Baseline neutrophil-to-lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Background Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess “response”. Aim To assess the prognostic and therapeutic implications of baseline neutrophil‐to‐lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis. Methods Patients recruited to the STOPAH trial and an independent validation group were analysed retrospectively. Area under the receiver operating curve (AUC) analysis was performed. Kaplan‐Meier analysis was used to assess survival. Log‐rank test and odds ratio (OR) were used for comparative analysis. Results Baseline NLR was available for 789 STOPAH patients. The AUC for NLR was modest for 90‐day outcome (0.660), but was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. Ninety‐day survival was not affected by prednisolone treatment if NLR 8 but mortality was reduced with prednisolone treatment when the NLR was 5‐8 (21.0% cf. 34.5%; P = 0.012). Prednisolone treatment increased the chance of Lille response if the NLR was ≥ 5 (56.5% cf. 41.1%: P = 0.01; OR 1.86) but increased the risk of day 7 infection (17.3% cf. 7.4%: P = 0.006; OR 2.60) and AKI (20.8% cf. 7.0%: P = 0.008; OR 3.46) if the NLR was > 8. Incorporation of NLR into a modified Glasgow alcoholic hepatitis score (mGAHS) improved the AUC to 0.783 and 0.739 for 28‐day and 90‐day outcome, respectively. Conclusion The NLR is associated with AKI and infection in severe alcoholic hepatitis. The NLR identifies those most likely to benefit from corticosteroids at baseline (NLR 5‐8). The mGAHS has a good predictive value for 28‐ and 90‐day outcomes

Living Heritage Approach and Impact of Not-for-profit Banking for Women Entrepreneurs

Women entrepreneurs face many grievances especially in developing countries in regard to their business operations, financial instruments, and literacy. Provision of which, can increase their sales and productivity within micro-economies of the tourism industry. Experiences and Learnings from application of UNESCO\u27s (United Nations Educational, Scientific and Cultural Organization) Living Heritage Approach in developing countries such as India suggests that synergies between communities of place, practice and interest results in a resilient business forum for women entrepreneurs in regards to their financial capability, health conditions, bank loans, rent agreements, and overall future financial health. This is showcased in the research through data collection of financial literacy and on-ground initiatives for the education of sanitation and health. Moreover, collaboration with not-for-profit banks providing loans to women entrepreneurs and the scope of increasing productivity in small economies of the tourism industry leads to a healthy next-generation of women oligopolies that collaborate in market segmentation, price-fixing and increasing profits thereby reducing poverty around the vicinity and increase investments in family healthcare and sanitation. The research also points out social biases, patriarchy, and inequalities that women face in their daily lives that make them incapable of inducing entrepreneurial activities, which are suppressed by collective women empowerment groups made within the community

Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis

publisher: Elsevier articletitle: Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis journaltitle: Journal of Hepatology articlelink: http://dx.doi.org/10.1016/j.jhep.2017.11.017 content_type: article copyright: Crown Copyright © 2017 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. All rights reserved

Sustainability and consumer behaviour

Existing research suggests that sustainable strategies of many corporate organizations are internally focused and aim to boost companies’ brand images, improve their competitive positions and to increase wealth for their shareholders. Such sustainable initiatives lack a genuine commitment to long-term green production, ecological integrity, human welfare and green buying behaviour. Yet, not many consumers have developed the mindset to buy green products even when companies strive hard to preserve sustainable standards through externally-focused initiatives to promote fair trade, ecological protection and social justice. While consumers’ demand for products can be analyzed and predicted through economic models, their green consumption behaviour is not always predictable and goes far beyond simple rational analysis. Some consumers even take sustainability matters less seriously due to complex and sometimes divisive sustainability discussions by world leaders. Models to address these sustainability issues are also limited. This chapter, therefore, uses the lens of cohered emergent theory to propose a corporate sustainability model that can promote pro-environmental practices and inspire firms to involve consumers actively in their sustainable development activities. It encourages consumers to become green buyers who consume goods and service responsibly and motivate firms to develop marketing campaigns that are eco-friendly and ethically acceptable to changing consumer behaviour. The chapter also motivates policymakers to introduce policies that can actively bring the ideas of corporate managers, the consuming public, and other environmental-friendly stakeholders together to develop adaptive production and consumption programmes that can promote economic benefits, eco-friendly environments and social justice