Multilevel Marketing Diffusion and the Risk of Pyramid Scheme Activity: The Case of Fortune Hi‐Tech Marketing in Montana

While statisticians have simulated the expected rate of growth in pyramid schemes, this research examines actual data on the spread of an alleged pyramid scheme in Montana. Fortune Hi-Tech Marketing (FHTM) was a multilevel marketing firm, sued by six states and the Federal Trade Commission and permanently shut down in 2014. Data from a settlement with the State of Montana provide a population of participants in a geographic region with definable markets and offer unique insights into local contagion. The authors analyze the pattern of FHTM adoption within a diffusion-of-innovation framework. The findings confirm that nearly all adoption results from interpersonal influence (i.e., imitation) and indicate that participation is higher in counties with larger economic contractions. The authors add to existing guidance about early indicators of fraudulent activity and discuss intervention and prevention strategies that reflect the imitative nature of this diffusion process

Living in a Gender-Binary World: Implications for a Revised Model of Consumer Vulnerability

Baker, Gentry, and Rittenburg’s (2005) model of consumer vulnerability outlines the personal, social, and structural characteristics that frame consumers’ experiences of vulnerability in the marketplace. Later applications and enhancements have expanded consumer vulnerability theory. While the theory has been applied in numerous settings, to date it has not been used to examine the ways that gender identity may intersect with market factors to produce vulnerability. Application in this setting also allows for the integration of various model enhancements, and the examination of vulnerability using a more complete formulation of the theory. Based on in-depth qualitative interviews and collages, along with examples from current marketing practice, our research shows consumer vulnerability to be a useful lens for understanding gender variant consumers’ experiences and the ways in which marketing systems can be engaged to reshape those experiences

Building Solar Capacity in Maine: The Greater Bangor Solarize Case Study

Despite being a mature technology with significantly decreasing costs over the last decade and various financial incentives available periodically, solar photovoltaic energy systems currently generate approximately 1 percent of Maine’s electricity. There have been eight Solarize campaigns in Maine, which aimed to increase residential- and commercial-scale solar adoption through group purchasing. In 2017, the Greater Bangor Solarize campaign increased the number of residential solar installations by 63 percent and solar power capacity by 52 percent in the participating towns compared to the previous seven years. We surveyed the Greater Bangor Solarize participants to better understand the motivations, concerns, and barriers to residential solar adoption in central Maine. We find a significant demographic divide exists between the Solarize participants and the general Maine population. We also observe that environmental stewardship and energy security are the primary motivations for considering solar and that overall cost remains the primary concern

Application of Socio-technical Systems Analysis to Operational Auditing Methodology: Theory and Application

Internal auditing emerged early in the Twentieth Century as a subsidiary activity of accounting (Sawyer,1981, p.18). Internal auditors were usually employed in the accounting department and checked routine accounting activities. Their primary concern was compliance with financial accounting controls. Over more than five decades, internal auditors' responsibilities have grown to include evaluation of operations and management controls. This evaluation encompasses what have come to be known as the ''Three E 's" Efficiency, Economy, and Effectiveness (Morse, 1971; Nich, et al., 1987). According to Morse (1971) the purpose of Operational Auditing is "to identify opportunities for greater efficiency and economy or for improved effectiveness in carrying out procedures or operations." Internal Auditing has not, however, always succeeded in its new role as Operational Auditing. Nich, et al. (1987) state that two of the reasons for this lack of success are that "internal auditors are neither organizationally positioned nor particularly competent to play a broader role Cas operational auditors]" (p.4). Nich, et al. (1987) recognize the relevance of attempting to evaluate efficiency, economy, and effectiveness. They state, however, that operational auditors cannot always perform that function because of deficiencies in extant operational auditing methods. They believe that the deficiencies stem in part from the transactional orientation in Operational Auditing methods that has been carried over from Financial Auditing methods. One obvious solution to the problem of deficient methodologies, and one proposed by Nich, et al. (1987) is to adopt various methods of other, related disciplines. Two areas they suggest are Information Systems and Industrial Engineering. Other disciplines could be suggested. This paper, however, proposes the adoption of one particular methodology, Socio-Technical Systems Analysis (STSA), as an appropriate methodology for Operational Auditing. STSA is a design and analysis approach that attempts to jointly optimize both technical and social system needs of the organization. "The STS approach views the organizational control system as a network of interacting and interdependent subsystems'' (Thomas, 1985). The four steps of a Socio-Technical Analysis are the Organizational Scan, the Technical System Analysis, the Social System Analysis, and the Design, Analysis, Redesign Effort. The four steps systematically link a study of the organization's goals and objectives to an analysis of policies and procedures and, ultimately, an identification of problems and possible solutions. Chapter I of this paper will discuss in detail the extant operational auditing methodology. Chapter II will discuss in more detail the goals and objectives of operaiv tional auditing, and possible reasons why the goals and objectives are not currently being met. The progress of Operational Auditing toward a more systems oriented view of the organization is demonstrated. Chapter III of this paper will present the theory and background of STSA, and STSA is proposed as a methodology that could be incorporated into Operational Auditing methodology in order to alleviate some of the existing problems. Chapter III includes the rationale for proposing STSA as an Operational Auditing methodology. Chapter IV will present an example of the STSA process adapted for operational auditing use.Accountin

