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Background: Approximately 85% of the U.S. military active duty population is male and less than 50 years of age, with elevated levels of known risk factors for oropharyngeal squamous cell carcinoma (OPSCC), including smoking, excessive use of alcohol, and greater numbers of sexual partners, and elevated prevalence of human papilloma virus (HPV). Given the recent rise in incidence of OPSCC related to the HPV, the Department of Defense Serum Repository provides an unparalleled resource for longitudinal studies of OPSCC in the military for the identification of early detection biomarkers. Methods: We identified 175 patients diagnosed with OPSCC with 175 matched healthy controls and retrieved a total of 978 serum samples drawn at the time of diagnosis, 2 and 4 years prior to diagnosis, and 2 years after diagnosis. Following immunoaffinity depletion, serum samples were analyzed by targeted proteomics assays for multiplexed quantification of a panel of 146 candidate protein biomarkers from the curated literature. Results: Using a Random Forest machine learning approach, we derived a 13-protein signature that distinguishes cases versus controls based on longitudinal changes in serum protein concentration. The abundances of each of the 13 proteins remain constant over time in control subjects. The AUC for the derived Random Forest classifier was 0.90. Conclusions: This 13-protein classifier is highly promising for detection of OPSCC prior to overt symptoms. Impact: Use of longitudinal samples has significant potential to identify biomarkers for detection and risk stratification.

PurposeThe purpose of this paper is to analyze three characteristics of strategic alliances in Italy to estimate their influence on financial performance. The authors test how alliance complexity, strategic planning and accounting control influence revenue growth, asset growth and EBITDA margin.Design/methodology/approachThis paper uses contractual and financial data to test hypothesized relationships in structural equation modelling (SEM) using partial least squares (PLSs).FindingsThis paper highlights that the extent of strategic planning positively influences the growth in assets but not in revenue or EBITDA margin. In addition, the findings of this paper support the idea that the complexity in the alliance is significantly related to the quantity of accounting controls within alliance.Originality/valueThis paper improves existing research on the subject, as it contributes to open the black box of alliances’ internal operations by examining the details of 50 Italian contracts to create a multidimensional profile of each alliance.

This paper aims to bridge a gap in the literature by investigating a continuous audit case for anticorruption. The evolution of technology can offer valuable opportunities to integrate legality checks and business processes that are consistent with the growing call to fight corruption at the institutional level. Since the last decade, researchers have proposed conceptual frameworks demonstrating the visible advantages of continuous auditing and data mining, but significant difficulties still exist in practice. This process has been implemented in only a few cases, and the lack of empirical studies implies a need for additional research on this topic. To fill this gap, we adopt the framework proposed by Chan and Vasarhelyi (2011) and identify success factors for the implementation of continuous auditing. For the analysis, we use the research methodology of a single case study and focus on the Italian company Acciai Speciali Terni Spa (AST), the only steelwork company in Europe that has been ISO 37001 certified. This study demonstrates the practical impact of continuous auditing and data mining on strategic risk control by empirically testing the Chan and Vasarhelyi (2011) framework for the specific issue of anticorruption. The results show that effective continuous auditing is centered on an integrative and change management approach and that strategic vision, risk mapping, and a no‐corruption culture are among the most influential factors. The AST case demonstrates that technology is currently essential for supporting strategic risk control but only if it is integrated with consistent growth in organizational and managerial capabilities.

Telecommunication infrastructures provide essential services to urban communities. During an emergency caused by a seismic event, their functionality is crucial to guarantee communication among users and also facilitate search and rescue operations. In this paper, a methodology to model and quantify the seismic vulnerability and resilience of wireless telecommunication networks is presented. The case study is a virtual city resembling a typical medium-sized European city. Three separate networks managed by as many mobile network operators have been designed out of information gathered from a crowdsourced database and visual satellite inspections. The interdependence with the built environment is taken into account by associating the failure of network components with the collapse of the buildings hosting them. Three vulnerability indexes for the resilience analysis of urban telecommunication networks have been defined considering failed telecommunication towers, throughput, and the number of users per base station. They have been calculated after four seismic scenarios with different characteristics and intensities.

