Opportunity to Create a Canadian Subsidiary for Axyon Consulting in British Columbia

Axyon Consulting is a privately held US company offering full service professional Open Text Enterprise Content Management (ECM) consulting. The North American ECM market is growing at a considerable rate and the opportunities for ECM consulting services are presenting themselves at a faster pace than the market is able to deliver. Axyon recognizes the need to service the BC market and is currently exploring opportunities to expand operations within Canada.This report examines the opportunity for Axyon to develop a subsidiary operation in British Columbia. The trends and issues that affect the ECM and consulting industries are identified, the BC competitive environment and market opportunities are evaluated, and the market expansion plans are examined. The plan provides strategies and recommendations to address the resource challenges, with respect to recruiting, deploying and retaining consulting resources. These strategies and recommendations, as well as the other elements provided in the plan should serve as an implementation model for the subsidiary, Axyon Canada

Jinnah and the Theatre of Politics

En este artículo estudio cómo el fundador de Paquistán, Mohammad Ali Jinnah, consiguió ser el líder de los musulmanes a pesar de su comportamiento herético, educación británica y arrogancia que, lejos de alejarlo de las masas, apuntalaron su popularidad. Jinnah venía a representar una política basada en la iniciativa más que en la búsqueda de lo tradicionalmente auténtico. La política musulmana en India rechazaba el nacionalismo por pertenencia a un espacio físico, que habría reducido a los seguidores del Profeta a una minoría, no a una nación.In this essay I will look at the way in which Pakistan’s founder, Mohammad Ali Jinnah, managed to lead Muslims without claiming to resemble them in any way. His heretical background, anglicized character and sheer arrogance instead served to augment rather than detract from Jinnah’s popularity, because he represented a politics based on novelty rather than heredity, artifice rather than authenticity. Muslim politics in colonial India was founded upon the rejection of blood-and-soil forms of nationality, which could only define the Prophet’s followers there as a minority and not a nation. Pakistan therefore had to be fought for in the purely ideal terms of a political logic, whose iconic representation was to be found in the biography of the man hailed as its creator

Development of a Metabolic Syndrome Mouse Model of Breast Cancer

Metabolic syndrome is a cluster of disorders, including obesity, atherosclerosis, inflammation and insulin resistance. It is associated with increased risk of various types of cancers including breast cancer. Obesity in particular is a risk factor for an aggressive tumour phenotype and reduced survival of patients with breast cancer. To understand the underlying mechanisms I aimed to develop and characterise a metabolic syndrome mouse with an orthotopic model of breast cancer. Apolipoprotein E (ApoE) is involved in the catabolism of triglycerides and cholesterol, and the ApoE knockout mouse model is prone to obesity and development of atherosclerosis. The double knockout ApoE/ArKO mouse displays all features of metabolic syndrome. At 6 months of age, wild type, ApoE and ApoE/ArKO C57BL/6 mice were inoculated with the murine breast cancer cell line E0771. Growth of tumours in the mammary fat pad and mouse weight were measured until tumours reached ethical endpoint. The hypoxia marker, pimonidazole, was injected 90min prior to euthanasia, and plasma, organs and tumours were harvested and weighed. Half of each tumour was formalin fixed and paraffin embedded for Immunohistochemical (IHC) analysis of cancer associated adipocytes (perilipin), proliferation (phosphohistone-H3), estrogen receptor status (ERα) and hypoxia (pimonidazole adducts). The other half was frozen and processed for tumour lysates, which were used to measure hypoxia inducible factor 1 (HIF-1α) by Western blotting, and adipokines, using an antibody array. Vascular endothelial growth factor (VEGF) and Insulin-like growth factor binding protein 5 (IGFBP5) concentrations were further analysed by an ELISA assay. HIF-1α levels in EO771 cells were analysed by subjecting the cells to hypoxic conditions. ApoE mice weighed more than wild type and ApoE/ArKO mice, and showed increased cellular proliferation. ApoE/ArKO mice had the least omental fat and the smallest tumours. IHC analysis showed that EO771 tumours in ApoE mice had the highest number of intratumoral, perilipin positive adipocytes (p<0.01), and tumours from ApoE/ArKO had the highest percentage of phosphohistone-H3 positive cells (p<0.05). All tumours stained negative for ER-α. Pimonidazole staining was prominent in all tumours, with secondary tumours staining strongly. From Western blot analysis, tumours grown in ApoE/ArKO mice had the highest level of HIF-1α, and HIF-1α levels were higher in secondary tumours compared to primary tumours (p<0.05). A range of adipokines was differentially expressed in tumours grown in the three different genetic backgrounds. VEGF concentrations were higher in primary tumours from ApoE/ArKO mice than ApoE and wild type mice. Primary tumours from ApoE/ArKO mice had significantly lower concentrations of IGFBP5 (p<0.01). My findings show that breast tumours grown in ApoE/ArKO mice have an aggressive tumour phenotype, with increased proliferation, tumour hypoxia and VEGF concentration. These models represent valuable tools for research that will bridge the gap between cell culture models and breast cancer patients