Food Insecurity in Maine Higher Education

In 2017–2018, University of Maine Cooperative Extension and Maine Campus Compact conducted a statewide analysis to assess the extent and subsequent effects of food and housing insecurity within the college student population. A total of 26 higher education institutions (community colleges and private and public four-year colleges and universities) throughout the state of Maine received surveys to investigate food and housing insecurity. This study reports on the findings from the 1,704 completed surveys from 24 of those campuses. We found significant food insecurity among respondents. The results demonstrate how food insecurity relates to institutional, geographic, and student characteristics. We discuss the implications for higher education policy across Maine and practices at individual institutions

Efficacy and Tolerability of Solifenacin 5 mg Fixed Dose in Korean Children with Newly Diagnosed Idiopathic Overactive Bladder: a Multicenter Prospective Study

We investigated the efficacy and tolerability of solifenacin 5 mg fixed dose in children with newly diagnosed idiopathic overactive bladder (OAB). A total of 34 children (male/female patients = 16/18) aged under 13 years (mean age: 7.2 +/- 2.3; range: 5-12) who were newly diagnosed with OAB from January 2012 to September 2014 were prospectively evaluated with open-label protocol. All patients were treated with solifenacin 5 mg fixed dose once daily for at least 4 weeks. The efficacy and tolerability of solifenacin were evaluated 4, 8, and 12 weeks after the initiation of treatment. The mean voiding frequency during daytime was decreased from 9.4 +/- 3.0 to 6.5 +/- 2.3 times after the 12-week treatment (P<0.001). The mean total OAB symptom score (OABSS) decreased from 7.7 +/- 4.2 to 3.1 +/- 3.1 after the 12-week treatment (P<0.001). The urgency and urgency urinary incontinence (UUI) domains significantly improved from the 12-week treatment, and complete resolution of urgency occurred in 38.9% of patients and the percentage of children with UUI among urgent patients decreased from 79.4% to 57.1%. According to 3-day voiding diaries, the average bladder capacity increased from 90.4 +/- 44.4 to 156.2 +/- 67.3 mL (P<0.001). Drug-induced adverse effects (AEs) were reported in 7 patients (20.6%). Our results indicate that solifenacin 5 mg fixed dose is effective against OAB symptoms, and its tolerability is acceptable without significant AEs in children with OAB.ope

A phase i pharmacokinetic study of the vascular disrupting agent ombrabulin (AVE8062) and docetaxel in advanced solid tumours

Background: The vascular disrupting agent ombrabulin shows synergy with docetaxel in vivo. Recommended phase II doses were determined in a dose escalation study in advanced solid tumours. Methods: Ombrabulin (30-min infusion, day 1) followed by docetaxel (1-h infusion, day 2) every 3 weeks was explored. Ombrabulin was escalated from 11.5 to 42 mg m -2 with 75 mg m -2 docetaxel, then from 30 to 35 mg m -2 with 100 mg m -2 docetaxel. Recommended phase II dose cohorts were expanded. Results: Fifty-eight patients were treated. Recommended phase II doses were 35 mg m -2 ombrabulin with 75 mg m -2 docetaxel (35/75 mg m -2; 13 patients) and 30 mg m -2 ombrabulin with 100 mg m -2 docetaxel (30/100 mg m -2; 16 patients). Dose-limiting toxicities were grade 3 fatigue (two patients; 42/75, 35/100), grade 3 neutropaenic infection (25/75), grade 3 headache (42/75), grade 4 febrile neutropaenia (30/100), and grade 3 thrombosis (35/100). Toxicities were consistent with each agent; mild nausea/vomiting, asthaenia/fatigue, alopecia, and anaemia were common, as were neutropaenia and leukopaenia. Diarrhoea, nail disorders and neurological symptoms were frequent at 100 mg m -2 docetaxel. Pharmacokinetic analyses did not show any relevant drug interactions. Ten patients had partial responses (seven at 30 mg m -2 ombrabulin), eight lasting >3 months. Conclusions: Sequential administration of ombrabulin with 75 or 100 mg m -2 docetaxel every 3 weeks is feasible

