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We use response data collected by a lender to estimate the probabilities of loan offers being accepted by the applicants and the survival probabilities of default and of paying back early. Combining all those together we estimated the expected profit surface for the lender at the time of application before making an offer to an applicant. The results show how a lender could find the optimal interest rate to increase the expected profit or its market share. We also consider how different optimal decision policies could be applied to different market segments. Journal of the Operational Research Society (2010) 61, 430-442. doi: 10.1057/jors.2009.33 Published online 1 April 2009 Keywords: profitability; acceptance; credit; take-up

We investigate the incremental roles of information that becomes available only after a revolving loan has been granted in explaining and predicting the time taken until the borrower makes a second purchase. Using data relating to a store card, granted around the time of first purchase and used in Belgium, we find that characteristics of a first purchase and remaining credit available for use enhance the explanatory and predictive power of application characteristics. The relationship differs between good and poor payers. Journal of the Operational Research Society (2005) 56, 1041-1050. doi:10.1057/palgrave.jors.2601933 Published online 16 February 2005 Keywords: credit scoring; survival analysis; risk; banking

The high cost of maintenance in the processing industry implies the need for optimal planning of maintenance strategy. In order to achieve this there is a need to understand the underlying failure processes, which are often very complex. In this paper, a new semi-parametric approach, combining Cox regression with density kernal smoothing, is introduced to estimate the underlying performance. The approach has been applied to several processes and it allowed insight into each process, which would not have been achieved if traditional approaches had been used. Particularly, the refurbishment of processes had a significant impact on the rate failure. This paper concludes by assessing this impact of refurbishment on the maintenance programme. Keywords: maintenance; repair; asset life; semi-parametric methods; cox regression; smoothing

Background: The COVID‐19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods: The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results: Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set‐up, patient movement and operating theatre equipment when producing a COVID‐19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non‐filter devices, are discussed in detail. Conclusion: There is not enough evidence to quantify the risks of COVID‐19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis. [ABSTRACT FROM AUTHOR]

Copyright of BJS Open is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of BJS Open is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: The concept of using specific dietary components to selectively modulate the gut microbiota to confer a health benefit, defined as prebiotics, originated in 1995. In 2018, a group of scientists met at the International Scientific Association for Probiotics and Prebiotics annual meeting in Singapore to discuss advances in the prebiotic field, focussing on issues affecting functionality, research methodology and geographical differences. Methods and Results: The discussion ranged from examining scientific literature supporting the efficacy of established prebiotics, to the prospects for establishing health benefits associated with novel compounds, isolated from different sources. Conclusions: While many promising candidate prebiotics from across the globe have been highlighted in preliminary research, there are a limited number with both demonstrated mechanism of action and defined health benefits as required to meet the prebiotic definition. Prebiotics are part of a food industry with increasing market sales, yet there are great disparities in regulations in different countries. Identification and commercialization of new prebiotics with unique health benefits means that regulation must improve and remain up‐to‐date so as not to risk stifling research with potential health benefits for humans and other animals. Significance and Impact of Study: This summary of the workshop discussions indicates potential avenues for expanding the range of prebiotic substrates, delivery methods to enhance health benefits for the end consumer and guidance to better elucidate their activities in human studies. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method: Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30‐day complications, were compared between left‐sided and right‐sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results: In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left‐sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion: Despite equal ERP compliance, postoperative ileus was higher after right‐sided colectomies. This finding was associated with Crohn's disease and fluid overload. [ABSTRACT FROM AUTHOR]

An attempt to create the ultimate core surgical training post. [ABSTRACT FROM AUTHOR]

Background: Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The 'Hughes Repair' combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.Methods/design: This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.Discussion: A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.Trial Registration: Trial Registration Number: ISRCTN 25616490 . Registered on 1 January 2012. [ABSTRACT FROM AUTHOR]

The article presents a study to see whether attending the Cardiff thyroid fine needle aspiration (FNA) cytology course, a hands-on, simulation-based course designed to improve thyroid FNA, improves FNA technique.

There has been increasing interest in red wine anthocyanins in relation to changes brought about by lactic acid bacteria in the human digestive system. Anthocyanins are modified multiple times prior to being absorbed, so that intact anthocyanins are unlikely to survive the process, although the parent compounds may still act as local antioxidants within the digestive system. Metabolites such as phenolic acids are easier to absorb, and are thus more bioavailable. This study has investigated the biotransformation of the representative Pinot noir anthocyanin, malvidin-3-glucoside, into metabolites by Lactobacillus plantarum at pH 3.4, 4.2, 5.9 and 7.0 incubated anaerobically at 37°C for up to 24 hours. The metabolites were identified by HPLC-MS. Anthocyanin glycosides were found to be completely hydrolyzed by all selected strains at pH 5.9 after 24 h of incubation. The anthocyanins were quite stable under acidic conditions (pH 3.4) but were highly unstable at neutral pH due to both chemical and microbial degradation. The main metabolites were phenolic acids such as gallic acid and protocatechuic acid. They showed greater antioxidant activity than the parent anthocyanins, as indicated by radical scavenging assays and through an assessment of reducing strength using cyclic voltammetry. [ABSTRACT FROM AUTHOR]

