Provider and participant views and experiences of the ESTEEM dietary intervention for pregnant women with metabolic risk factors: a qualitative study

Background ESTEEM (Effect of Simple, Targeted diEt in prEgnant women with Metabolic risk factors on pregnancy outcomes), was a randomised controlled trial of a dietary intervention based on the Mediterranean diet. Intervention programmes like this are recognised in the literature as complex to evaluate and engagement and adherence are problematic. There is a need for dietary interventions in pregnancy which are simple and effective. The aim The aim of this study was to explore the views and experiences of the ESTEEM dietary intervention in a pregnant cohort with metabolic risk factors. Methods Qualitative methods using interviews with women, partners (separately) and focus groups with health care professionals were carried out. Data were analysed using thematic analysis. The findings Women were able to plan and adapt their food and use the ESTEEM diet to their own and their family’s advantage. Conversely, some of the information provided during the ESTEEM intervention made women more aware of their metabolic risk factors and more anxious. Women found solutions to their individual concerns during the ESTEEM intervention, by sharing information and ideas, and by supporting each other. Partners perceived the dietary intervention as having benefits for themselves, the mother as well as their children. Men appeared to hold mothers to be mainly responsible for feeding the children and ensuring that what they ate was healthy. Health care professionals considered that developing and maintaining good relationships with women, and skilful and flexible approaches to enable dietary change were needed. They also emphasised the need to include family and friends, and in particular, children in interventions. Conclusions In order to effect dietary change, the material context in which people live must be taken into consideration. Diet and lifestyle interventions will become truly effective if they are codesigned with women and families and health care is co-produced with people

Performance of Small and Medium Enterprises: Evidence from Nigerian Business Environment

There is growing body of evidence supporting the relationship between planning practices and perceived benefits in organizations. Most of  the studies carried out have been limited only to large enterprises in developed economies. There is, however some fewer empirical work that has examined the relationship between planning and organizational performance in under-developed countries. To fill this gap, this study examined the relationship between formal planning and business performance having taken a sample of manufacturing SMEs in Nigeria. Data and relevant information elicited from selected respondents in SMEs were analyzed. Results of the analysis revealed that there exists a significant relationship between planning and performance of SMEs. The findings of the study provided some insight to fill the research gap and contribute to the literature which can be useful to owners and managers of SMEs

Internal Marketing and Market Orientation of Mobile Telecommunication Companies in Nigeria

The purpose of this study was to empirically investigate how Internal Marketing influences Market Orientation of Mobile Telecommunication Firms in Nigeria. Three hundred and seventy four (374) copies of the questionnaire were administered to respondents. Upon retrieval and data cleaning, 338 copies were subjected to Data analysis. Data analyses were aided by the use of SPSS version 20 and hypotheses were tested using the Simple Regression method. After the data analysis, it was revealed that: Most sampled employees agreed that internal marketing has led the firm to have sufficient understanding of the needs and preferences of customers to be able to continuously create superior value for them, understand the short-term strengths and weaknesses and the long-term capabilities of both current and potential competitors, and has been responsible for the improved level of their networks’ ability to coordinate personnel and other resources throughout the organisation. Internal Communication, Job Satisfaction and Employee Motivation were found to be strong dimensions of Internal Marketing that positively and significantly influences all the three measures of Market Orientation (customer focus, competitor focus and interfunctional coordination). There is a significant and positive influence of Organisational Commitment on the relationship between Internal Marketing and Market Orientation. We therefore concluded that all the three dimensions of Internal Marketing (internal communication, job satisfaction and employee motivation) positively correlate with the measures of Market Orientation (customer focus, competitor focus and interfunctional coordination). Also, there is a significant and positive influence of Organisational Commitment as moderating variable on the relationship between Internal Marketing and Market Orientation. Based on the findings and conclusions we recommended that since Internal Communication, Job Satisfaction and Employee Motivation all positively relates with Market Orientation, Mobile telecommunication firms in Nigeria should: Improve how both informal and formal information are exchanged between management and employee. Improve their physical facilities, equipment and communication materials, create opportunities for career development and regularly evaluate employees satisfaction with their work situation to know if employee’ enjoy and sees their job as pleasurable and satisfying. Improve employee motivation by giving financial incentives for additional work done, giving health insurance and also make the work environment comfortable. Also, since Organisational Commitment positively and significantly influences the relationship between Internal Marketing and Market Orientation, Mobile Telecommunication firms need to improve activities in the organisation that will make the employees proud to associate with the organisation as a result make them to be loyal and proud to discuss their organisation with others outside the organisation and want to stay even if they get a better offer