Reclassification of ICD-9 Codes into Meaningful Categories for Oncology Survivorship Research

Background. The International Classification of Disease, ninth revision (ICD-9) is designed to code disease into categories which are placed into administrative databases. These databases have been used for epidemiological studies. However, the categories used in the ICD9-codes are not always the most effective for evaluating specific diseases or their outcomes, such as the outcomes of cancer treatment. Therefore a re-classification of the ICD-9 codes into new categories specific to cancer outcomes is needed. Methods. An expert panel comprised of two physicians created broad categories that would be most useful to researchers investigating outcomes and morbidities associated with the treatment of cancer. A Senior Data Coordinator with expertise in ICD-9 coding, then joined this panel and each code was re-classified into the new categories. Results. Consensus was achieved for the categories to go from the 17 categories in ICD-9 to 39 categories. The ICD-9 Codes were placed into new categories, and subcategories were also created for more specific outcomes. The results of this re-classification is available in tabular form. Conclusions. ICD-9 codes were re-classified by group consensus into categories that are designed for oncology survivorship research. The novel re-classification system can be used by those involved in cancer survivorship research

Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire:results from an observational cohort study in Dutch primary care

OBJECTIVES: To determine the minimal important difference (MID) of the International Prostate Symptom Score (IPSS) and the Overactive Bladder Questionnaire short form (OAB-q SF) assessed in primary care among patients treated for lower urinary tract symptoms (LUTS).DESIGN: Single-arm, open-label observational cohort study with a 6-week follow-up.SETTING: Twenty-two pharmacies in the Netherlands.PARTICIPANTS: We enrolled Dutch men with uncomplicated LUTS who received a new alpha-blocker prescription from their general practitioner or urologist.PRIMARY AND SECONDARY OUTCOMES: The IPSS and OAB-q SF were completed before and after 6 weeks of therapy. At 6 weeks, men also completed the Patient Global Impression of Improvement (PGI-I). The mean change scores of the IPSS and OAB-q SF were calculated for each PGI-I outcome category, with the category 'a little better' used to determine the MID. The SE of measurement (SEM) was calculated for each questionnaire.RESULTS: In total, 165 men completed follow-up. The MID was 5.2 points (95% CI 3.9 to 6.4; SEM 3.6) for the IPSS and 11.0 points (95% CI 7.1 to 14.9; SEM 9.7) for the OAB-q SF. For both questionnaires, CIs showed an overlap with the no-change categories. However, the MID for the IPSS was higher in men with severe baseline symptoms (7.1; 95% CI 5.3 to 9.0) than in men with moderate baseline symptoms (3.2; 95% CI 1.7 to 4.8).CONCLUSION: In this study, the MID for the IPSS was considerably higher than the MID of 3.1 reported in the only other study on this topic, but may be due to methodological differences. Interpretation of the MID for the OAB-q SF is hampered by the overlap with the SEM. Future studies are needed to confirm our results because correlations between the PGI-I and symptom questionnaires were suboptimal.</p

Minimal important changes in standard deviation units are highly variable and no universally applicable value can be determined

