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Supplementary Table 1 Sequencing Primers used for FcGR 2a ( H/R,rs1801274) and FcGR3a (F/V;rs396991) polymorphisms genotyping

Supplemental tables and figures Supplemental Table 1. Study drug exposure. Supplemental Table 2. Select AEs at relatively high frequency led to disproportionately more frequent irinotecan/5-FU dose changes (reduced, interrupted, or withdrawn) on the duligotuzumab arm. Supplemental Figure 1. CONSORT patient flow diagram

Purpose: Duligotuzumab is a dual-action antibody directed against EGFR and HER3.Experimental Design: Metastatic colorectal cancer (mCRC) patients with KRAS ex2 wild-type received duligotuzumab or cetuximab and FOLFIRI until progression or intolerable toxicity. Mandatory tumor samples underwent mutation and biomarker analysis. Efficacy analysis was conducted in patients with RAS exon 2/3 wild-type tumors.Results: Of 134 randomly assigned patients, 98 had RAS ex2/3 wild-type. Duligotuzumab provided no progression-free survival (PFS) or overall survival (OS) benefit compared with cetuximab, although there was a trend for a lower objective response rate (ORR) in the duligotuzumab arm. No relationship was seen between PFS or ORR and ERBB3, NRG1, or AREG expression. There were fewer skin rash events for duligotuzumab but more diarrhea. Although the incidence of grade ≥3 AEs was similar, the frequency of serious AEs was higher for duligotuzumab.Conclusions: Duligotuzumab plus FOLFIRI did not appear to improve the outcomes in patients with RAS exon 2/3 wild-type mCRC compared with cetuximab + FOLFIRI. Clin Cancer Res; 24(10); 2276–84. ©2018 AACR.

Purpose: Two germline Fc-γ receptor (FCGR) polymorphisms, rs1801274 [FCGR2A;His(H)131Arg(R)] and rs396991 [FCGR3A;Phe(F)158Val(V)] produce altered proteins through amino acid substitutions; both are reported to be associated with cetuximab-related outcomes. We performed a validation of these polymorphisms in NCIC CTG CO.17, a randomized trial of cetuximab monotherapy in refractory, metastatic colorectal cancer expressing EGFR.Experimental Design: DNA extracted from formalin-fixed paraffin-embedded tissue was genotyped. In addition to log-rank tests, Cox proportional hazard models assessed their relationships with overall (OS) and progression-free survival (PFS), adjusting for clinically important prognostic factors, along with a polymorphism–treatment arm interaction term.Results: Somatic KRAS status was wild-type for exon 2 in 153 (52%) of 293 patients, from whom tumor DNA was available. For FCGR2A H/H, a genotype–treatment interaction for KRAS wild-type patients was observed for OS (P = 0.03). In KRAS wild-type patients carrying FCGR2A H/H, cetuximab (vs. no cetuximab) improved survival substantially, with adjusted HRs (aHR) of 0.36 (OS) and 0.19 (PFS) and absolute benefits of 5.5 months (OS; P = 0.003) and 3.7 months (PFS; P = 0.02). In contrast, patients carrying FCGR2A R alleles (H/R or R/R) had aHRs of only 0.78 (OS; 2.8-month benefit) and 0.53 (PFS; 1.6-month benefit). No relationships were found for rs396991 (FCGR3A).Conclusions: In the CO.17 trial, cetuximab worked best for patients with KRAS wild-type colorectal cancers carrying FCGR2A H/H genotypes. Significantly lower benefits were observed in patients carrying germline FCGR2A R alleles. Clin Cancer Res; 22(10); 2435–44. ©2016 AACR.

Through the use of qualitative inquiry, this study seeks to discuss the findings of the impact of a knowledge of media and information literacy (MIL) on the personal and ethical decisions of a select group of college graduates in Jamaica. The study is undergirded by Alagaran’s Explore, Engage, and Empower Model of MIL and sought to investigate the media and information literacy knowledge level that exists among college graduates, to determine how knowledge of MIL affects their ethical decisions and the impact it has on their daily life choices. Findings indicate that participants were generally familiar with the composite term “media and information literacy”. Their responses reflect adherence to MIL principles geared towards making ethical choices in their use of information and indicate that a knowledge of media and information literacy is important in the personal decision making of college graduates in Jamaica.

Mark Jeffery introduces the generative process behind the 2019 convening of in>time, an annual festival of Chicago’s tight-knit experimental performance scene. in>time closed the decade by celebrating the history of Goat Island, the ground-breaking company that itself formally disbanded ten years before. The 2019 festival continued as a retrospective exhibition, goat island archive—we have discovered the performance by making it, presented at the Chicago Cultural Center. Jeffery describes how the curatorial team paired nine artists/collectives with each of Goat Island’s past performances. Distributed across the city, all nine works arose in answer to one central question: “In endings, what is it to begin again?”

Disability Acts are aimed at providing disabled students with both physical and intellectual access to education. The research takes into account UNESCO’s mission and Universal Declaration of Human Rights (1948) that education as a fundamental human right lies at the heart of equal access. The document analysis approach was used to select six Caribbean countries’ disability Acts to examine the kind of access indicated for educational institutions and libraries. The roles of the stakeholders who are expected to implement the Acts were also examined. Additionally, document analysis was used to determine if what was seen in these Acts were actually being implemented. The disability Acts selected were those from a Commonwealth Caribbean country that developed national policies or acts on disability and that the Acts had specific articles on access to education for disabled persons. It was discovered that the clauses with regards to access and stakeholders’ role in implementing the Acts were very limited. There is also a significant gap between what is written in the Acts and what is actually taking place. One recommendation that was suggested was that each country treat their Act as a priority as equal access is a human right as emphasized by UNESCO.