This paper presents a dataset of images generated via 3D graphics rendering. The dataset is composed by pictures of the junction between the high-speed shaft and the external bracket of the power generator inside a wind turbine cabin, in presence and absence of oil leaks. Oil leak occurrence is an anomaly that can verify in a zone of interest of the junction. Since the wind turbines industry is becoming more and more important, turbines maintenance is growing in importance accordingly. In this context a dataset, as we propose, can be used, for example, to design machine learning algorithms for predictive maintenance. The renderings have been produced, from various framings and various leaks shapes and colors, using the rendering engine Keyshot9. Subsequent preprocessing has been performed with Matlab, including images grayscale conversion and image binarization. Finally, data augmentation has been implemented in Python, and it can be easily extended/customized for realizing any further processing. The Matlab and Python source codes are also provided. To the authors’ knowledge, there are no other public available datasets on this topic.

Accidental broken dental needles during dental blocks have become a rare occurrence but still occur. Although the treatment for such occurrence is controversial, an increasing body of literature demonstrates that migration of such needles is possible. In this case, we report on a 48-year-old male with migration of a broken dental needle from an inferior alveolar block. Over the course of 2 years, we demonstrated radiological documentation of the course of migration with penetration of the internal jugular vein at the jugular foramen which was subsequently successfully retrieved through a transcervical approach without neurovascular injury. This case is unique given the location of migration to the skull base as well as radiologically documented time course. Furthermore, it highlights the need for prompt retrieval of broken dental needles given the high potential of migration and injury to neurovascular structures.

This paper aims to provide a contribution on how the small and medium enterpris-es (SMEs) may reduce the gap between theory and practice on management con-trol knowledge. The paper adopts a knowledge transfer (KT) approach grounded on Liyanage et al.'s (2009) framework. A project of management accounting (MA) implementation in a SME located in Umbria is presented and discussed fol-lowing a strong interventionist research approach. The case demonstrates the knowledge management relevance on MA implementation, able to integrate and reinforce the influence of contingency variables and institutional pressures. It con-tributes to show how the MA implementation has been positively influenced by the SME absorptive capacity (AC) and willingness to learn (WTL), connected to some educational and technical conditions characterizing the entrepreneur and the organization. This paper provides a practical contribution for practitioners and SMEs involved in the implementation of MA tools, demonstrating that successful implementation requires gradual learning cycles and some organizational pre-conditions to bring successful results. It also contributes to scientific debate en-hancing the active role of the actors in designing and implementing managerial control systems, as well as providing an original view that involves the supply and demand for innovation in managerial systems as sources and receivers of man-agement control knowledge.

To evaluate the anatomic integrity of rotator cuff repair performed by medialized single row and augmented by a porcine dermal patch, in comparison with a nonaugmented group.We conducted a single-center, prospective, double-blinded, randomized controlled trial. The sample size was predefined, and patients were divided into a study group and a control group, assessed preoperatively and at 1, 3, 6, 12, and 24 months. The EuroQol-visual analog scale; Constant-Murley questionnaire; Disabilities of the Arm, Shoulder and Hand Score; and Simple Shoulder Test were administered. The humeral-acromial distance was calculated on radiographs. Tendon thickness, tear extension, and tendon signal intensity were all measured on magnetic resonance images (MRIs) along with an evaluation of footprint extension and a classification into one of 4 healing grades-healed, thinned, partially healed, not healed.The study population consisted of 92 patients who were equally randomized into 2 homogenous groups. Sixty-nine patients completed the 24-month follow-up. The study group showed a healing rate of 97.6% compared with 59.5% for the standard repair group. The study group showed better results in terms of repaired tendon thickness and footprint coverage, with a P value.05, although the tendon density was comparable. The study group showed better strength recovery and functionality with the outcome scores submitted. During the entire study, only 2 patients reported complications, calling for a biopsy during revision surgery.Rotator cuff repairs augmented with a porcine dermal patch resulted in excellent clinical outcomes with a higher healing rate and close-to-normal MRI findings. The technique is safe and effective; in addition, it is reproducible and allows for better outcomes compared with those of standard medialized single-row repairs.

Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS. Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management. Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8–17.6%]; P

Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.

Over the last decade, the topic of regional resilience has drawn the attention of public authorities due to the increasing number of natural disasters. The absence of a practical and concrete methodology makes it extremely difficult to evaluate resilience at the regional scale, which involves several concepts such as economics, social sciences, environment, etc. This paper proposes an indicator-based approach to assess the resilience assessment of Italian regions. A set of twelve indicators has been selected among publicly available census data. A time window of ten years was considered in the analysis. Three different resilience indexes were calculated for each region. The first is an overall measure of resilience, while the other two represent resilience during the emergency and the restoration phase following a disaster. Results highlight fundamental aspects that have a higher impact on regional resilience and can be used by decision-makers to effectively allocate resources. The procedure has also been extended to evaluate the regional epidemic risk which can be used as a preliminary tool to develop risk mitigation strategies against biological hazards.

