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Non-alcoholic fatty liver disease (NAFLD) is a fast-growing public health problem and predisposes to hepatocellular carcinoma (HCC) in a significant proportion of patients. Metabolic alterations might underlie the progression of NAFLD to HCC, but the magnitudes of risk and population-attributable risk fractions (PAFs) for various metabolic conditions that are associated with HCC risk in patients with NAFLD are unknown. We investigated the associations between metabolic conditions and HCC development in individuals with a prior history of NAFLD. The study included 11,245 participants in the SEER-Medicare database, comprising 1310 NAFLD-related HCC cases and 9835 NAFLD controls. We excluded individuals with competing liver diseases (e.g., alcoholic liver disease and chronic viral hepatitis). Baseline pre-existing diabetes mellitus, dyslipidemia, obesity, hypertension, hypothyroidism, and metabolic syndrome were assessed. Multivariable-adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). PAFs were also calculated for each metabolic condition. The results show that diabetes (OR = 2.39, 95% CI: 2.04–2.79), metabolic syndrome (OR = 1.73, 95% CI: 1.49–2.01), and obesity (OR = 1.62, 95% CI: 1.43–1.85) were associated with a higher HCC risk in individuals with NAFLD. The highest PAF for HCC was observed for pre-existing diabetes (42.1%, 95% CI: 35.7–48.5), followed by metabolic syndrome (28.8%, 95% CI: 21.7–35.9) and obesity (13.2%, 95% CI: 9.6–16.8). The major predisposing factors for HCC in individuals with NAFLD are diabetes mellitus, metabolic syndrome, and obesity, and their control would be critically important in mitigating the rising incidence of NAFLD-related HCC.

Gastric cancer (GC) is one of the most malignant neoplasms worldwide, accounting for about 770,000 deaths in 2020. The incidence of gastric cancer bone metastasis (GC-BM) is low, about 0.9–13.4%, and GC patients develop GC-BM because of a suitable bone microenvironment. Osteoblasts, osteoclasts, and tumor cells interact with each other, secreting cytokines such as PTHrP, RANK-L, IL-6, and other growth factors that disrupt the normal bone balance and promote tumor growth. The functions and numbers of immune cells in the bone microenvironment are continuously inhibited, resulting in bone balance disorder due to the cytokines released from destroyed bone and growing tumor cells. Patients with GC-BM are generally younger than 65 years old and they often present with a later stage of the disease, as well as more aggressive tumors. They usually have shorter overall survival (OS) because of the occurrence of skeletal-related events (SREs) and undetected bone destruction due to the untimely bone inspection. Current treatments of GC-BM focus mainly on gastric cancer and SRE-related treatment. This article reviews the clinical features, possible molecular pathogeneses, and the most commonly used diagnostic methods and treatments of bone metastasis in gastric cancer.

Kurt Sartorius (Hrsg.): Kolloquiumsbericht Alkoholgeschichte(n). Museum im Steinhaus – Schwäbisches Schnapsmuseum in Bönnigheim 2020. 96 Seiten, Folioformat mit zahlreichen meist farbigen Abbildungen. Broschur € 9,00 (zu beziehen im Museum, Meiereihof 5 + 7, 74357 Bönnigheim, schnamus@web.de)

Currently, the treatment of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) [HBV-HCC] relies on blunt tools that are unable to offer effective therapy for later stage pathogenesis. The potential of miRNA to treat HBV-HCC offer a more targeted approach to managing this lethal carcinoma; however, the complexity of miRNA as an ancillary regulator of the immune system remains poorly understood. This review examines the overlapping roles of HBx-dysregulated miRNA in HBV-HCC and immune pathways and seeks to demonstrate that specific miRNA response in immune cells is not independent of their expression in hepatocytes. This interplay between the two pathways may provide us with the possibility of using candidate miRNA to manipulate this interaction as a potential therapeutic option.