TPS3646 Background: In retrospective studies statin use during preoperative chemo-radiation (pCRT) for rectal cancer is associated with improved overall survival, pathological tumor response and treatment toxicity. In vivo preclinical studies show that statins radiosensitize cancer cells, with improved tumor control and reduced radiation-induced gastrointestinal (GI) and skin toxicities. A prospective randomized trial is justified to confirm these clinically important benefits. Tumor regression following pCRT has strong prognostic significance, as assessed radiologically (MRI-based tumor regression grading [mrTRG]) prior to, or pathologically (pathTRG) following, surgery. Using mrTRG after each treatment phase in total neoadjuvant therapy (TNT) programs could assess incremental tumor regression and optimize patient management including surgery. Methods: Design: This double-blind phase 2 trial is recruiting 222 patients planned to receive long-course fluoropyrimidine-based pCRT for rectal adenocarcinoma at 17 sites in New Zealand and Australia. Patients are randomized to simvastatin 40mg or placebo daily for 90 days, starting 1 week prior to pCRT, with minimization for major prognostic variables. Pelvic MRI at baseline and 6-8 weeks after pCRT will assess mrTRG. A protocol amendment allows TNT using consolidation chemotherapy after pCRT; MRI timing is unchanged. Primary objective: comparison of rates of grades 1-2 mrTRG following pCRT with simvastatin or placebo, considering mrTRG in 4 ordered categories (1, 2, 3, 4-5). Secondary objectives: comparison of rates of grades 1-2 pathTRG in resected tumors; incidence of > grade 2 acute GI and non-GI adverse events (AE); incidence of late GI AE; compliance with intended pCRT and trial medication; proportion of patients undergoing surgical resection post-pCRT; 3-year local recurrence rate, disease-free and cancer-specific survival; and pathological scores for radiation colitis. Tertiary and correlative objectives: association between mrTRG and pathTRG grouping; inter-observer scoring agreement on mrTRG and pathTRG; comparison of the association between tumor CD3+ and/or CD8+ T-cell infiltrates in diagnostic biopsies and pathTRG; intensity and distribution of subsets of infiltrating T-cells in irradiated resected normal and malignant tissue; and the effect of simvastatin on markers of systemic inflammation (modified Glasgow prognostic score and the neutrophil-lymphocyte ratio). Eligibility criteria exclude statin use within 6 weeks prior to trial entry, patients intolerant of statins, and planned use of oxaliplatin or biological agents during pCRT. Trial recruitment commenced April 2018 and 95 of 222 patients have been recruited as at 21 January 2022. Clinical trial information: ACTRN12617001087347.

Burnout has a damaging effect on both the wellbeing of medical professionals and patients alike. Empathy is an important part of the therapeutic relationship and could be damaged by burnout. We aimed to describe the prevalence of burnout, assess levels of empathy and explore the relationship between burnout and empathy among senior medical officers (SMOs). We hypothesised that there would be a negative correlation between empathy and burnout.This was a cross-sectional observational study involving SMOs from a variety of specialities. The focus is on SMOs with relatively prolonged contact times with patients. Email invitations were sent out requesting participation in an electronic survey on the QuestionPro platform. The survey comprised 42 questions enquiring about demographics, empathy (Jefferson Scale of Physician Empathy) and burnout (Copenhagen Burnout Inventory). Correlational analyses were performed.Three hundred and fourteen invitations were sent out and 178 responses were received (56.7% response rate). Forty-five percent of SMOs surveyed were experiencing high levels of personal burnout. There was a statistically significant negative correlation between empathy and patient-related burnout (p=0.018).The results show high levels of personal burnout among SMOs and suggest that empathy reduces as patient-related burnout increases. The nature of this relationship is a complex one, and other contributing variables should be considered.

Background Retrospective studies show improved outcomes in colorectal cancer patients if taking statins, including overall survival, pathological response of rectal cancer to preoperative chemoradiotherapy (pCRT), and reduced acute and late toxicities of pelvic radiation. Major tumour regression following pCRT has strong prognostic significance and can be assessed in vivo using MRI-based tumour regression grading (mrTRG) or after surgery using pathological TRG (pathTRG). Methods A double-blind phase 2 trial will randomise 222 patients planned to receive long-course fluoropyrimidine-based pCRT for rectal adenocarcinoma at 18+ sites in New Zealand and Australia. Patients will receive simvastatin 40 mg or placebo daily for 90 days starting 1 week prior to standard pCRT. Pelvic MRI 6 weeks after pCRT will assess mrTRG grading prior to surgery. The primary objective is rates of favourable (grades 1–2) mrTRG following pCRT with simvastatin compared to placebo, considering mrTRG in 4 ordered categories (1, 2, 3, 4–5). Secondary objectives include comparison of: rates of favourable pathTRG in resected tumours; incidence of toxicity; compliance with intended pCRT and trial medication; proportion of patients undergoing surgical resection; cancer outcomes and pathological scores for radiation colitis. Tertiary objectives include: association between mrTRG and pathTRG grouping; inter-observer agreement on mrTRG scoring and pathTRG scoring; studies of T-cell infiltrates in diagnostic biopsies and irradiated resected normal and malignant tissue; and the effect of simvastatin on markers of systemic inflammation (modified Glasgow prognostic score and the neutrophil-lymphocyte ratio). Trial recruitment commenced April 2018. Discussion When completed this study will be able to observe meaningful differences in measurable tumour outcome parameters and/or toxicity from simvastatin. A positive result will require a larger RCT to confirm and validate the merit of statins in the preoperative management of rectal cancer. Such a finding could also lead to studies of statins in conjunction with chemoradiation in a range of other malignancies, as well as further exploration of possible mechanisms of action and interaction of statins with both radiation and chemotherapy. The translational substudies undertaken with this trial will provisionally explore some of these possible mechanisms, and the tissue and data can be made available for further investigations. Trial registration ANZ Clinical Trials Register ACTRN12617001087347. (www.anzctr.org.au, registered 26/7/2017) Protocol Version: 1.1 (June 2017).

Purpose: Duligotuzumab is a dual-action antibody directed against EGFR and HER3. Experimental Design: Metastatic colorectal cancer (mCRC) patients with KRAS ex2 wild-type received duligotuzumab or cetuximab and FOLFIRI until progression or intolerable toxicity. Mandatory tumor samples underwent mutation and biomarker analysis. Efficacy analysis was conducted in patients with RAS exon 2/3 wild-type tumors. Results: Of 134 randomly assigned patients, 98 had RAS ex2/3 wild-type. Duligotuzumab provided no progression-free survival (PFS) or overall survival (OS) benefit compared with cetuximab, although there was a trend for a lower objective response rate (ORR) in the duligotuzumab arm. No relationship was seen between PFS or ORR and ERBB3, NRG1, or AREG expression. There were fewer skin rash events for duligotuzumab but more diarrhea. Although the incidence of grade ≥3 AEs was similar, the frequency of serious AEs was higher for duligotuzumab. Conclusions: Duligotuzumab plus FOLFIRI did not appear to improve the outcomes in patients with RAS exon 2/3 wild-type mCRC compared with cetuximab + FOLFIRI. Clin Cancer Res; 24(10); 2276–84. ©2018 AACR.