In October 2012, a group of scientists met at the 10th Meeting of the International Scientific Association of Probiotics and Prebiotics (ISAPP) in Cork, Ireland to discuss issues surrounding prebiotics and their development. This article summarises outputs from the meeting. Various prebiotic definitions were discussed and how the concept has evolved from targeting the colonic microbiome, through to the entire gastrointestinal tract and finally the ISAPP definition, which specifies fermentation as a key criterion. Structure and function relationships are becoming clearer with effects upon microbial diversity, determinations of selectivity and enhanced biological activity being major outcomes. Immune modulation and metal chelation were further facets. Biomass can be a useful, and economic, means of generating new prebiotics. Pectic oligomers from citrus are model examples. Testing aspects range from in vitro batch culture fermenters to multiple stage models, immobilized systems, animal, cellular studies and human trials. Analytical processes around microbiota characterization and functionality were compared. Human studies were seen as the definitive outcome, including 13C labeling of key interventions. For extra intestinal effects, atopic disease, respiratory infections, vaginal issues, oral disease, adiposity, liver damage and skin infections are all feasible. The general outcome was that microbiota modulation was the key mechanism that linked these interactions. In pet food applications, the market potential for prebiotics is huge. Health targets are similar to those of humans. Issues include monomeric composition, chain length, linkages, branching, microbiota beyond bifidobacteria, metabolic Junction, mechanisms of health effects. Molecular biology has unraveled some of the explanations for prebiotic influences e.g. gene clusters to show transporters, regulators, permeases, hydrolases, lacS. In Lactobacillus ruminis, fermentation studies have been aligned to genome annotations, showing an energy efficient and rapid transport of GOS. In bifidobacteria, functional genome analyses have demonstrated uptake of trisaccharides. Questions relating to patients were then raised. For example, are prebiotics related to disease treatment or health maintenance? If a prebiotic does not change the microbiota, then how does it operate? Case study trials in Inflammatory Bowel Disease were presented on patient access to prebiotics and information. These showed that their knowledge of prebiotics was poor, compared to probiotics. The group then discussed the next generation of prebiotics (e.g. anti-adhesive activities). The comparator was Human Milk Oligosaccharides, which both reduce adherence of pathogens and act as prebiotics. Studies with galactooligosacchardes (GOS) have used pyrosequencing to demonstrate varying species level effects. This has relevance for infant formulae. Prebiotic aspects of whole foods and their complexity was covered. Trials were described where cross feeding and co-metabolism had been investigated. Suggestions on other prebiotic influences, aside from bifidobacteria, were made and included metagenomics, metabonomics, gene expression, mRNA global sequencing, bile deconjugation, enzyme profiles, lipids, phenolics. The discussion suggested how prebiotics could move forward with a wider expansion of the concept, target populations, expanded microorganisms, health benefits, application of new technologies and improved consumer understanding being the main goals. [ABSTRACT FROM AUTHOR]

The intestinal mucosa is constantly exposed to a variety of microbial species including commensals and pathogens, the latter leaving the host susceptible to infection. Antimicrobial peptides (AMP) are an important part of the first line of defense at mucosal surfaces. Human β-defensins (HBD) are AMP expressed by colonic epithelial cells, which act as broad spectrum antimicrobials. This study explored the direct and indirect effects of green kiwifruit (KF) on human β-defensin 1 and 2 (HBD-1 and 2) production by epithelial cells. In vitro digestion of KF pulp consisted of a simulated gastric and duodenal digestion, followed by colonic microbial fermentation using nine human faecal donors. Fermenta from individual donors was sterile filtered and independently added to epithelial cells prior to analysis of HBD protein production. KF products obtained from the gastric and duodenal digestion had no effect on the production of HBD-1 or 2 by epithelial cells, demonstrating that KF does not contain substances that directly modulate defensin production. However, when the digested KF products were further subjected to in vitro colonic fermentation, the fermentation products significantly up-regulated HBD-1 and 2 production by the same epithelial cells. We propose that this effect was predominantly mediated by the presence of short-chain fatty acids (SCFA) in the fermenta. Exposure of cells to purified SCFA confirmed this and HBD-1 and 2 production was up-regulated with acetate, propionate and butyrate. In conclusion, in vitro colonic fermentation of green kiwifruit digest appears to prime defense mechanisms in gut cells by enhancing the production of antimicrobial defensins. [ABSTRACT FROM AUTHOR]

We examined the effects of whole kiwifruit on gut microbiota using an in vitro batch model of gastric-ileal digestion and colonic fermentation. Faecal fermentations of gold and green kiwifruit, inulin and water (control) digests were performed for up to 48 h. As compared to the control, gold and green kiwifruit increased Bifidobacterium spp. by 0.9 and 0.8 log(10) cfu/ml, respectively (P < 0.001), and the Bacteroides-Prevotella-Porphyromonas group by 0.4 and 0.5 log(10) cfu/ml, respectively. Inulin only had a bifidogenic effect (+0.4 log(10) cfu/ml). This was accompanied with increases in microbial glycosidases, especially those with substrate specificities relating to the breakdown of kiwifruit oligosaccharides, and with increased generation of short chain fatty acids. The microbial metabolic activity was sustained for up to 48 h, which we attribute to the complexity of the carbohydrate substrate provided by whole kiwifruit. Kiwifruit fermenta supernatant was also separately shown to affect the in vitro proliferation of Bifidobacterium longum, and its adhesion to Caco-2 intestinal epithelial cells. Collectively, these data suggest that whole kiwifruit may modulate human gut microbial composition and metabolism to produce metabolites conducive to increased bifidobacteria-host association. [ABSTRACT FROM AUTHOR]