ObjectivesTo assess space-time trends in malnutrition and associated risk factors among children (DesignMultiround national panel survey using multistage random sampling.SettingNational, community based.ParticipantsCommunity-based sample of children and adults. Sample size: 3254 children in wave 1 (2008) to 4710 children in wave 5 (2017).Primary outcomesStunting, wasting/thinness and obesity among children (ResultsBetween 2008 and 2017, a larger decline nationally in stunting among children (ConclusionsWhile improvements in stunting have been observed, thinness/wasting and obesity prevalence remain largely unchanged. The geographic and sociodemographic heterogeneity in childhood malnutrition has implications for equitable attainment of global nutritional targets for 2025, with many districts having dual epidemics of undernutrition and overnutrition. Effective subnational-level public health planning and tailored interventions are required to address this challenge.

The potential of exploitation of miRNA as diagnostic agents and therapeutic tools will likely only be realized when a complete knowledge of their biology is revealed. Despite more than a decade of research, the use of miRNA as diagnostic and therapeutic tools remains a 'work in progress'. The objective of this review is to explore more recent developments in the role of deregulated miRNAs in hepatocellular carcinoma (HCC). This includes emerging insights involving miRNA biogenesis, their deregulation by cancer and their role in deregulating the principal HCC cancer pathways. Specific attention is directed at the role of deregulated miRNAs in HCC in a developing country context with high hepatitis B/C burden, as well as an examination of the challenges that confront the use of extracellular miRNAs as commercially viable diagnostic tools to detect early stage HCC.

Background A wide range of studies has investigated the diagnostic proficiency of extracellular microRNAs (miRNAs) in hepatocellular cancer (HCC). HCC is expected to increase in Sub-Saharan Africa (SSA), due to endemic levels of viral infection (HBV/HIV), ageing and changing lifestyles. This unique aetiological background provides an opportunity for investigating potentially novel circulating miRNAs as biomarkers for HCC in a prospective study in South Africa. Methods This study will recruit HCC patients from two South African cancer hospitals, situated in Durban and Pietermaritzburg in the province of KwaZulu-Natal. These cases will include both HBV mono-infected and HBV/HIV co-infected HCC cases. The control group will consist of two (2) age and sex-matched healthy population controls per HCC case randomly selected from a Durban based laboratory. The controls will exclude patients if they have any evidence of chronic liver disease. A standardised reporting approach will be adopted to detect, quantify and normalize the level of circulating miRNAs in the blood sera of HCC cases and their controls. Reverse transcription quantitative polymerase chain reaction (RT-qPCR) will be employed to quantity extracellular miRNAs. Differences in concentration of relevant miRNA by case/control status will be assessed using the Wilcoxon rank-sum (Mann-Whitney U) test. Adjustment for multiple testing (Bonferroni correction), receiver operating curves (ROC) and optimal breakpoint analyses will be employed to identify potential thresholds for the differentiation of miRNA levels of HCC cases and their controls. Discussion Although there is a growing base of literature regarding the role of circulating miRNAs as biomarkers, this promising field remains a ‘work in progress’. The aetiology of HBV infection in HCC is well understood, as well as it’s role in miRNA deregulation, however, the mediating role of HIV infection is unknown. HCC incidence in SSA, including South Africa, is expected to increase significantly in the next decade. A combination of factors, therefore, offers a unique opportunity to identify candidate circulating miRNAs as potential biomarkers for HBV/HIV infected HCC. Electronic supplementary material The online version of this article (10.1186/s12885-017-3915-z) contains supplementary material, which is available to authorized users.

Hepatocellular carcinoma (HCC) is a disease of global public health significance with mortality on the rise, despite the preventable nature of its risk factors especially in Africa. It is now the sixth most common cancer worldwide, fifth in males, and ninth in females. HCC incidence and mortality are predicted to increase in African countries constrained by limited resources to combat endemic levels of viral infection and synergistic environmental risk factors. The changing nature of HCC etiology is particularly illustrated here with the traditional risk factors like viral hepatitis coexisting alongside high human immunodeficiency virus (HIV) prevalence and rapidly increasing urbanization that have promoted a sharp increase in additional risk factors like coinfection, type 2 diabetes mellitus, and obesity. Although there are some differences in etiology between North Africa and sub-Saharan Africa, risk factors like chronic viral hepatitis B and C, aflatoxin exposure, and iron overload predominate. Aggressive hepatitis B genotypes, combined with hepatitis B virus/hepatitis C virus/HIV coinfections and aflatoxin exposure, promote a more aggressive molecular phenotype. In parallel to a better understanding of the molecular etiology of HCC, policy and planning initiatives to address the burden of HCC must be anchored within the reality of the limited resources available. Establishment and coordination of cancer registries across Africa is needed to improve the quality of data necessary to galvanize action. Preventive measures including hepatitis B vaccination programs, measures to prevent maternal-to-child and child-to-child transmission, delivery of universally accessible antiretroviral and antiviral treatments, and reduction of dietary aflatoxin exposure can contribute markedly to reduce HCC incidence. Finally, the development of biomarkers and new therapeutic interventions will need a better understanding of the unique genetic and epigenetic characteristics of HCC on the continent. We present a narrative review of HCC in Africa, discussing present and future trends.

Service delivery in South African municipal areas differs widely across jurisdictional boundaries. The paper illustrates the potential of geo-spatial mapping to quantify and map service delivery inequality at local municipal level in order to differentiate policy interventions. Data from a national 2007 South African survey were analysed to assess absolute levels and relative inequality of service delivery at district and local municipality levels. Not surprisingly, the results showed a wide variation in absolute service delivery levels when comparing richer urban districts to poorer rural ones. Service delivery inequality, however, was low in the richest urban districts, as well as the poorest rural ones. Conversely, service delivery inequality was highest in the more recently industrialised districts that contained both urban and rural municipalities. The scatter distribution of service delivery inequality versus absolute levels of service delivery appears to largely support Kuznets’ (1955) inverse U theory of inequality. Further analysis and discussion of the findings, however, illustrates that urban planners in both rich and poor South African municipalities are confronted with a number of dilemmas.

This paper investigates household dissolution and changes in asset wealth (socio-economic position) in a rural South African community containing settled refugees. Survival analysis applied to a longitudinal dataset indicated that the covariates increasing the risk of forced household dissolution were a reduction in socio-economic position (asset wealth), adult deaths and the permanent outmigration of more than 40% of the household. Conversely, the risk of dissolution was reduced by bigger households, state grants and older household heads. Significant spatial clusters of former refugee villages also showed a higher risk of dissolution after 20 years of permanent residence. A discussion of the dynamics of dissolution showed how an outflow/inflow of household assets (socio-economic position) was precipitated by each of the selected covariates. The paper shows how an understanding of the dynamics of forced household dissolution, combined with the use of geo-spatial mapping, can inform inter-disciplinary policy in a rural community.

The incidence and mortality of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HBV-HCC) is an intractable public health problem in developing countries that is compounded by limited early detection and therapeutic options. Despite the early promise of utilizing the regulatory role of miRNA in liver cancer, this field remains largely in the work-in-progress phase. This exploratory review paper adopts a broad focus in order to collate evidence of the regulatory role of miRNA in each stage of the HBV-HCC continuum. This includes the regulatory role of miRNA in early HBV infection, chronic inflammation, fibrosis/cirrhosis, and the onset of HCC. The paper specifically investigates HBV dysregulated miRNA that influence the expression of the host/HBV genome in HBV-HCC pathogenesis and fully acknowledges that this does not cover the full spectrum of dysregulated miRNA. The sheer number of dysregulated miRNA in each phase support a hypothesis that future therapeutic interventions will need to consider incorporating multiple miRNA panels.

African students continue to underperform in South Africa's schools and universities. This paper investigates the comparative performance of African chartered accountancy students from school to post-university level. The paper employed a mixed-method approach to analyse a series of cross-sectional datasets. The results showed that African students have underperformed at school, university and at post-university level, although the performance gap appears to be narrowing in the first professional chartered accountancy examination. The differential performance of these students was explained by poorer marks in mathematics and English that can be traced back to historical legacies in the education sector. South African universities, moreover, perpetuate this disadvantage because they have retained Eurocentric teaching approaches. In order to remove these barriers, tuition at school and university must be complemented by cross-cultural teaching practices and bridging programmes.