Activator protein-1 (AP-1) signalling in human atherosclerosis: results of a systematic evaluation and intervention study

Animal studies implicate the AP-1 (activator protein-1) pro-inflammatory pathway as a promising target in the treatment of atherosclerotic disease. It is, however, unclear whether these observations apply to human atherosclerosis. Therefore we evaluated the profile of AP-1 activation through histological analysis and tested the potential benefit of AP-1 inhibition in a clinical trial. AP-1 activation was quantified by phospho-c-Jun nuclear translocation (immunohistochemistry) on a biobank of aortic wall samples from organ donors. The effect of AP-1 inhibition on vascular parameters was tested through a double blind placebo-controlled cross-over study of 28 days doxycycline or placebo in patients with symptomatic peripheral artery disease. Vascular function was assessed by brachial dilation as well as by plasma samples analysed for hs-CRP (high-sensitivity C-reactive protein), IL-6 (interleukin-6), IL-8, ICAM-1 (intercellular adhesion molecule-1), vWF (von Willebrand factor), MCP-1 (monocyte chemoattractant protein-1), PAI-1 (plasminogen activator inhibitor-1) and fibrinogen. Histological evaluation of human atherosclerosis showed minimal AP-1 activation in non-diseased arterial wall (i.e. vessel wall without any signs of atherosclerotic disease). A gradual increase of AP-1 activation was found in non-progressive and progressive phases of atherosclerosis respectively (P<0.044). No significant difference was found between progressive and vulnerable lesions. The expression of phospho-c-Jun diminished as the lesion stabilized (P<0.016) and does not significantly differ from the normal aortic wall (P<0.33). Evaluation of the doxycycline intervention only revealed a borderline-significant reduction of circulating hs-CRP levels (−0.51 μg/ml, P=0.05) and did not affect any of the other markers of systemic inflammation and vascular function. Our studies do not characterize AP-1 as a therapeutic target for progressive human atherosclerotic disease

Patient-reported outcomes in a trial of exenatide and insulin glargine for the treatment of type 2 diabetes

BACKGROUND: Patient-reported measures can be used to examine whether drug differences other than clinical efficacy have an impact on outcomes that may be important to patients. Although exenatide and insulin glargine appear to have similar efficacy for treatment of type 2 diabetes, there are several differences between the two treatments that could influence outcomes from the patient's perspective. The purpose of the current study was to examine whether the two drugs were comparable as assessed by patient-reported outcomes using data from a clinical trial in which these injectable medications were added to pre-existing oral treatment regimens. METHODS: Patients were randomized to either twice daily exenatide or once daily insulin glargine during a 26-week international trial. At baseline and endpoint, five patient-reported outcome measures were administered: the Vitality Scale of the SF-36, The Diabetes Symptom Checklist – Revised (DSC-R), the EuroQol EQ-5D, the Treatment Flexibility Scale (TFS), and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Change from baseline to endpoint was analyzed within each treatment group. Group differences were examined with General linear models (GLMs), controlling for country and baseline scores. RESULTS: A total of 549 patients with type 2 diabetes were enrolled in the trial, and current analyses were conducted with data from the 455 per protocol patients (228 exenatide and 227 insulin glargine). The sample was primarily Caucasian (79.6%), with slightly more men (55.2%) than women, and with a mean age of 58.5 years. Paired t-tests found that both treatment groups demonstrated statistically significant baseline to endpoint change on several of the health outcomes instruments including the DSC-R, DTSQ, and the SF-36 Vitality subscale. GLMs found no statistically significant differences between groups in change on the health outcomes instruments. CONCLUSION: This analysis found that both exenatide and insulin glargine were associated with significant improvements in patient-reported outcomes when added to oral medications among patients with type 2 diabetes. Despite an additional daily injection and a higher rate of gastrointestinal adverse events, treatment satisfaction in the exenatide group was comparable to that of the glargine group, possibly because of weight reduction observed in patients treated with exenatide

Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies