Ambition meets reality: Lessons from the taro boom in Nicaragua

Between 2006 and 2011, Nicaragua shipped an average of US$ 9.4 million per year of smallholder-produced fresh taro (Colocasia esculenta) to the United States; however, by 2016, the US market for Nicaraguan taro had effectively collapsed. We analyse the short-lived taro boom from the perspective of complex adaptive systems, showing how shocks, interactions between value chain actors, and lack of adaptive capacity among chain actors together contributed to the collapse of the chain. Primary data was collected from businesses and smallholders in 2010 and 2016 to understand the actors involved, their business relations, and the benefits and set backs they experienced along the way. The results show the capacity of better-off smallholders to engage in a demanding market, but also the struggles faced by more vulnerable smallholders to build new production systems and respond to internal and external shocks. Local businesses were generally unprepared for the uncertainties inherent in fresh horticultural trade or for engagement with distant buyers. Existing guides and tools for designing value chain interventions will benefit from greater attention to the circumstances of local actors and the challenges of building productive inter-business relations under higher levels of risk and uncertainty. Results demonstrate the need for a greater awareness of adaptive capacity within marketing systems that involve smallholders, a more critical look at the underlying assumptions of interventions for building these value chains, and the need for alternative planning scenarios, better risk mitigation and adaptation strategies. This case serves as a wake-up call for practitioners, donors, researchers and the private sector on how to identify market opportunities and the design of more robust strategies to respond to them

Proceso administrativo para la selección y contratación de los recursos humanos en el área de producción de la Tabacalera Fernández de Nicaragua S.A. (TAFENIC). 2022. Estelí, Nicaragua

Esta investigación tiene como objetivo general analizar el desarrollo de las funciones del proceso administrativo para la selección y contratación del personal que labora en el área de producción de la Tabacalera AJ. Fernández Cigars de Nicaragua S.A. (TAFENIC), con sede en la ciudad de Estelí en el año 2022. De acuerdo al enfoque filosófico es una investigación de carácter cuali-cuantitativa o mixta. Las técnicas de recopilación de datos que se aplicaron fueron: investigación documental, entrevistas semi-estructuradas y una encuesta a colaboradores del área de producción de TAFENIC. Los resultados demostraron que existe una carencia y una necesidad de un sistema bien establecido para el proceso de selección y contratación. Actualmente la empresa está teniendo dificultades internas provocadas por la inestabilidad laboral, alta rotación de personal, y el cumplimiento de tareas. Se desconoce el desempeño que tienen las áreas y los colaboradores porque se carece de un proceso de evaluación formal, lo único que evalúan y comparan son los rendimientos productivos de tabaco en las distintas unidades productivas de TAFENIC. En base a estos resultados, y para mejorar este proceso de selección y contratación se sugieren cinco estrategias que son: Establecer un sistema formal de contratación de personal, estabilidad laboral, evaluación al personal, políticas de contratación y relación y comunicación

Proceso administrativo para la selección y contratación de los recursos humanos en el área de producción de la Tabacalera Fernández de Nicaragua S.A. (TAFENIC). 2022. Estelí, Nicaragua

Esta investigación tiene como objetivo general analizar el desarrollo de las funciones del proceso administrativo para la selección y contratación del personal que labora en el área de producción de la Tabacalera Fernández de Nicaragua S.A. (TAFENIC), con sede en la ciudad de Estelí en el año 2022. De acuerdo al enfoque filosófico es una investigación de carácter cuali-cuantitativa o mixta. Las técnicas de recopilación de datos que se aplicaron fueron: investigación documental, entrevistas semi-estructuradas y una encuesta a colaboradores del área de producción de TAFENIC. Los resultados demostraron que existe una carencia y una necesidad de un sistema bien establecido para el proceso de selección y contratación. Actualmente la empresa está teniendo dificultades internas provocadas por la inestabilidad laboral, alta rotación de personal, y el cumplimiento de tareas. Se desconoce el desempeño que tienen las áreas y los colaboradores porque se carece de un proceso de evaluación formal, lo único que evalúan y comparan son los rendimientos productivos de tabaco en las distintas unidades productivas de TAFENIC. En base a estos resultados, y para mejorar este proceso de selección y contratación se sugieren cuatro estrategias que son: Establecer un sistema formal de contratación de personal, implementar un sistema adecuado de evaluación al personal, motivación al personal, y relación y comunicación

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791

Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Rationale & Objective: It is unclear whether the effect of canagliflozin on adverse kidney and cardiovascular events in those with diabetic kid-ney disease varies by age and sex. We assessed the effects of canagliflozin among age group categories and between sexes in the Canagli-flozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) study.Study Design: Secondary analysis of a random-ized controlled trial. Setting & Participants: Participants in the CREDENCE trial. Intervention: Participants were randomly assigned to receive canagliflozin 100 mg/d or placebo.Outcomes: Primary composite outcome of kid-ney failure, doubling of serum creatinine con-centration, or death due to kidney or cardiovascular disease. Prespecified secondary and safety outcomes were also analyzed. Out-comes were evaluated by age at baseline (<60, 60-69, and >_70 years) and sex in the intention-to-treat population using Cox regression models.Results: The mean age of the cohort was 63.0 & PLUSMN; 9.2 years, and 34% were female. Older age and female sex were independently associ-ated with a lower risk of the composite of adverse kidney outcomes. There was no evidence that the effect of canagliflozin on the primary outcome (acomposite of kidney failure, a doubling of serum creatinine concentration, or death from kidney or cardiovascular causes) differed between age groups (HRs, 0.67 [95% CI, 0.52-0.87], 0.63 [0.4 8-0.82], and 0.89 [0.61-1.29] for ages <60, 60-69, and >_70 years, respectively; P = 0.3 for interaction) or sexes (HRs, 0.71 [95% CI, 0.5 4-0.95] and 0.69 [0.56-0.8 4] in women and men, respectively; P = 0.8 for interaction). No differences in safety outcomes by age group or sex were observed.Limitations: This was a post hoc analysis with multiple comparisons.Conclusions: Canagliflozin consistently reduced the relative risk of kidney events in people with diabetic kidney disease in both sexes and across age subgroups. As a result of greater background risk, the absolute reduction in adverse kidney outcomes was greater in younger participants.Funding: This post hoc analysis of the CREDENCE trial was not funded. The CREDENCE study was sponsored by Janssen Research and Development and was conducted collaboratively by the sponsor, an academic-led steering committee, and an academic research organization, George Clinical.Trial Registration: The original CREDENCE trial was registered at ClinicalTrials.gov with study number NCT02065791