The exponential rise in cancer costs in South Africa (SA) was illustrated in a recent Sunday Times article entitled ‘The cost of cancer can be a debt sentence’.[1] Our minister of health talks of a ‘war’ against the high costs of cancer drugs, and epidemiologists project a sharply rising incidence. Eminent international medical journals, such as The Lancet, underline the fact that cancer cost is a growing international problem that confronts even the richest countries. Indeed, the question may be posed: if richer countries in the world are battling to cover the costs of cancer, what is the prognosis for SA?

Achieving high growth that is sustainable is an elusive goal for all but a few great companies. Despite the relative importance of this topic, limited research has been performed to explain this phenomenon, especially in a South African context. This paper adopts an exploratory approach to investigate some of the variables that influence company growth, as well as their choice of strategy. A mixed method incorporating descriptive statistics, regression analysis and qualitative evaluation, was used to test the research questions. A sample of 202 JSE companies indicated 28% were high growth entities, 39% medium growth and 33% achieved growth of less than 10%. A further survey of 30 Chief Executive Officers (CEO) indicated that they believed the top five growth drivers were acquisitions, managerial talent, operational efficiency, an entrepreneurial flair (low growth companies excluded) and the development of networks and partnerships. The respondents, however, ranked the number and importance of these growth drivers very differently with high growth companies citing a broader range of growth drivers than the other respondents. Quite surprisingly, the respondents appear to have underestimated the importance of industry and economy effects. Furthermore, high growth companies appeared to develop a broader spectrum of strategies that were more likely to be linked to their choice of growth driver. Interestingly, high growth companies were the only respondents to develop formal partnership and incentive strategies. In conclusion, the results re-enforce the impression that successful organizations develop a multiplicity of strategies that are always underpinned by operational efficiency.

The assimilation of refugees into their host community economic structures is often problematic. The paper investigates the ability of refugees in rural South Africa to accumulate assets over time relative to their host community. Bayesian spatial–temporal modelling was employed to analyse a longitudinal database that indicated that the asset accumulation rate of former Mozambican refugee households was similar to their host community; however, they were unable to close the wealth gap. A series of geo-statistical wealth maps illustrate that there is a spatial element to the higher levels of absolute poverty in the former refugee villages. The primary reason for this is their physical location in drier conditions that are established further away from facilities and infrastructure. Neighbouring South African villages in close proximity, however, display lower levels of absolute poverty, suggesting that the spatial location of the refugees only partially explains their disadvantaged situation. In this regard, the results indicate that the wealth of former refugee households continues to be more compromised by higher mortality levels, poorer education, and less access to high-return employment opportunities. The long-term impact of low initial asset status appears to be perpetuated in this instance by difficulties in obtaining legal status in order to access state pensions, facilities, and opportunities. The usefulness of the results is that they can be used to sharpen the targeting of differentiated policy in a given geographical area for refugee communities in rural Africa. Copyright © 2011 John Wiley & Sons, Ltd.

AimsThis paper aims to examine: the status and the use of financial and non‐financial measures, and the balanced scorecard (BSC) in Bangladeshi companies; the reasons for BSC adoption; and associated problems.Design/methodology/approachData via a questionnaire were obtained from the chief accounting and finance officers of a cross section of 60 Bangladeshi companies listed on the Dhaka Stock Exchange. A combination of descriptive statistics, bi‐variate, and multi‐variate techniques of statistics were used to test three research questions.FindingsThe results indicate that financial measures are more widely used, but that 78.4 per cent of companies use some non‐financial indicators. Further, the exercise of a full BSC is limited to only 10 per cent of the sample. The results also show that companies adopt these frameworks to aid decision making, and the problems associated with the adoption of BSC include a cost‐benefit perspective and a lack of management support.Practical implicationsThe findings suggest many companies are using a dashboard of financial and non‐financial performance measures that could possibly be a precursor to adopting more holistic performance measurement frameworks like the BSC.Originality/valueThere have been recent calls for more in‐depth analysis of the management accounting systems of emerging countries and these findings contribute further knowledge to an under researched area. In particular, the paper demonstrates how a performance measurement framework may evolve in an emerging country context.