The case concerns a real $25 million program consisting of nine concurrent projects to deliver and implement a custom-built in-store customer relationship management (CRM) system and a new point-of-sale system in 400 stores of a national retail chain. The name of the company has been disguised for confidentiality reasons. Once deployed, the new system should give Clothes ‘R’ Us a significant strategic advantage over competitors in the marketplace; it will increase in-store manager productivity, cut costs, and ultimately drive increased sales for the retail chain. The program is in crisis, however, because the product managers have just left to join a competitor. The explicit details of the program are given, including examples of best practice program governance and the real activity network diagram for the program. Detailed Excel spreadsheets are also provided with the actual earned value data for the program. Students analyze the spreadsheets and the data given in the case to diagnose the impact of the most recent risk event and past risk events that occurred in the program. Ultimately students must answer the essential executive questions: What is wrong with the program? How should it be fixed, and what is the impact in time and money to the program? In addition, qualitative warning signs are given throughout the case—these warning signs are red flags to executives for early proactive intervention in troubled projects.The goal of the case is to teach complex program oversight. Students analyze actual earned value data for a real $25 million program consisting of nine concurrent programs and assess the impact of risk events as they occur in the program. A key takeaway of the case is that relatively simple tools (Excel spreadsheets and time tracking) combined with good project planning can be used to effectively control very complex projects. Students also learn the qualitative warning signs within programs that can serve as early indicators of problems.

Should B&K Distributors implement a Web-based customer portal with an integrated marketing campaign? Asks readers to assist Jim Anfield, business development director for JDA Consulting, and Nancy O'Neil, B&K Distributor's sales VP, in determining the feasibility of this project. They must build the final ROI projections and develop recommendations for B&K's senior management team. Emphasizes the importance of assumptions and the range of possible outcomes. Based on a real-life management decision for a mid-size firm.To teach ROI analysis best practices for technology project investments, requiring the analysis of several factors to conduct a thorough review of the investment's feasibility.

The case is based on a real $25 million project at a major U.S.-based computer manufacturer. For confidentiality reasons the company has been disguised as A&D High Tech. The Web-based online ordering system project is required by sales and marketing for the fall holiday season. If the project misses this window, the firm will lose substantial market share to competitors. Part (B) takes place three months into the original project plan. The project manager has just been fired and the management challenge is to find out what is wrong with the project and recommend fixes. In addition, the scope of the project has changed: the VP of marketing has an additional promotional bundle requirement. A&D High Tech (A) examines how to create and analyze a project plan in Microsoft Project. In order to make the case manageable for students we reduced the size of the project, and corresponding number of resources, to approximately $1 million, but retained all of the features of the original project. Part (B) gives actual work done on each task three months into the project. Students must answer the management questions: Can the project be fixed and completed in time for the holiday season? Can the additional requirements be incorporated, and if so, what is the best approach? In order to answer these questions, earned value data can be extracted from Microsoft Project and analyzed. These data provide important insights into the root cause of problems with the project. The next step is to reduce the scope of the project and reassign resources. However, one must be aware that indiscriminately adding people can slow a project down, not speed it up. Finally, the additional promotional bundle requirement from the VP of marketing provides an important outsourcing management discussion. The case can also be taught using other project management software tools, such as Primavera.The case teaches students how to analyze a project in trouble using Microsoft Project (or other project management software tool). More important, the case teaches prospective executives how to manage a project in trouble by first accurately diagnosing the problems, then reducing scope where necessary, and finally replanning the project with reallocated resources. In addition, students will learn the tradeoffs of outsourcing to highly specialized professionals vs. average contractors.

The Ariba Implementation at MED-X case is designed to teach students how to analyze a program that is experiencing problems and recommend solutions. Specifically, the case introduces students to earned value analysis and program oversight for an e-procurement technology program. The case centers on MED-X's need to quickly discover why the company's e-procurement implementation project was not going according to plan. Once a cause has been discovered, students will need to make a recommendation to fix the problem. Data for the simplified program, consisting of two concurrent projects, is given to students, who should in turn analyze the project using earned value analysis. The case is an easy introduction to program management and oversight for executives and MBA students, and teaches the essentials of earned value project management.Students will learn how to control and act in oversight of large complex programs, as well as how to apply earned value metrics to analyze a simplified program consisting of two projects. Analyzing the project enables students to learn the strengths and pitfalls of the earned value approach. From a management decision perspective, the case gives students the tools to succinctly answer the questions: How much will the project cost? How long will it take? What is wrong with the project?

On April 6, 2005, Sony Corporation announced the signing of a global partnership program contract with the Federation Internationale de Football Association (FIFA) and the organizer of the FIFA World Cup. The contract, which represented the first global marketing and communications platform for the Sony Group, would run from 2007 to 2014 with a contract value (excluding services and product leases) of 33.0 billion yen (approximately $305 million). This was a very significant marketing investment for Sony, since the cost of event sponsorship with advertising was typically two or three times the cost of the sponsorship rights; hence, Sony was potentially investing a billion dollars or more on FIFA-related marketing campaigns over the next several years. Many Sony senior executives were questioning the return on investment (ROI) of the FIFA sponsorship opportunity.To define key metrics and articulate a methodology for campaign measurement pre- and post-campaign to quantify ROI. To design a new Sony marketing campaign to activate the FIFA sponsorship opportunity, define metrics for measurement, and learn to use a balanced scorecard approach. Since the FIFA sponsorship is a brand campaign, nonfinancial metrics are primarily used. The key to success is to have a clearly defined sponsorship marketing strategy and business objectives.

In March 2009, Steve Fowler, vice president of strategy and client service at full-service advertising agency Ayzenberg, had just completed what he considered to be one of the most innovative campaigns he had ever handled. Capcom, a leader in the video gaming industry, had just launched Resident Evil® 5 (RE5), the latest release of one of the industry's most valuable game franchises. RE5, a powerful asset with a passionate fan base, had warranted the use of an online viral, or word-of-mouth (WOM), campaign for its worldwide game launch. Although the creative work and appropriate media for the RE5 launch had been meticulously planned, Fowler was also interested in measuring the effectiveness of the campaign to better serve his client. In the past, measuring WOM was practically impossible. However, a software company named Meteor Solutions had found a way to do exactly that. Fowler and his team had worked with Meteor to execute several campaigns for other clients, but he had never applied Meteor tools on such a large scale. Fowler knew Capcom would want to hear specific WOM figures. What was the return on investment for the RE5 campaign and the implications for future campaigns? Had the Meteor tools provided comprehensive and actionable information, or was more work needed before these solutions could be widely used in advertising?How to measure the value and fully leverage social media marketing including key success factors, challenges, metrics and implications for future campaigns and other industries.