The paper introduces a number of risk-rating models for UK small businesses applying an accounting-based approach, which uses financial ratios to predict corporate bankruptcy. An enhancement to these models is considered through features typical to retail credit risk modelling. A common problem of default prediction consists in the relatively small number of bankruptcies or real defaults available for model-building. In order to expand the `default' group beyond bankrupt companies, the paper considers adopting four different definitions of `a failing business' by investigating combinations of financial distress levels. The impact of each default definition on the choice of predictor variables and on the model's predictive accuracy is explored. In addition, the paper examines the value of categorizing financial ratios used as predictor variables. [ABSTRACT FROM AUTHOR]

The article deals with the role of physicians and patients in reducing wasteful and harmful health care provided by the National Health Service (NHS) in Great Britain.

Equipment in the process industry is often subject to decay and requires maintenance, repair and eventual replacement. The challenge of competition and the accompanying regulatory regime requires that actions be integrated and cost effective. Ansell and colleagues in 2001 explored an approach to the assessment of asset life of maintained equipment in the process industry using a semiparametric approach. Using stochastic dynamic programming techniques an approach to find the optimal strategy was also developed by Ansell and colleagues. The approach was illustrated using data from the water industry. A major aspect in the development of optimal strategy for repair and replacement is the cost of these activities. Often the costs can only be ascertained roughly in terms of hours expended on the activity. Detailed costings are rarely available. The discount factor will depend on the interest rate in place. Generally a conservatively high level has been taken but with current low rates one needs to explore the sensitivity of solution to the discount factor. Also there is a need to explore the sensitivity of the solution to changes in the costs of the maintenance activities involved. In this paper we explore the stability of the results to changes in the relative costs. It is seen that two costs seem to be more important than the others; hence the accounting effort appears to be best directed towards these costs. One concern that arises from these results is the impact of the maintenance events. In past modelling the impact of maintenance has been assumed to have a fixed effect. This was derived from study of data. It is felt that this assumption may be too simple and so a differing model is explored to examine this issue. [ABSTRACT FROM AUTHOR]

Processing equipment in the water industry is subject to decay and requires maintenance, repair and eventual replacement. The challenge of competition within the water industry and the accompanying regulatory regime requires that actions be integrated and cost effective. This is an industry, which has considerable data on the failure of its equipment, but until recently very few models of the maintenance process have been built. This paper describes the context of this problem for clean water processing where the equipment is that required to purify water, It proposes a model based on the virtual and operating age of the components. The operating age reflects the true age of the equipment while the virtual age allows for the cumulative effect of maintenance actions performed on the equipment. The model also allows for different types of equipment by describing degradation by Cox's proportional hazards model. Thus the special features of the equipment and environment in which the equipment operates are described by a set of characteristics, which modify the hazard rate of the failure time of the equipment. This approach using Cox's model with virtual and operating age can be applied to other processing industries including the gas industry and the 'dirty water' side of the water industry. The model is formulated as a stochastic dynamic programming or Markov decision process and the form of the optimal policy is determined. This shows that repair and replacement should only be performed when the equipment has failed and describes general conditions when replacement is appropriate. The optimal policy is calculated numerically using the value iteration algorithm for a specific example based on data on failure. [ABSTRACT FROM AUTHOR]

Significant advances in the pharmacological prophylaxis of venous thromboembolism have occurred since warfarin and unfractionated heparin were introduced for this indication nearly 60 years ago. Despite these advances, coumarin derivatives such as warfarin remain the only orally active anticoagulants available for prophylaxis in venous thromboembolism. Although administered orally, coumarin derivatives are not convenient to use, because they have narrow therapeutic indexes and require routine coagulation monitoring and dose adjustment. This is inconvenient for patients and physicians and costly for the healthcare system. Low-molecular-weight heparins, which are administered in fixed or weight-adjusted doses and do not require monitoring, are widely used for the prevention of venous thromboembolism in patients in both the hospital and the outpatient setting. However, these drugs must be given subcutaneously, which can be difficult for outpatients and resource-intensive for in-hospital use. Likewise, fondaparinux, the synthetic pentasaccharide, must be administered subcutaneously. Consequently, there remains a need for new orally active anticoagulants that can be given in fixed doses and do not have a narrow therapeutic index, so that coagulation monitoring is unnecessary. Because such agents would be more convenient for patients and physicians, they would probably expand the use of prophylaxis in venous thromboembolism in those at risk, and would simplify treatment of patients with established venous thromboembolism. [ABSTRACT FROM AUTHOR]