A limited number of studies in Africa have reconciled human resource management (HRM) programs with cultural diversity as represented by Hofstede's cultural dimensions. The objective of this study is to examine how Western-based HRM can be modified to embrace cultural diversity in an African context. A mixed methodology employed a survey, as well as a case study in Mozambique. The results indicate high levels of power distance, collectivism, uncertainty avoidance, and feminism that are very similar to Kenya. These dimensions differed across a spectrum of employee levels illustrating cultural hybridization at firm level in a multinational operating in Africa. The results also illustrate the importance of a range of health, family, and societal beliefs in the workplace. Finally, a series of HRM recommendations were developed in an African context with respect to the selection, training, performance measurement, and management programs of the company.

How to set up successful multicultural human resource management programmes remains a contentious issue. This study examined variables that influenced job satisfaction in the workforce of a multinational company operating in Mozambique. It took a mixed methods approach and analysed case study data using a combination of content, thematic, descriptive and statistical techniques. The results indicate that the level of job satisfaction of these employees was comparable to that of employees in former Soviet Bloc countries; however, it varied significantly across levels of employee. The results also demonstrate that, to be more successful, ‘foreign’ management practices should be adapted to the local culture and, further, that humanism in the African workplace can positively mediate a traditional instrumentalist rewards system.

Background There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors. Methods We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals. Results From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country. Conclusions We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.

The development of multiple stakeholder performance measurement frameworks (PMF) is a complex process in the public research sector. The objective of the paper was to investigate whether the performance measurement framework (PMF) of a state owned research organization could be adapted to the Balanced Scorecard (BSC). A conceptual framework developed a hybrid form of BSC that could be applied in a research setting before describing a case study setting. A case study, as well as a survey was employed to investigate the research questions. The results suggest that the research sector PMF incorporated the properties the organization’s value chain, as well as reflected its strategies and key actions. Furthermore, suitable performance measures had been created for all the organization’s stakeholders. Further inductive analysis indicated that the PMF resembled a hybrid form of BSC based on the Moullin (2002) public sector framework. Finally, the results indicated that the PMF motivated its researchers at operations level, however, a survey of opinions suggests there was a significant difference in opinion between different categories of researchers.

The success of black economic empowerment (BEE) is still not clear. The objective of this paper is to assess the results of BEE equity transfers and contribute to the development of a framework to assess the cost/benefit of transferring equity in this fashion. BEE data from 62 companies listed on the Johannesburg Stock Exchange were analysed using a qualitative methodology and descriptive analysis. The results indicate that respondent companies have transferred less than 25 per cent equity to BEE partners, that a majority of firms appear to support the social objectives of BEE, that external partners appear to best promote shareholder wealth, and that the primary source of funding for BEE equity transactions is third-party funding or the respondent companies themselves. Finally, the Malaysian experience of affirmative action offers some useful lessons for South Africa's BEE programme, as well as some valuable insights into the economics of wealth redistribution.

This paper presents an overview of contracting arrangements in agribusiness procurement practices in South Africa. The objective of this paper is to contribute to a better understanding of the structures and issues of raw commodity procurement in South African agribusiness supply chains. The results suggest that a wide range of institutions are employed to procure raw commodities for the South African agroprocessing sector and that companies are increasingly moving away from the open market as a source of supply for raw commodities, and are utilising contractual arrangements instead. According to the main findings, 78.5% of the total volume of fruit and vegetables procured by agribusiness companies for processing is based on some form of contracting arrangement. The balance is procured through a combination of the open market, own estates, agents and imports. It is only in the case of potatoes, onions, beans and peanuts that a stronger reliance on the spot market is evident. South African retailers source 70% to 100% of their fresh produce directly from farmers (usually through growing programmes). The procurement of meat, poultry and eggs appears to favour vertical integration (and in some cases own production), medium- to long-term contracts and long-term ‛informal’ supply arrangements with selected groups of farmers.