This case is designed to teach how to structure information technology (IT) infrastructure outsourcing deals from both the outsourcer and the client perspective. Office Supply Incorporated (OSI) is a company in crisis, with challenges in its cost structure and poor IT performance. Outsourcing to Technology Infrastructure Solutions is an opportunity to both reduce costs and complexity for the firm, but students first must consider whether outsourcing is a good strategic fit for OSI. Detailed spreadsheet templates are given that are based on a real outsourcing client engagement for a major infrastructure outsourcing company. The spreadsheets are complex but have been simplified so that they automatically calculate when populated, allowing the students to quickly move to answering the management challenge: how should TIS price and structure the outsourcing deal? Answering this question provides deep insights into the business case for IT outsourcing and how outsourcers financially engineer a deal structure to ensure a win-win outcome for both the client and outsource service provider.Students will: Understand the strategic context of IT outsourcing and when it will benefit a firm; Understand IT infrastructure outsourcing and management issues such as personnel reductions and organizational change; Learn which outsourcing pricing model is the best fit for a project; Create a rigorous cost-benefit financial analysis and ROI model for IT infrastructure outsourcing; Analyze the model and learn how to financially engineer the deal to be a win-win for the outsourcer and client.

In 2001 Accenture took the bold step of separating from its parent, Arthur Andersen. The new firm that emerged had a bright future ahead, but it also faced the challenge of building a new IT infrastructure that could support a global organization that consults on leading-edge technology. Accenture's CIO at the time, Ed Schreck, knew that becoming a master of your own trade was not an easy task. Frank Modruson, Schreck's successor and the person responsible for carrying forward the IT transformation challenge from 2002 on, had ambitious plans for the new technology infrastructure that was to replace Arthur Andersen's legacy systems. Difficult decisions had to be made. Should the firm continue with a decentralized approach to managing technology platforms, in which each country chooses its own IT platforms and has autonomy to run them? Or should the firm take a mixed approach, in which the same standard applications would run throughout the enterprise but would be managed independently by individual offices? Or should Accenture espouse a “one-firm” approach and boldly shoot for a centralized implementation of its most critical systems, with all its offices interconnected on the same “instance” of a software platform? Furthermore, should the firm retain its traditional conception of IT as cost center, or should it migrate to a scheme that recognizes IT as a service provision center that generates measurable value for the organization? These questions and many others drove Accenture's CIO team to undertake one of the most remarkable IT transformations in a global organization in recent years.To understand best practices for transforming an IT infrastructure. To offer a step-by-step approach to rationalizing a billion-dollar-plus IT technology infrastructure. To understand the connection between strategy and architecture in delivering high performance for an organization. To understand organizational change strategies and approaches in dealing with complexity in very large companies.

Quantifying the efficacy of marketing is an age-old challenge. As John Wanamaker said a century ago, “Half the money I spend on advertising is wasted; the trouble is I don't know which half.” The big difference today, however, is that the Internet enables detailed tracking of marketing campaigns in real time, or near time. Exemplifies how to leverage the Internet to dramatically improve the efficacy of marketing. Centers upon the Microsoft Security Guidance marketing campaign, which was designed to change IT professionals' perception of Microsoft's software product security. The integrated marketing campaign involved print media, analyst relations, and online advertising. The advertising was designed to drive IT professionals to a Web site on security guidance, then sign them up for free in-person security training classes. Illustrates two important best practices for marketing in the Internet age: first, the campaign was designed to be measured, and second, agility was specifically designed into the campaign. In addition to tracking weekly click-through data from the print and online advertising, the campaign also used online pop-up customer perception surveys. Analyzing the click-though data, Microsoft realized it had a problem at the end of the first week of the campaign–there were far fewer signups for the training sessions than anticipated. By the end of the second week the campaign was changed, resulting in a huge improvement in efficacy. Creates a scorecard illustrating the pros and cons of the Microsoft approach compared to a more traditional campaign. Illustrates how, rather than creating big-bang campaigns, high-performing marketing organizations today are continually experimenting. They build flexibility into campaigns and design them to be measured.To learn how to leverage the Internet in marketing campaigns, analyze click-through data and online survey results acquired in near time, and learn how it is used to fine tune and dramatically improve a campaign. Furthermore, illustrates how nonfinancial metrics can be used to quantify marketing efficacy.

The case centers on Shilling & Smith's acquisition of Xteria Inc. and the resulting need to quickly scale the company's IT infrastructure to accommodate the acquisition. The case is based on a real leasing problem faced by a major retail firm in the Chicago area when it purchased a small credit card processing firm and scaled the operations to handle the retail firm's credit card transactions. The CIO of Shilling & Smith needs to determine which lease option is the best means of providing the technical infrastructure needed to support the firm after the acquisition of Xteria. Several issues will drive this decision, including the value and useful life of the equipment, as well as the strategic context of the firm. This case examines how to evaluate different lease options when acquiring data center information technology infrastructure. Specifically, the case addresses software vs. hardware leasing, different lease terms, and choosing between different lease structures depending on the strategy and needs of a company. This case enables students to understand the different types of technology leases and in which situations these leases would be employed.The Shilling & Smith case examines how to evaluate different lease options when acquiring data center information technology infrastructure. Specifically, students learn software vs. hardware leasing, different lease terms, and how to choose between different lease structures depending on the strategy and needs of the company. A secondary objective of the case is to teach students the important components and relative costs of information technology infrastructure.