Multimodal, Unstable Theory

The refinement of courseware is a natural quandary. After years of practical research into simulated annealing, we disprove the study of consistent hashing, demonstrates the extensive importance of programming languages. We construct new trainable information (SUSU), proving that the memory bus and model checking are generally incompatible

Technology-Supported Guidance Models Stimulating the Development of Critical Thinking in Clinical Practice: Mixed Methods Systematic Review

publishedVersio

The Freshman, vol. 5, no. 1

The Freshman was a weekly, student newsletter issued on Mondays throughout the academic year. The newsletter included calendar notices, coverage of campus social events, lectures, and athletic teams. The intent of the publication was to create unity, a sense of community, and class spirit among first year students

Nivolumab in Advanced Hepatocellular Carcinoma: Safety Profile and Select Treatment-Related Adverse Events From the CheckMate 040 Study.

BACKGROUND: CheckMate 040 assessed the efficacy and safety of nivolumab in patients with advanced hepatocellular carcinoma (HCC). Understanding the safety profile of nivolumab is needed to support the management of treatment-related adverse events (TRAEs). This analysis assessed the safety of nivolumab monotherapy in the phase I/II, open-label CheckMate 040 study. MATERIALS AND METHODS: Select TRAEs (sTRAEs; TRAEs with potential immunologic etiology requiring more frequent monitoring) occurring between first dose and 30 days after last dose were analyzed in patients in the dose-escalation and -expansion phases. Time to onset (TTO), time to resolution (TTR), and recurrence of sTRAEs were assessed, and the outcome of treatment with immune-modulating medication (IMM) was evaluated. RESULTS: The analysis included 262 patients. The most common sTRAE was skin (35.5%), followed by gastrointestinal (14.5%) and hepatic (14.1%) events; the majority were grade 1/2, with 10.7% of patients experiencing grade 3/4 events. One patient had grade 5 pneumonitis. Median (range) TTO ranged from 3.6 (0.1-59.9) weeks for skin sTRAEs to 47.6 (47.1-48.0) weeks for renal sTRAEs. Overall, 68% of sTRAEs resolved, with median (range) TTR ranging from 3.7 (0.1-123.3+) weeks for gastrointestinal sTRAEs to 28.4 (0.1-79.1) weeks for endocrine sTRAEs. Most gastrointestinal and all hepatic events resolved with treatment in accordance with established toxicity management algorithms. In 57 patients (40%), sTRAEs were managed with IMM. Reoccurrence of sTRAEs was uncommon following rechallenge with nivolumab. CONCLUSION: Nivolumab demonstrated a manageable safety profile in this analysis of patients with advanced HCC. A majority of sTRAEs resolved with treatment. IMPLICATIONS FOR PRACTICE: Nivolumab is a viable treatment option for patients with previously treated advanced hepatocellular carcinoma as it has demonstrated durable tumor responses and promising survival. Nivolumab has a manageable safety profile. The most common select treatment-related adverse events (sTRAEs) in this analysis were skin related (35%). Gastrointestinal and hepatic sTRAEs were observed in approximately 14% of patients. The majority of sTRAEs resolved (68%). Safety events are easier to manage if addressed early. Patient education on signs and symptoms to watch out for and the importance of early reporting and consultation should be emphasized