PurposeThe purpose of this paper is to explore the role of the entrepreneur in the knowledge transfer (KT) process of a start-up enterprise and the ways that role should change during the development phase to ensure mid-term business survival and growth.Design/methodology/approachAn in-depth, qualitative case study of Birra Flea, an Italian Craft Brewery, is presented and analysed using Liyanageet al.’s (2009) framework to identify the key components of the KT process, including relevant knowledge, key actors, transfer steps and the criteria for assessing its effectiveness and success.FindingsThe entrepreneur played a fundamental and crucial role in the start-up process, acting as a selective and passionate broker for the KT process. As Birra Flea matures and moves into the development phase, the role of the entrepreneur as KT’s champion needs to be integrated and distributed throughout the organisation, with the entrepreneur serving as a performance controller.Research limitations/implicationsThis study enriches the knowledge management literature by applying a framework designed to provide a general description of KT, with some modifications, to a single case study to demonstrate its effectiveness in differentiating types of knowledge and outlining how KT can be configured to support essential business functions in an SME.Practical implicationsThe analysis systematises the KT mechanisms that govern the start-up phase of an award-winning SME, with suggestions for how to manage KT during the development phase. Seldom are practitioners given insight into the mechanics of a successful SME start-up; this analysis serves as a practical guide for those wishing to implement effective KT strategies to emulate Birra Flea’s success.Originality/valueThe world’s economy thrives on SMEs, yet many fail as start-ups before they even have a chance to reach the development phase, presenting a motivation to study the early stages of SMEs. This study addresses that gap with an in-depth theoretical analysis of successful, effective KT processes in an SME, along with practical implications to enhance the knowledge, experience and skills of the actors that sustain these vital economic enterprises.

This paper aims to understand whether traditional management accounting tools (e.g. financial statement, reclassification and contribution margin analysis) contribute to foster dialogue and innovation in business networks composed of SMEs (small and medium-sized enterprises). Through the analysis of a case study, the paper focuses on a contractual network operating in the paper&print sector in Italy. Framing the analysis in the Simons’ construct (1990 and 1995), who distinguishes between diagnostic and interactive controls, the paper provides insights on the use of management control in inter-organizational settings, arguing that the traditional accounting tools can play an innovative role in network success. The contribution of the paper is on the ongoing debate on which functions, accounting information and MCSs (management control systems) may play in networks. In particular, findings shed light on the need to adapt the distinction between "diagnostic" and "interactive" in the network setting, given the horizontal and non-hierarchical relationships between the units involved.

This paper aims at providing some conceptual references to academics and practi-tioners useful for guiding the strategic planning process in alliance formation. Research on strategic networking is a multidisciplinary field drawing from different theoretical perspectives. It emphasizes the strategic value of alliances in its various forms but rarely attempts to model the strategic planning process and to test its validity empirically. Most of the contributions are focused on specific aspects of strategy, rarely providing a holistic view able to address the strategic process and contents by explicitly recognizing the existence of different kinds of alliances. Drawing from three different but interconnected theoretical roots (strategic net-work, strategic analysis, and value chain management) and adopting a deductive approach, this conceptual paper proposes a comprehensive framework for strategic planning in alliance formation and four theoretical propositions. These propositions shed light on the relationships between strategic planning process and three different kinds of business collaboration, and focus on the implications of the integrating process for network value creation. The different goals and complexity of such typologies, although not mutually exclusive, specifically influence the strategic analysis contents, the process of negotiation, and the construction of strategic consensus between partners.

The Pampean agroecosystems are oriented to providing a few Ecosystem Services (ES) with undesired consequences on the environment, particularly the loss of biodiversity and cultural ES. In this context, it is necessary to find ways to make agricultural production compatible with biodiversity conservation through sustainable practices. Rural tourism is a form of productive diversification that generates additional economic income for farmers and may encourage the conservation of uncultivated semi-natural environments. Thus, agroecosystems could provide a greater variety of ES, achieving their multifunctionality. For this, it is necessary to understand the link between land use and biodiversity and the psycho-social factors that stimulate or limit farmers to conserve their field’s semi-natural environments. To this end, we conducted a study with three approaches: 1) we evaluated the intentions of rural Pampa’s farmers of conserving uncultivated environments through surveys analyzed under the framework of the Theory of Planned Behavior, 2) we explored the preferred environments for recreation through a self-administered survey to rural tourists, and 3) we conducted bird surveys to associate land use with biodiversity. The results showed a trend of greater intention to conserve uncultivated environments in farmers with rural tourism than without rural tourism. These intentions were related to more positive attitudes due to the intrinsic and utilitarian values of conserving uncultivated environments and less identification with agriculture only as a source of economic income. Tourists preferred semi-natural environments for recreation, which also sustain higher bird diversity. Results allowed to detect key aspects to influence farmers to achieve a greater intention to conserve uncultivated environments and manage them to supply multiple ES.

Ultrasound has been widely investigated for food processing applications. To date studies have been mainly carried out using contact-type ultrasound systems. Recently it has been demonstrated that ultrasonic waves propagated via gases including air using non-contact ultrasound devices may also be employed to enhance various food processes with minimal impact on food quality. Airborne acoustic ultrasound has been shown to be suitable for various food and non-food applications including drying, defoaming and decontamination. This novel technology is currently being actively investigated to increase the limited knowledge on the specific mechanisms involved in airborne ultrasound assisted operations. Some of the main challenges that have hampered efficient energy transmission through air have been addressed by the development of new types of transducers. The objective of this review is to outline various potential applications of airborne ultrasound including drying, defoaming and inactivation of microorganisms. Equipment types, mechanisms and challenges encountered are also discussed.

This paper aims to explore the relationships between knowledge management (KM), performance measurement systems (PMSs), and small and medium enterprises&rsquo, (SMEs) economic sustainability in knowledge-intensive sectors. The literature demonstrates that SMEs are often characterized by unstructured KM approaches and limited PMS implementation, being at the same time affected by scarce profitability and financial issues. Adopting the knowledge-based view of the firm and the contingency theory of PMSs, we tested the impact of two alternative KM approaches (exploitation and exploration) on SMEs&rsquo, economic sustainability, measuring the moderating effect of PMS use (diagnostic and interactive). Through an ordinary least squares (OLS) regression of data collected for 219 Italian medium firms operating in knowledge-intensive sectors, this study provides evidence on how a specific KM approach supports the SME economic sustainability and how a consistent implementation and use of PMS amplify the relationship between KM and economic sustainability. Data analysis confirms the relevance of some key concepts of the knowledge-based view of the firm, especially the positive impact of the KM exploration approach on economic sustainability. Additionally, the paper extends empirical evidence for the PMS moderating effect on the KM&ndash, performance relationship. To the best of our knowledge, this is the first time that a study provides evidence for the relationships among KM, PMSs, and economic sustainability in the SME setting. Moreover, our findings lead to some managerial implications, especially they encourage SME entrepreneurs and managers to design a coherent KM approach and to implement an adequate PMS in order to support economic sustainability.

In a context of widespread acceptance and implementation of the United Nations Sustainable Development Goals (SDGs), this paper discusses the possible relationship between intellectual capital (IC) and nonfinancial information (NFI), particularly related to SDGs and corporate social responsibility (CSR) in a stakeholder engagement perspective. Prior studies called for further investigation about nonfinancial risk disclosure and claimed that companies mandated to disclose risk-related information tend to focus mainly on financial risks. Therefore, given the growing attention of regulators to the content of mandatory companies&rsquo, NFI brought to the Directive 2014/95/EU, this study intends to contribute to fill this literature gap by investigating the drivers of risk-related disclosure quality (RDQ) and to what extent it could be affected by the structural capital (SC), as one of the components of IC. The empirical analysis is based on a sample made of 51 Italian large undertakings and groups. The study uses content analysis to assess the RDQ from firms&rsquo, corporate reports. Regression analysis is used to examine if there is an influence of SC toward RDQ, both considered as a single information package and with specific reference to environmental disclosure. Results reveal that a positive association exists between RDQ and SC. Moreover, it is providing some support for the positive correlation between SC and the firm&rsquo, s size. In this sense, the paper contributes to existing risk reporting literature as a pioneering study identifying an IC driver to determine the quality of risk and risk management information. For regulators, this study highlights how, in a context of mandatory disclosure, the quality of information could also depend on firm characteristics (SC). For practitioners, the paper helps in understanding the role of IC in order to increase the quality of the corporate risk reporting.

Reinforced concrete structural components such as beams are subject during their service life to different loading conditions that may affect their durability and efficiency. This can reduce the safety level of the structure over time until it degrades completely and reaches its ultimate limit state. In particular, cracking conditions due to tensile conditions can be developed leading to the exposure of the steel reinforcements to the aggression of external agents, such as chlorides. Being able to monitor the development and the evolution of cracking is crucial and this research is aimed at this purpose. In particular, laboratory tests have been performed on reinforced concrete beams equipped with distributed fiber optics sensors to monitor the state of cracking. This technology has been selected because its inherent accuracy and low noise. Furthermore, since technology relies of optical signals, the sensors are not affected by electrical and magnetic noise. They are also resistant to high temperatures and chemically reactive environments. The main objectives of the presented first part of this research are focused on the deformation and temperature assessment after concrete pouring, crack detection, localization and opening quantification.

The accuracy of structural models significantly depends on the availability of input design parameters such as the dimensions of resisting elements, material properties, joint connection details, loading conditions, etc. When dealing with old structures, a lot of this information is not accessible, which leads to the introduction of many uncertainties into the model. In the last few decades, several structural health monitoring (SHM) techniques have been used to compensate such lack of data and perform more reliable structural analyses. However, SHM might result in costly and time-consuming surveys that can be as well affected by uncertainties due to environmental effects, measurement noise, and signal processing errors. This paper discusses and introduces a straightforward SHM procedure to collect the fundamental information to achieve a better accuracy and reliability of the finite element model of the considered building. The methodology starts with the acquisition of structural data from available construction drawings and Building Information Modeling (BIM) to create a preliminary finite element model. Then a series of non-destructive tests are performed using thermal camera, sclerometer, pachometer to identify the fundamental structural parameters. In addition, environmental noise measured through accelerometers is used to determine the principal frequencies of the structure. Harmonic excitations are then horizontally applied to resisting elements using a vibrodyne. The proposed methodology was tested on an RC school building located in Melzo (Milan, Italy). Statistical and signal processing techniques are then utilized to interpret the acquired signals and consequently update and calibrate the structural model for the vulnerability assessment. The processed signals revealed substantial differences with the original FE model. Thus, rigidity, mass and damping were modified accordingly.

Background This study aims to explore if the arthroscopically assisted reduction and internal fixation (ARIF) technique is superior to the traditional open reduction and internal fixation (ORIF) technique in the treatment of tibial lateral plateau fractures. Methods Forty patients with tibial plateau fractures (Schatzker type I–III) treated with ARIF or ORIF from 2012 to 2017 were included in this retrospective study. All patients received pre-operative radiographs and CT scans. The patients were divided into two groups (ARIF or ORIF). All patients had a minimum follow-up of 12 months and an average follow-up of 44.4 months. The clinical and radiographic outcomes were evaluated according to the Knee Society Score (KSS) and the modified Rasmussen radiological score. Results Satisfactory clinical and radiological results were found in 39 out of 40 (97.5%) patients. KSS and modified Rasmussen radiological score were significantly better in ARIF group. The mean KSS was 92.37 (± 6.3) for the ARIF group and 86.29 (± 11.54) for the ORIF group (p

Environmental, social, and governance (ESG) data are in high demand in financial markets. However, the ESG data provided by companies do not allow for use in the investment decision-making process. The main limiting point for this is a lack of comparability across companies. This paper analyzes the problem of comparability with the aim to evaluate the intra-industry comparability of sustainability reports, framing the analysis on Global Reporting Initiative (GRI) Standards and discussing the results with the support of legitimacy and stakeholder theories. Drawing upon stakeholder and legitimacy theories, as well as financial and sustainability accounting concepts, we propose a theoretical framework of comparability and a methodology to evaluate the level of comparability on a sector-specific basis. The methodological approach adopted in this study is broadly qualitative, with the use of a multiple-stages model. Based on the example of one industry, we discovered that, despite comparability being mostly relevant to the listed companies from the oil and gas sector, the sustainability reports of these companies are still not comparable. Our findings reveal that, despite the availability of a large amount of ESG data and the existence of sustainability frameworks, the problem of comparability is still relevant even for companies that are theoretically most inclined to be comparable.

Background: Different augmentation techniques have been described in the literature in addition to the surgical treatment of proximal humeral fractures. The aim of this systematic review was to analyze the use of cements, bone substitutes, and other devices for the augmentation of proximal humeral fractures. Methods: A systematic review was conducted by using PubMed/MEDLINE, ISI Web of Knowledge, Cochrane Library, Scopus/EMBASE, and Google Scholar databases according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines over the years 1966 to 2019. The search term “humeral fracture proximal” was combined with “augmentation”; “polymethylmethacrylate, PMMA”; “cement”; “bone substitutes”; “hydroxyapatite”; “calcium phosphates”; “calcium sulfate”; “cell therapies”, and “tissue engineering” to find the literature relevant to the topic under review. Results: A total of 10 clinical studies considered eligible for the review, with a total of 308 patients, were included. Mean age at the time of injury was 68.8 years (range of 58–92). The most commonly described techniques were reinforcing the screw–bone interface with bone PMMA cement (three studies), filling the metaphyseal void with synthetic bone substitutes (five studies), and enhancing structural support with metallic devices (two studies). Conclusion: PMMA cementation could improve screw-tip fixation. Calcium phosphate and calcium sulfate injectable composites provided good biocompatibility, osteoconductivity, and lower mechanical failure rate when compared to non-augmented fractures. Mechanical devices currently have a limited role. However, the available evidence is provided mainly by level III to IV studies, and none of the proposed techniques have been sufficiently studied.

Background Hemoptysis is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). Antifibrinolytic agents have shown efficacy in a broad range of bleeding disorders and conditions. Objectives The goal of this study was to examine the use of antifibrinolytic agents in managing hemoptysis in CF. We developed a clinical treatment pathway for inpatient and outpatient use, and rates of admission for bleeding prior to and following implementation of the pathway are reported. Methods All adult patients with CF treated with systemic antifibrinolytic agents over a 54-month period according to the treatment pathway were analyzed. Data collected included demographic characteristics, baseline CF-related characteristics, and bleeding and treatment parameters. Effectiveness of the pathway was evaluated via comparison of annualized hemoptysis admission rates prior to and following pathway enrollment. Results Seventy-two distinct episodes of hemoptysis treated with antifibrinolytic agents were analyzed in a total of 21 adult patients with CF. Two-thirds of episodes treated involved moderate or massive hemoptysis. Bleeding ceased following a median of 2 days. Outpatient treatment was associated with a 50% reduction in the annualized hemoptysis admission rate following pathway enrollment (2.44 vs 1.23 admissions per year; P = .0024) that was independent of other changes in management. Antifibrinolytic therapy was well tolerated. One central catheter-associated upper extremity DVT was observed in a patient with previous thrombosis in the same vessel. Conclusions A pathway using systemic antifibrinolytic therapy to treat hemoptysis in patients with CF was associated with a reduction in hospital admissions. No serious adverse events were observed. Additional studies are needed to further define the benefits of systemic antifibrinolytic use in patients with CF.

Airborne power ultrasound is a green technology with a great potential for food and environmental applications, among others. This technology aims at producing permanent changes in objects and substances by means of the propagation of high-intensity waves through air and multiphase media. Specifically, the nonlinear effects produced in such media are responsible for the beneficial repercussions of ultrasound in airborne applications. Processing enhancement is achieved through minimizing the impedance mismatch between the ultrasonic radiator source and the medium by the generation of large vibration displacements and the concentration of energy radiation thus overcoming the high acoustic absorption of fluids, and in particular of gases such as air. Within this work the enhancing effects of airborne power ultrasound in various solid/liquid/gas applications including drying of solid and semi-solid substances, and the agglomeration of tiny particles in air cleaning processes are presented. Moreover, the design of new ultrasonic devices capable of generating these effects are described along with practical methods aimed at maintaining a stable performance of the tuned systems at operational powers. Hence, design strategies based on finite element modelling (FEM) and experimental methods consolidated through the years for material and tuned assembly characterizations are highlighted.

Network, Smart, and Open are three keywords that nowadays guide information systems (ISs) research. We discuss the relevance that these three topics, concerning technological and organizational innovations (i.e. cloud, smart technologies and networking), play for the development of accounting and management information systems. The aim is to investigate how these innovations could influence ISs, with a particular focus on accounting and management information systems, enhancing their information potentialities and their ability to support decision making processes, and improving accounting methodologies; performance measurement systems; data management; information systems architecture, external and internal reporting.