In 1992 Joe Jackson, former manager of DuPont Motorsports for twelve years, was angling to get the paint business at Rick Hendrick's sixty-five automotive dealerships across the United States. In order to win the Hendrick car dealership paint contract, Jackson and Hendrick met to discuss the possibility of sponsoring Hendrick's new team and rookie NASCAR driver—Jeff Gordon. As a result of that meeting, DuPont signed on to be the primary sponsor. By 2006 Gordon was a NASCAR superstar, and the DuPont logo—viewed by millions—was a household brand. While this level of exposure was exciting for the company, executives at DuPont could not help but wonder if they were fully leveraging this tremendous marketing opportunity. Gordon was on fire—but was DuPont maximizing the heat? The DuPont-NASCAR case tasks students and executives with designing a creative marketing campaign to activate the NASCAR sponsorship opportunity and maximize value beyond conventional sponsorship marketing. This open-ended challenge encourages students and executives to think outside of the traditional marketing tactics typically employed by business-to-consumer (B2C) NASCAR sponsors. Additionally, the nature of DuPont creates the need to develop a multi-dimensional plan that caters to a breadth of brands. Beyond designing a new marketing campaign, a key objective of the case is to focus students and executives on designing metrics for measurement of the return on investment (ROI) into a campaign plan. As a first step, it is important to clearly articulate the campaign, business strategy, and key business objectives mapped to the strategy.Students and executives learn how to design a marketing campaign for measurement. Specifically, they are tasked with designing a new marketing campaign for DuPont to activate the DuPont/NASCAR relationship. Students and executives must define metrics for measurement and learn to use a balanced score card approach. Since the DuPont sponsorship of Hendrick Motorsports is a brand campaign built to reach the DuPont business-to-business (B2B) customer, both non-financial and financial metrics are used. The key to success is to have a clearly defined sponsorship marketing strategy and business objectives. The case teaches students and executives how to define key metrics and articulate a methodology for campaign measurement pre and post to quantify the return on investment (ROI).

A major barrier for growth of large multi-business unit firms is the inability to resource the critical initiatives to win—both in terms of dollars and people. The underpinning of the challenge involves the conflict between resourcing current cash-generating legacy businesses vs. new initiatives which may not, in the short term, produce positive financial results. Most companies do not have a formal portfolio process to deal with this fundamental issue. Danaka is a fictional company based on real business experiences. The company has strong growth markets as well as markets that are commoditizing. Unfortunately, the latter represent a sizable portion of the company's business. A framework is given that establishes a matrix to analyze the Danaka businesses using their critical financial criteria—cash generation and top-line growth. Projects are divided into four categories based on how they fit into the matrix, and resource allocations are then analyzed. Students discover that the current allocation does not enable Danaka to meet its aggressive growth goals. The case incorporates an interactive spreadsheet model in which students can dynamically change the various resource allocations and see the impact on future top-line growth. The essence of the case is how to manage the resource allocation for a multi-business unit firm when present allocations will not meet future growth goals.The key learning of this case is that when business leaders set financial goals, they must understand how they are expending their resources. More often than not, significant changes must occur that could be wrenching to the organization. The key learning objectives are: (1) realize the importance of performing a portfolio analysis; (2) discuss the issues involved in making the changes; and (3) understand how to put the decision process in place.

The case is based on a real $25 million project at a major U.S.-based computer manufacturer. For confidentiality reasons the company has been disguised as A&D High Tech. The Web-based online ordering system project is required by sales and marketing for the fall holiday season. If the project misses this window, the firm will lose substantial market share to competitors. The A&D High Tech case examines how to create and analyze a project plan in Microsoft Project. Specifically, data is given to build the project plan step-by-step and then analyze the plan using the Microsoft project management tool. In order to make the case manageable for students we reduced the size of the project, and corresponding number of resources, to approximately $1 million, but retained all of the features of the original project. The project plan that students construct from the data given in the case is fraught with risks, and students must apply risk management techniques to diagnose the plan. Ultimately, students must answer the management question: Will the project be completed for the holiday shopping season? This case is the first in a series; the second is the case entitled “A&D High Tech (B): Managing Scope Change.” The case can also be taught using other project management software tools, such as Primavera.The case teaches students how to build a project plan in Microsoft Project (or other project management software tools). More important, the case teaches prospective executives how to analyze a project plan and identify risks of the plan, and define strategies to mitigate these risks. Students learn that in the planning stage of any project the risks are highest, but this is the best opportunity for proactive management intervention.

Mergers and acquisitions (M&A) are often very complex management endeavors. Analyzes the IT component of M&A for two financial institutions. Students are tasked with assisting Mike Farrell, the CIO of New Millennium Financial (NMF), a new company created through the merger of FinStar Financial and D&L Bank, in determining the optimal combined IT portfolio. To accomplish this task the strategic business objectives of the firm must be clearly understood and the IT projects in the pipelines of both institutions analyzed. Students must make an IT portfolio management decision and answer the question: What is the optimal IT strategy and project portfolio for NMF?To apply a framework to manage a company's IT portfolio, i.e., understand the company's strategic context, develop business objectives that align with its strategy, assess IT investments, and develop a portfolio of IT projects that support the objectives. The framework is iterative, i.e., IT investments are assessed on a regular basis based on their performance and risk/return tradeoffs. Also to introduce a leading Web-based tool, ProSight, that helps managers organize IT portfolios.

By 2009 Netflix had all but trounced its traditional bricks-and-mortar competitors in the video rental industry. Since its founding in the late 1990s, the company had changed the face of the industry and threatened the existence of such entrenched giants as Blockbuster, in large part because of its easy-to-understand subscription model, policy of no late fees, and use of analytics to leverage customer data to provide a superior customer experience and grow its e-commerce media platform. Netflix's investment in data collection, IT systems, and advanced analytics such as proprietary data mining techniques and algorithms for customer and product matching played a crucial role in both its strategy and success. However, the explosive growth of the digital media market presents a serious challenge for Netflix's business going forward. How will its analytics, customer data, and customer interaction models play a role in the future of the digital media space? Will it be able to stand up to competition from more seasoned players in the digital market, such as Amazon and Apple? What position must Netflix take in order to successfully compete in this digital arena?To examine the benefits and risks of investment in analytical technology as a means for mining customer data for business insights. Students will develop a strategy position for Netflix's investment in technology and its digital media business. Students must also consider how new corporate partnerships and changes to the customer channel model will allow the company to prosper in the highly competitive digital space.

The case is based on a real supply chain outsourcing management decision at a major manufacturing company. The company has been disguised for confidentiality reasons. The case discusses different types of outsourcing, supply chain management, the benefits and risks of outsourcing, and various pricing models for outsourcing contracts. Students must make a management decision and answer these questions: Is supply chain outsourcing a viable option for DB Toys? What will the return on investment be? What is the best outsourcing model? What is the best pricing model?Students learn the different types of outsourcing, supply chain management, the benefits and risks of outsourcing, and various pricing models for outsourcing contracts. Students also learn how to calculate the return on investment of supply chain outsourcing. Most important, the case enables students to understand the strategic context of outsourcing, and to decide which outsourcing model and pricing is appropriate.