Purpose/objectives: The objective of the study is to contribute to a better understanding of the key variables that influence the profitability of this sector, as well as to develop a reliable model to predict retail fuel sales volumes in an urban setting. Problem investigated: South African fuel retail outlets are confronted by a wide range of variables that constrain profit and a significant number of outlets are not profitable. In the event of further deregulation, it is conceivable that many fuel stations will go out of business. Methodology: A combination of a quantitative and a case study methodology, in conjunction with a literature review, was used to test the principal research questions. Findings/implications: The results suggest that location significantly influences urban retail fuel sales volumes whilst fuel station size and the fuel price play a lesser role. Other significant factors, however, also influence fuel station profitability. The demand for petrol appears to be relatively inelastic in the short term and more elastic over the long term. Conversely, the demand for diesel appears to be completely inelastic. Value: The article promotes a better understanding of the cost dynamics of the fuel industry. In this regard, the model constructed to predict urban fuel station turnover indicated high levels of reliability. Furthermore, few comparable studies have been published in accounting journals. Conclusion: The study concludes that urban petrol stations selling more than 370 000 liters of fuel per month are likely to be profitable and that location is a key variable influencing sales. In the event of deregulation, many operators are likely to be eliminated because of high levels of competition and low profit margins. An even greater number of fuel stations, therefore, will be reliant on non forecourt activities to survive.

The industrialization of agriculture and the potential problem of small-scale farmer marginalization calls for a fresh approach to the design of agribusiness supply chain arrangements in developing countries. The objective of the paper is to contribute to a better understanding of institutional arrangements that can promote stable smallholder agribusiness contracting arrangements in a developing country context. A case study approach, incorporating a transaction cost framework, is used to test whether trust can significantly change the contract characteristics of supply. The results suggest that although the presence of trust can influence the contract characteristics of a supply arrangement, it may not be significant because of other factors in a developing country context. Bearing this in mind, a number of institutional arrangements are recommended in order to promote more stable contract conditions.

Activity Based Costing (ABC) has been researched extensively in developed countries. Research on these issues in South Africa is limited. This article creates a better understanding of the design of ABC systems in South Africa, comparing ABC implementation in South Africa to that in several developed/developing countries. A quantitative methodology was adopted to evaluate the extent of ABC implementation. A survey‐case study methodology was used to identify reasons for implementation/ non‐implementation, problems and critical success factors relating to implementation. The results show that the extent of ABC implementation in South Africa is lower than that found in developed countries, but the evidence is inconclusive. Nevertheless, the results suggest that the issues facing ABC implementers in South Africa are similar to those faced in many other countries. This study provides South African companies with a comparative framework of important variables to be considered in implementing ABC.

The development of performance measures in service companies has not kept abreast with their manufacturing counterparts despite the unprecedented growth of this sector in recent decades. The objective of this paper is to contribute towards a better understanding of the design of performance measures in the service sector. More specifically, the objective of the paper is to develop a framework that can test the appropriateness of a service company’s performance measures. Two case studies in the service sector were employed to test the research question. The results indicate that the suggested framework is capable of testing the appropriateness of a service company’s performance measures in any service sector. The usefulness of the study is that the expanded standardised framework contributes to the literature of performance measurement, as well as facilitates the design of performance measurement systems in the service sector.

Industrial firms world wide have shed non-core business and outsourced these activities. An increasing number of sugar producers in Southern Africa have also outsourced their sugarcane production activities for both strategic and equity reasons. The purpose of the study is to use a transaction cost analysis (TCA) approach to assist the firm, as an outsourcer, make and structure an outsourcing decision. A Case Study methodology, which includes data from two major Southern African sugar producers, is employed to test the research questions. The results indicate that sugarcane production should not be outsourced on a partial specification contract basis but rather co-ordinated by a more relational structure like a strategic alliance. The results also suggest that the suitability of a strategy-based structure can sometimes be contradicted by a transaction cost analysis approach. Finally, the results indicate a conflicting South African agribusiness scenario, namely, the need to expand small-farm supply versus the economic goal of profit maximisation.