The purpose of this paper is to assess and integrate the application of the balance scorecard (BSC) logic into business networks identifying functions and use that such performance measuring tool may undertake for SME’s collaborative development. Thus, the paper analyses a successful case study regarding an Italian network of small companies, evaluating how the multidimensional perspective of BSC can support strategic an d operational network management as well as communication of financial and extra financial performance to stakeholders. The study consists of a qualitative method, proposing the application of BSC model for business networks from international literature. Several meetings and interviews as well as triangulation with primary and secondary documents have been conducted. The case study allows to recognize how BSC network logic can play a fundamental role on defining network mission, supporting management control as well as measuring and reporting the intangible assets formation along the network development lifecycle. This is the first time application of a BSC integrated framework for business networks composed of SMEs. The case study demonstrates operational value of BSC for SME’s collaborative development and success

According to the current criteria, the diagnosis of early allograft dysfunction usually cannot be established before the end of the first week after liver transplantation. Thus, early predictive tests for detecting allograft dysfunction are still warranted to prevent allograft failure. This study was undertaken to assess the role of low serum factor V activity as an early prognostic factor (postoperative day 2) after liver transplantation.A retrospective review of all consecutive adult patients who underwent first orthotopic whole-graft liver transplant at our institution between March 2002 and June 2011 was undertaken. Primary endpoint was graft failure within 90 days after transplantation.Of all 105 patients analyzed in this study, 39 (37.1 %) were female and 66 (62.9 %) were male. Mean age was 52.7 ± 11.7 years, and median follow-up period was 2474 ± 164 days. There were overall 33 (31.4 %) deaths, 13 of those occurring on the first 90 post-transplant days. Multivariate analysis demonstrated that serum factor V lower than 41.5 % and female gender had a negative impact not only on allograft failure/death within 90 days after transplantation (RR = 5.30, CI = 1.40-20.2, p = 0.015 and RR = 5.23, CI = 1.53-21.33, p = 0.008) but also on overall mortality. For prediction of allograft failure/death occurring during the first 3 months, serum factor V level of 41.5 % or lower exhibited a specificity of 87.9 %, a sensitivity of 42.9 %, an accuracy of 81.9 %, a positive predictive value of 35.3 %, and a negative predictive value of 90.9 %.Assessment of serum factor V levels on postoperative day 2 might be a promising prognostic tool for early prediction of inferior outcomes after liver transplantation.

Power ultrasound (PU) is an emerging, innovative, energy saving and environmental friendly technology that is generating a great interest in sectors such as food and pharmaceutical industries, green chemistry, environmental pollution, and other processes, where sustainable and energy efficient methods are required to improve and/or produce specific effects. Two typical effects of PU are the enhancement of mass transfer in gases and liquids, and the induction of particle agglomeration in aerosols. These effects are activated by a variety of mechanisms associated to the nonlinear propagation of high amplitude ultrasonic waves such as diffusion, agitation, entrainment, turbulence, etc. During the last years a great effort has been jointly made by the Spanish National Research Council (CSIC) and the company Pusonics towards introducing novel processes into the market based on airborne ultrasonic plate transducers. This technology was specifically developed for the treatment of gas and multiphasic media characterized by low specific acoustic impedance and high acoustic absorption. Different strategies have been developed to mitigate the effects of the nonlinear dynamic behavior of such ultrasonic piezoelectric transducers in order to enhance and stabilize their response at operational power conditions. This work deals with the latter advances in the mitigation of nonlinear problems found in power transducers; besides it describes two applications assisted by ultrasound developed at semi-industrial and laboratory scales and consisting in extraction via dense gases and particle agglomeration. Dense Gas Extraction (DGE) assisted by PU is a new process with a potential to enhance the extraction kinetics with supercritical CO 2 . Acoustic agglomeration of fine aerosol particles has a great potential for the treatment of air pollution problems generated by particulate materials. Experimental and numerical results in both processes will be shown and discussed.