This case focuses on the challenge of quantifying the return on investment (ROI) of a large technology project, enterprise resource planning (ERP), in the nonprofit environment of the San Diego City Schools. The school district does not generate a profit, so traditional revenue enhancement arguments do not work. Instead, the case discusses the internal processes re-design and system consolidation enabled by the new ERP system. The system ROI is composed of two major components: cost savings from removal of legacy applications and productivity improvements. The cost containment benefits are relatively straightforward to quantify, but do not justify the system. The productivity improvements are harder to quantify, and many can be categorized as soft benefits. Furthermore, many of the productivity and cost-saving benefits will not be realized without personnel reductions, which are especially difficult in school districts and government agencies. The case debrief therefore discusses the tradeoffs quantifying soft benefits and productivity improvements, best practices for management decision making, and the organizational change necessary to realize the ROI.The case teaches students how to analyze ROI for a large enterprise IT system in nonprofit or government organizations. Financial ROI is applicable for the hard cost benefits but some benefits are more difficult to quantify, and students learn how to factor these into the decision making as well. In addition, organizational change can be particularly challenging in the government or nonprofit context; the case enables a discussion of strategies for workforce re-deployment in these settings.

In this return on investment (ROI) for customer relationship management (CRM) case scenario, students must calculate the ROI for analytic CRM enabled by an enterprise data warehouse. The case is based upon a real-life consulting engagement with a major Fortune 100 telecommunications company. In this case the executive management team's strategic objective is to grow the customer base by 5 percent annually by customer acquisition. The internal rate of return calculated from the data given in the case is more than 800 percent for one year, and sensitivity analysis shows this is a robust projection, suggesting it should be funded without question. However, the strategy of the firm is customer acquisition in an environment of high customer churn. As a result of these dynamics, the revenues and net income of the firm are actually decreasing by hundreds of millions of dollars each year. A better solution would realize that the executive team has the incorrect strategic objective. Customer acquisition is the wrong approach in an environment of high customer churn and executives should focus on customer retention and cross-sell and up-sell to high-value customers. The case discussion therefore takes students beyond CRM ROI to focuses on the key strategic concepts of customer relationship management.Students learn how to calculate return on investment (ROI) for analytic customer relationship management (CRM) initiatives. The case also discusses in detail the difference between operational CRM and analytic CRM. The case solution is relatively straightforward with a very good ROI. However, the true learning of the case is for students to understand the strategic context of analytic CRM and to question assumptions in any ROI model.

A major barrier for growth of large multi-business-unit firms is the inability to resource the critical initiatives to win—both in terms of dollars and people. The underpinning of the challenge involves the conflict between resourcing current cash-generating legacy businesses vs. new initiatives which may not, in the short term, produce positive financial results. Most companies do not have a formal portfolio process to deal with this fundamental issue. The Healthcare Solutions business unit of Danaka is a fictional business based on real business experiences. The principle challenge is the need for this business to free up $300 million of current, budgeted R&D projects to fund new, unfunded initiatives to meet its five-year growth objectives. Tools and processes are introduced via interactive spreadsheets that show how to make the tough portfolio decisions on a project-by-project basis.When business leaders set financial goals, they must understand how they are expending their resources. More often than not, significant changes must occur that could be wrenching to the organization. The key learning objectives of the case are: (1) realizing the importance of doing the portfolio analysis, (2) discussing the processes and issues involved in making the changes, and (3) understanding how to put the decision process in place.

Rob Griffin, senior vice president and U.S. director of search for Media Contacts, a communications consulting firm, is faced with the task of optimizing search engine marketing (SEM) for Air France. At the time of the case, SEM had become an advertising phenomenon, with North American advertisers spending $9.4 billion in the SEM channel, up 62% from 2005. Moving forward, Griffin wants to ensure that the team keeps its leading edge and delivers the results Air France requires for optimal Internet sales growth. The case centers upon Air France's and Media Contacts' efforts to find the ideal SEM campaign to provide an optimal amount of ticket sales in response to advertising dollars spent. This optimal search marketing campaign is based on choosing effective allocation of ad dollars across the various search engines, as well as selecting appropriate keywords and bid strategies for placement on the search result page for Internet users.In determining the optimal strategy, the case presents background information on the airline industry as well as the Internet search options available at the time, including Google, Microsoft MSN, Yahoo!, and Kayak. Additionally, background information is provided on SEM and its associated costs and means of measuring the successfulness of each marketing effort. The case illustrates how one must first determine the key performance indicators for the project to guide analysis and enable comparison of various SEM campaigns. Cost per click and probability to produce a sale differ among publishers. Therefore, using a portfolio application model's quadrant positions can be used to determine optimal publisher strategies. Additionally, pivot tables help illustrate campaigns and strategies that have historically been most successful in meeting Air France's target Internet sales. Multiple recommendations on how Media Contacts can assist Air France in improving its SEM strategy can be derived from the data provided.Students learn how to optimally leverage the Internet in generating customer sales in a cost-effective manner. Students will analyze and manipulate a variety of data using pivot tables to determine optimal strategies for obtaining maximum total online bookings through the various online channels available. Using a portfolio application model, students can determine an optimal publisher strategy and complete copy improvement analysis.

Technology projects are inherently risky; research shows that large IT projects succeed as originally planned only 28 percent of the time. Building flexibility, or real options, into a project can help manage this risk. Furthermore, the management flexibility of options has value, as the downside risk is reduced and the upside is increased. The case is based upon real options analysis for an enterprise data warehouse (EDW) and analytic customer relationship management (CRM) program at a major U.S. firm. The firm has been disguised as Global Airlines for confidentiality reasons. The data mart consolidation or EDW marginally meets the hurdle rate for the firm as analyzed using a traditional net present value (NPV) analysis. However, different tactical deployment strategies help mitigate the risk of the project by building options into the project, and the traditional NPV is expanded by the real option value. Students analyze the different deployment strategies using a binomial model compound option Excel macro, and calculate the volatility using Monte Carlo analysis in Excel. A step-by-step tutorial is provided to teach students how to accomplish the real options analysis for a simplified project, and this tutorial is easily generalized by students to the case scenario. In addition to the tactical options, the case also has the strategic growth option of analytic CRM. Students must therefore analyze both the tactical and strategic growth options and make a management recommendation on funding the project and also recommend an optimal deployment strategy to manage the project risk.The case teaches real options for technology projects. Students learn how to calculate real option values, where the key input of volatility is obtained by Monte Carlo analysis in Excel. Students also learn that the real option value is “real,” resulting from active management mitigating the risk of the project and improving the upside. Most important, students understand the difference between tactical vs. strategic growth options and the important management issues to consider.