Nivolumab in Advanced Hepatocellular Carcinoma: Safety Profile and Select Treatment-Related Adverse Events From the CheckMate 040 Study

Background. CheckMate 040 assessed the efficacy and safety of nivolumab in patients with advanced hepatocellular carcinoma (HCC). Understanding the safety profile of nivolumab is needed to support the management of treatment-related adverse events (TRAEs). This analysis assessed the safety of nivolumab monotherapy in the phase I/II, open-label CheckMate 040 study. Materials and Methods. Select TRAEs (sTRAEs; TRAEs with potential immunologic etiology requiring more frequent monitoring) occurring between first dose and 30 days after last dose were analyzed in patients in the dose-escalation and -expansion phases. Time to onset (TTO), time to resolution (TTR), and recurrence of sTRAEs were assessed, and the outcome of treatment with immune-modulating medication (IMM) was evaluated. Results. The analysis included 262 patients. The most common sTRAE was skin (35.5%), followed by gastrointestinal (14.5%) and hepatic (14.1%) events; the majority were grade 1/2, with 10.7% of patients experiencing grade 3/4 events. One patient had grade 5 pneumonitis. Median (range) TTO ranged from 3.6 (0.1–59.9) weeks for skin sTRAEs to 47.6 (47.1–48.0) weeks for renal sTRAEs. Overall, 68% of sTRAEs resolved, with median (range) TTR ranging from 3.7 (0.1–123.3+) weeks for gastrointestinal sTRAEs to 28.4 (0.1–79.1) weeks for endocrine sTRAEs. Most gastrointestinal and all hepatic events resolved with treatment in accordance with established toxicity management algorithms. In 57 patients (40%), sTRAEs were managed with IMM. Reoccurrence of sTRAEs was uncommon following rechallenge with nivolumab. Conclusion. Nivolumab demonstrated a manageable safety profile in this analysis of patients with advanced HCC. A majority of sTRAEs resolved with treatment

Early-Onset, Coexisting Autoimmunity and Decreased HLA-Mediated Susceptibility Are the Characteristics of Diabetes in Down Syndrome

OBJECTIVE: Down syndrome (DS) is associated with an increased risk of diabetes, particularly in young children. HLA-mediated risk is however decreased in children with DS and diabetes (DSD). We hypothesized that early-onset diabetes in children with DS is etiologically different from autoimmune diabetes. RESEARCH DESIGN AND METHODS: Clinical and immunogenetic markers of autoimmune diabetes were studied in 136 individuals with DSD and compared with 194 age- and sex-matched individuals with type 1 diabetes, 222 with DS, and 671 healthy controls. HLA class II was analyzed by sequence-specific primed PCR. Islet autoantibodies were measured by radioimmunoassay. RESULTS: Age at onset of diabetes was biphasic, with 22% of DS children diagnosed before 2 years of age, compared with only 4% in this age-group with type 1 diabetes in the general population (P < 0.0001). The frequency of the highest-risk type 1 diabetes–associated HLA genotype, DR3-DQ2/DR4-DQ8, was decreased in both early- and later-onset DSD compared with age-matched children with type 1 diabetes (P < 0.0001), although HLA DR3-DQ2 genotypes were increased (P = 0.004). Antibodies to GAD were observed in all five samples tested from children diagnosed at ≤2 years of age, and persistent islet autoantibodies were detected in 72% of DSD cases. Thyroid and celiac disease were diagnosed in 74 and 14%, respectively, of the DSD cohort. CONCLUSIONS: Early-onset diabetes in children with DS is unlikely to be etiologically different from autoimmune diabetes occurring in older DS children. Overall, these studies demonstrate more extreme autoimmunity in DSD typified by early-onset diabetes with multiple autoimmunity, persistent islet autoantibodies, and decreased HLA-mediated susceptibility