The inclusion of small-scale commercial farmers in South African agribusincss supply chains is a national priority and there is an urgent need for managerial accounting (MAS) inputs to successfully accomplish this objective. This paper explores ways that small fanners can be cost effectively incorporated in modern agricultural supply chains. A case study methodology is used to test the research questions. The results demonstrate that small-scale fanners can successfully compete with larger growers with respect to production and cost efficiency. The results also illustrate that small-scale farmers generate higher levels of transaction cost than medium and large scale suppliers. A series of proposals are then developed in order to reduce the transaction cost of small farm supply. In conclusion. smallscale fanners can be successfully incorporated in agribusiness supply chains but only if special measures are taken to reduce differential transaction cost.

ObjectivesThe present study aimed to test the association between high and low carbohydrate diets and obesity, and second, to test the link between total carbohydrate intake (as a percentage of total energy intake) and obesity.Setting, participants and outcome measuresWe sought MEDLINE, PubMed and Google Scholar for observation studies published between January 1990 and December 2016 assessing an association between obesity and high-carbohydrate intake. Two independent reviewers selected candidate studies, extracted data and assessed study quality.ResultsThe study identified 22 articles that fulfilled the inclusion and exclusion criteria and quantified an association between carbohydrate intake and obesity. The first pooled strata (high-carbohydrate versus low-carbohydrate intake) suggested a weak increased risk of obesity. The second pooled strata (increasing percentage of total carbohydrate intake in daily diet) showed a weak decreased risk of obesity. Both these pooled strata estimates were, however, not statistically significant.ConclusionsOn the basis of the current study, it cannot be concluded that a high-carbohydrate diet or increased percentage of total energy intake in the form of carbohydrates increases the odds of obesity. A central limitation of the study was the non-standard classification of dietary intake across the studies, as well as confounders like total energy intake, activity levels, age and gender. Further studies are needed that specifically classify refined versus unrefined carbohydrate intake, as well as studies that investigate the relationship between high fat, high unrefined carbohydrate–sugar diets.PROSPERO registration numberCRD42015023257.

The objective of this paper is to contribute to the design of agribusiness smallholder contracting linkages in South Africa. A fresh approach to design is adopted that combines a case study in the timber industry, the lessons of history and the economics of organisational architecture. The results confirm that the transaction characteristics of the grower-processor supply chain influence the level of managed co-ordination, that small-scale farmers generate incremental transaction cost and that medium and small-scale farmers can compete with larger growers in the supply chain. The results, however, are inconclusive with respect to the role of contracting as an institution to overcome the barriers of entry to the timber industry. A series of proposals are then developed in order to reduce transaction cost and achieve higher levels of contract enforcement in smallholder contracting arrangements with agribusiness. This paper concludes that large numbers of small-scale farmers can be effectively incor...

The problems of screening costs, as well as poor data, potentially lead to the underestimation of the incidence of hepatocellular carcinoma (HCC). In particular, this is problematic in developing countries with limited resources and poor data. The study develops a model to inform policy makers of the true incidence and potential extra cost of HCC in a developing country context.Using Globocan 2012 data, we employed an ecological correlation design at country level to associate HCC incidence data with relevant determinant data like HBV-HCV and other exposure factors. A Poisson regression model was used to estimate potentially missed incident cases of HCC by country and region based on the country risk factor covariate values.The results indicated that HBV and HCV prevalence were significantly associated with HCC incidence (p0.001) and potentially accounted for 94%% of incident HCC in 2012. We estimated a total of 120,772 potentially missed incident HCC cases in 2012. These cases are largely predicted for South Asia (21,000), North Asia (15,000), Western Africa (14,500) and Eastern Africa (12,500).Developing countries, with poorer quality data and a high historical burden of hepatitis, were predicted to have the majority of missed HCC cases in 2012 based on our model. These countries are, therefore, less able to detect, budget for or manage HCC. The high cost of HCC treatment, as well as its economic implications, poses a challenge in resource poor settings.