[Objectives] This study aims to describe the distribution of anchor-based minimal important change (MIC) estimates in standard deviation (SD) units and examine if the robustness of such estimates depends on the specific SD used or on the methodological credibility of the anchor-based estimates. [Design and Setting] We included all anchor-based MIC estimates from studies published in MEDLINE and relevant literature databases upto October 2018. Each MIC was converted to SD units using baseline, endpoint, and change from baseline SDs. We performed a descriptive analysis of MICs in SD units and checked how the distribution would change if MICs with low methodological credibility were excluded from the analysis. [Results] We included 1, 009 MIC estimates from 182 studies. The medians and interquartile ranges of MICs in SD units were 0.43 (0.25 to 0.69), 0.42 (0.22 to 0.70), and 0.51 (0.28 to 0.78) for baseline, endpoint, and change SD units, respectively. Some MICs were extremely large or small. The distribution did not change significantly after excluding MICs estimated by less credible methods. [Conclusions] The size of the universally applicable MIC in SD units could not be determined. Anchor-based MICs in SD units were widely distributed, with more than half in the range of 0.2 to 0.8

Use of tocilizumab and sarilumab alone or in combination with corticosteroids for covid-19: systematic review and network meta-analysis

Objective: To compare the effects of interleukin 6 receptor blockers, tocilizumab and sarilumab, with or without corticosteroids, on mortality in patients with covid-19. Design: Systematic review and network meta-analysis. Data sources: World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature, and two prospective meta-analyses (up to 9 June 2021). Review methods: Trials in which people with suspected, probable, or confirmed covid-19 were randomised to interleukin 6 receptor blockers (with or without corticosteroids), corticosteroids, placebo, or standard care. The analysis used a bayesian framework and assessed the certainty of evidence using the GRADE approach. Results from the fixed effect meta-analysis were used for the primary analysis. Results: Of 45 eligible trials (20 650 patients) identified, 36 (19 350 patients) could be included in the network meta-analysis. Of 36 trials, 27 were at high risk of bias, primarily due to lack of blinding. Tocilizumab, in combination with corticosteroids, suggested a reduction in the risk of death compared with corticosteroids alone (odds ratio 0.79, 95% credible interval 0.70 to 0.88; 35 fewer deaths per 1000 people, 95% credible interval 52 fewer to 18 fewer per 1000; moderate certainty of evidence), as did sarilumab in combination with corticosteroids, compared with corticosteroids alone (0.73, 0.58 to 0.92; 43 fewer per 1000, 73 fewer to 12 fewer; low certainty). Tocilizumab and sarilumab, each in combination with corticosteroids, appeared to have similar effects on mortality when compared with each other (1.07, 0.86 to 1.34; eight more per 1000, 20 fewer to 35 more; low certainty). The effects of tocilizumab (1.12, 0.91 to 1.38; 20 more per 1000, 16 fewer to 59 more; low certainty) and sarilumab (1.07, 0.81 to 1.40; 11 more per 1000, 38 fewer to 55 more; low certainty), when used alone, suggested an increase in the risk of death. Conclusion: These findings suggest that in patients with severe or critical covid-19, tocilizumab, in combination with corticosteroids, probably reduces mortality, and that sarilumab, in combination with corticosteroids, might also reduce mortality. Tocilizumab and sarilumab, in combination with corticosteroids, could have similar effectiveness. Tocilizumab and sarilumab, when used alone, might not be beneficial.This project is supported by two Canadian Institutes of Health Research grants (VR4-172738; MM1-174897). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.publishedVersio

Jinnah and the theatre of politics

In this essay I will look at the way in which Pakistan’s founder, Mohammad Ali Jinnah, managed to lead Muslims without claiming to resemble them in any way. His heretical background, anglicized character, and sheer arrogance instead served to augment rather than detract from Jinnah’s popularity, because he represented a politics based on novelty rather than heredity, artifice rather than authenticity. Muslim politics in colonial India was founded upon the rejection of blood-and-soil forms of nationality, which could only define the Prophet’s followers there as a minority and not a nation. Pakistan therefore had to be fought for in the purely ideal terms of a political logic, whose iconic representation was to be found in the biography of the man hailed as its creator

The terrorist as humanitarian

A global society has come into being, but as yet it possesses no political institutions proper to its name. I will make the case that new forms of militancy, like that of al-Qaeda, achieve meaning in this institutional vacuum while representing, in their own way, the search for a global politics. From environmentalism to pacifism, such a worldwide politics can only be one that takes humanity itself as its object. This article aims to show that militant practices are informed by the same search that animates humanitarianism, which has become the global aim and signature of all politics today. © Berghahn Journals