This case is based on a real-life consulting engagement with a major Fortune 100 telecommunications company. The name of the firm has been disguised for confidentiality reasons. Completing the case teaches students how to develop a cost-containment ROI analysis and develop a business case for a large enterprise technology project. The class discussion focuses on strategies to understand and manage the risks of the project and organizational issues. In addition, the case teaches students good questions to ask when reviewing a complex project business case, and how to present a project for funding approval. This case is the second in a series of three cases designed to teach students ROI analysis for technology projects; the first is “B&K Distributors: Calculating Return on Investment for a Web-Based Customer Portal” and the third is the case “ROI for a Customer Relationship Management Initiative at GST.”The case objective is for students to learn how to compute a return on investment (ROI) analysis for a large cost-containment technology project. Students learn the best practice of computing the range of possible outcomes (the best, worst, and expected case), and how to present the results to senior management. In addition, students learn how to incorporate important management issues of personnel reduction and technology project risk into an ROI analysis.

“MDCM, Inc. (B): Strategic IT Portfolio Management” examines the steps involved in developing a portfolio of IT projects aligned with a company's strategic objectives. Specifically, the case describes a situation where a firm has launched a transformation strategy but has yet to develop a complementary IT strategy. Students must select the optimal portfolio of projects aligned with the strategic objectives and define the global project execution strategy. The projects have both risks and dependencies. U.S.-based MDCM, Inc. specializes in medical device contract manufacturing and assembly. For the past five years, MDCM had grown by making more than twenty acquisitions of companies based outside the United States. This growth strategy enabled MDCM to better match its services to its customers, who had become larger and more global. In MDCM (A), the CIO of MDCM needed to determine the company's IT strategy and objectives. In doing so, he needed to ensure that they were properly aligned with the company's overall strategy and the new organization developed under an initiative called Horizon 2000. In a lecture prior to the cases, students should be introduced to the framework of IT portfolio management and how it can help focus IT efforts. In MDCM (B), the CIO has performed an audit of MDCM's IT and found twelve projects that are potential investment candidates for the next three years. The challenge for the IT Portfolio Management team is to identify the priority and appropriate sequence of investments to be made. The case assumes that students have knowledge of corporate IT. More specifically, the case is targeted for those who are or plan to become executives who would manage IT strategy and IT investment decisions either directly or in an oversight role. This case is the second in a series; the first is the case “MDCM, Inc. (A): IT Strategy Synchronization.”For this case, students create a portfolio management process and apply it to the IT project portfolio of a global manufacturing company. Students will learn how to balance risk and return of projects and short-term vs. long-term wins. They also create an activity network diagram, stressing the importance of understanding global resource constraints and execution timing. Students also learn the nuances of portfolio selection, e.g., outsourcing decision making and build vs. buy for a global firm.

BACKGROUND: Using hypofractionation (fewer, larger doses of daily radiation) to treat localized prostate cancer may improve convenience and resource use. For hypofractionation to be feasible, it must be at least as effective for cancer‐related outcomes and have comparable toxicity and quality of life outcomes as conventionally fractionated radiation therapy. OBJECTIVES: To assess the effects of hypofractionated external beam radiation therapy compared to conventionally fractionated external beam radiation therapy for men with clinically localized prostate cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and trials registries from 1946 to 15 March 2019 with reference checking, citation searching and contact with study authors. Searches were not limited by language or publication status. We reran all searches within three months (15th March 2019) prior to publication. SELECTION CRITERIA: Randomized controlled comparisons which included men with clinically localized prostate adenocarcinoma where hypofractionated radiation therapy (external beam radiation therapy) to the prostate using hypofractionation (greater than 2 Gy per fraction) compared with conventionally fractionated radiation therapy to the prostate delivered using standard fractionation (1.8 Gy to 2 Gy per fraction). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. Two authors independently assessed trial quality and extracted data. We used Review Manager 5 for data analysis and meta‐analysis. We used the inverse variance method and random‐effects model for data synthesis of time‐to‐event data with hazard ratios (HR) and 95% confidence intervals (CI) reported. For dichotomous data, we used the Mantel‐Haenzel method and random‐effects model to present risk ratios (RR) and 95% CI. We used GRADE to assess evidence quality for each outcome. MAIN RESULTS: We included 10 studies with 8278 men in our analysis comparing hypofractionation with conventional fractionation to treat prostate cancer. Primary outcomes Hypofractionation may result in little or no difference in prostate cancer‐specific survival [PC‐SS] (HR 1.00, 95% CI 0.72 to 1.39; studies = 8, participants = 7946; median follow‐up 72 months; low‐certainty evidence). For men in the intermediate‐risk group undergoing conventional fractionation this corresponds to 976 per 1000 men alive after 6 years and 0 more (44 fewer to 18 more) alive per 1000 men undergoing hypofractionation. We are uncertain about the effect of hypofractionation on late radiation therapy gastrointestinal (GI) toxicity (RR 1.10, 95% CI 0.68 to 1.78; studies = 4, participants = 3843; very low‐certainty evidence). Hypofractionation probably results in little or no difference to late radiation therapy genitourinary (GU) toxicity (RR 1.05, 95% CI 0.93 to 1.18; studies = 4, participants = 3843; moderate‐certainty evidence). This corresponds to 262 per 1000 late GU radiation therapy toxicity events with conventional fractionation and 13 more (18 fewer to 47 more) per 1000 men when undergoing hypofractionation. Secondary outcomes Hypofractionation results in little or no difference in overall survival (HR 0.94, 95% CI 0.83 to 1.07; 10 studies, 8243 participants; high‐certainty evidence). For men in the intermediate‐risk group undergoing conventional fractionation this corresponds to 869 per 1000 men alive after 6 years and 17 fewer (54 fewer to 17 more) participants alive per 1000 men when undergoing hypofractionation. Hypofractionation may result in little to no difference in metastasis‐free survival (HR 1.07, 95% CI 0.65 to 1.76; 5 studies, 4985 participants; low‐certainty evidence). This corresponds to 981 men per 1000 men metastasis‐free at 6 years when undergoing conventional fractionation and 5 more (58 fewer to 19 more) metastasis‐free per 1000 when undergoing hypofractionation. Hypofractionation likely results in a small, possibly unimportant reduction in biochemical recurrence‐free survival based on Phoenix criteria (HR 0.88, 95% CI 0.68 to 1.13; studies = 5, participants = 2889; median follow‐up 90 months to 108 months; moderate‐certainty evidence). In men of the intermediate‐risk group, this corresponds to 804 biochemical‐recurrence free men per 1000 participants at six years with conventional fractionation and 42 fewer (134 fewer to 37 more) recurrence‐free men per 1000 participants with hypofractionation Hypofractionation likely results in little to no difference to acute GU radiation therapy toxicity (RR 1.03, 95% CI 0.95 to 1.11; 4 studies, 4174 participants at 12 to 18 weeks' follow‐up; moderate‐certainty evidence). This corresponds to 360 episodes of toxicity per 1000 participants with conventional fractionation and 11 more (18 fewer to 40 more) per 1000 when undergoing hypofractionation. AUTHORS' CONCLUSIONS: These findings suggest that moderate hypofractionation (up to a fraction size of 3.4 Gy) results in similar oncologic outcomes in terms of disease‐specific, metastasis‐free and overall survival. There appears to be little to no increase in both acute and late toxicity.

Fewer than 5% of adult cancer patients participate in clinical trials, with multiple patient, clinician and institutional barriers identified. This study aimed to explore patient factors that impact access to cancer trials in New Zealand.A questionnaire that included demographics and factors that might impact trial participation was circulated via nine district health boards (DHBs) and four cancer foundations to patients with a cancer diagnosis.Between July 2016 and August 2017, 691 patients responded, 62% female and 77% aged50 years. Most patients (86%) would consider trial participation, which differed by income (p=0.0001) but not by age, tumour type or gender. Patients would consider attending another hospital (44%) or relocating (11%); 10% considered trials a last resort. Advantageous factors to participation included: benefiting others (92%), better treatment (82%), more scans and longer follow-up (47% and 51%). Disincentives included fear of randomisation (78%), treatment toxicities (71%), time and cost of more visits (40%) and unspecified future research (32%).Identified barriers to trial participation were similar in New Zealand to other developed countries. In this motivated cohort, patients are very interested in trial participation at any stage of their treatment and did not mind extra travel or tests.

TPS390 Background: Bleomycin, etoposide, and cisplatin (BEP) given 3-weekly x 4 is standard first-line chemotherapy for metastatic GCT categorised as intermediate risk or poor risk. Acceleration of standard regimens by shortening the cycle length improved cure rates in other cancers. We aim to determine the superiority of accelerated BEP versus standard BEP in this setting. Methods: This open label, randomised, phase III trial is conducted seamlessly in 2-stages. The primary endpoint for stage I (n=150) is complete response (CR); and for stage II (n=500) is progression free survival at 2 years (PFS2y). These sample sizes provide >80% power with a two-sided type error rate of 5% to detect an absolute improvement of 25% in the CR rate (stage II) and of 7% in the PFS2y (stage II). The target population is males and females aged 11 to 45 with intermediate-risk or poor-risk metastatic GCT of the testis, ovary, retroperitoneum, or mediastinum. Participants are randomised (1:1) to 4 cycles of standard BEP (q3w) or accelerated-BEP (q2w) with cisplatin 20mg/m2 D1-5, etoposide 100mg/m2 D1-5, bleomycin 30 KIU weekly x 12, and pegylated G-CSF D6 or filgrastim daily. Study assessments are 30 days after completing chemotherapy, 6 months from randomisation, and after completion of all post-chemotherapy treatments (e.g. surgery). Tumour tissue and baseline blood samples are collected for translational substudies including assessment of favourable versus unfavourable rates of decline in the novel biomarker miR-371. As of 13 October 2020, 140 participants have been recruited from 25 ANZ sites, 14 UK sites (led by Cambridge Clinical Trials Unit), and 140 USA sites (led by Children’s Oncology Group). The first planned interim analysis for safety (n=76) identified no safety concerns. The stage I analysis is anticipated mid-2021. This international randomised trial of chemotherapy for intermediate and poor-risk metastatic GCT is the first to include adults and children of both sexes. ClinicalTrials.gov: NCT02582697 Clinical trial information: NCT02582697.

This study used a quantitative survey to investigate the knowledge and use of online databases and the library's online public access catalog by final-year business associate degree students in five selected Jamaican community colleges. The study sought to determine students’ knowledge of electronic library resources, their value for electronic and print resources, the purposes for which students use electronic library resources, the influences on student use of electronic library resources, and the effects of training and instruction. Results from the study indicated that students are increasingly using Internet search engines for research purposes rather than online databases. Results also indicated that electronic library resources such as the OPAC are being underutilized by community college students. It was evident that proper instructional guidance is needed and welcomed by students. The findings of the study are critical to the implementation of policies and procedures geared toward sensiti...

To investigate differences in survival after diagnosis with colorectal cancer (CRC) by rurality, ethnicity and deprivation.In this retrospective cohort study, clinical records and National Collections data were merged for all patients diagnosed with CRC in New Zealand in 2007-2008. Prioritised ethnicity was classified using New Zealand Cancer Registry data; meshblock of residence at diagnosis was used to determine rurality and socioeconomic deprivation.Of the 4,950 patients included, 1,938 had died of CRC by May 2014. The five-year risks of death from CRC were: Māori 47%; Pacific 59%; non-Māori-non-Pacific (nMnP) 38%. After adjustment for demographic characteristics, comorbidity and disease stage at diagnosis, compared to nMnP the relative risk (RR) for Māori was 1.1 (95%CI: 0.8-1.3) and for Pacific 1.8 (95% CI: 1.4-2.5). We found no differences in risk of death from CRC by rurality, but some differences by deprivation.Disparity in outcome following diagnosis with CRC exists in New Zealand. Much of this disparity can be explained by stage of disease at diagnosis for Māori, but for Pacific peoples and those in deprived areas other factors may influence outcome. Further analyses of the PIPER data will explore the impact of any differences in management.