The concept of value, where shareholders are the main recipients of the created value, is changing towards more comprehensive models, which respond to the increased stakeholder awareness and urgent sustainability agenda. Hart and Milstein (2003) elaborated the widely used sustainable value concept in which they characterize temporal and spatial dimensions of value, and suggest strategic drivers for sustainability. Although the framework is highly cited, there is no review on the changes over more than ten years. In this paper, we adopted a structured literature review methodology to discover how the concept of sustainable value has been used by researchers and how it has been developed. Our findings show that sustainable value has mainly been used as the general phrase to describe positive business results instead of using it as a concept. Scholars, who make an in-depth analysis of sustainable value do not emphasize the time horizon of sustainable value as its peculiar characteristic while broad stakeholder surrounding is called to be an important feature of sustainable value. Additionally, strategic drivers for sustainability have moved from being purely environmental as in Hart and Milstein&rsquo, s (2003) concept: globalization, economic fluctuations, and knowledge innovation have become as important as green technologies and carbon-reduction policies.

This study examines the beliefs of the two main French schools of thought, mainly the ideas of Paul Leroy-Beaulieu and Gaston Jeze, which sought to influence the management of public finances, and their impact on the financing of the First World War by the French government. It highlights debates during the war on the best approach to deal with the extraordinary financial demands of the war and the experiences and influence of foreign governments on French financial management practices. The last part examines how the war affected qualitatively the French public finances, the financial dogmas, and the scientific approach to public finance.

In response to the accident at the Fukushima Daiichi nuclear power station in Japan, the U.S. Nuclear Regulatory Commission and U.S. Department of Energy agreed to jointly sponsor an accident recon...

In response to the accident at the Fukushima Daiichi nuclear power station in Japan, the U.S. Nuclear Regulatory Commission and U.S. Department of Energy agreed to jointly sponsor an accident reconstruction study as a means of assessing the severe accident modeling capability of the MELCOR code and developing an understanding of the likely accident progression. Objectives of the project included reconstruction of the accident progressions using computer models and accident data, and validation of MELCOR and the Fukushima models against plant data. In this study Sandia National Laboratories developed MELCOR 2.1 models of Fukushima Daiichi Units 1 (1F1), 2, and 3 as well as the Unit 4 spent fuel pool. This paper reports on the analysis of the 1F1 accident. Details are presented on the modeled accident progression, hypothesized mode of failures in the reactor pressure vessel (RPV) and containment pressure boundary, and release of fission products to the environment. The MELCOR-predicted RPV and conta...

Background There is no definite consensus on which indexation of left ventricular mass (LVM) should be used to better identify left ventricular hypertrophy (LVH). Left ventricular mass has been adjusted to height, to height 2.7 (h 2.7 ) and to body surface area (BSA). The aims of the present study were to evaluate the prevalence of LVH according to different indexations and different cut-offs and to identify the most useful indexation of LVM to detect hypertension-related LVH. Methods Echocardiographic LVH was defined as LVM to h 2.7 , LVM to BSA, LVM to height, LVM values in the upper 5th percentile of our gender-related LVM distribution, using different partition values suggested in previous population-based studies. Results Prevalence of LVH in the general population was 32% using the less restrictive criterion (LVH 49.2/46.7 g/m 2.7 ), 15% with the criterion of LVH 116/104 g/m 2 , and 3.8% with the most restrictive one (LVH 134/110 g/m 2 ). Prevalence of LVH in hypertensive subjects was almost twice than in normotensive subjects with all criteria. Only 20 subjects out of the 707 evaluated were found to have LVH with all six criteria. In multiple regression analysis SBP was independently associated with nonindexed LVM and was indexed to both BSA and h 2.7 . On the other hand, fat-free mass was a poweful predictor of nonindexed LVM or of LVM to BSA, whereas body mass index was the strongest predictor of LVM to h 2.7 . Conclusions The indexation of LVM to BSA, possibly with the cut-off of LVH 116/104, is probably the best criterion for identifying blood pressure–related LVH.

This paper will examine the importance of big data tools and digital technology for organizational design. Drawing on principles of cybernetics, particularly Ashby’s law of requisite variety and Beer’s Viable System Model (VSM), it will examine the potential implications of big data and digital developments for whether organizations need to be more centralized, decentralized or adopt networked arrangements with different level of stability and flexibility. The premise of the paper is that, for systems (such as organizations or collaborative networks) to remain viable, their internal complexity needs to reflect that of the environments in which they are based. Examples are provided from the case of the network agreement framework in Italy, which are analyzed using VSM as a theoretical framework.

Although the introduction of acellular dermal matrices is considered one of the most important advancements in alloplastic breast reconstruction, costs and local policy limit their use in Italy. The purpose of this study was to assess short-term outcomes following Surgimesh-PET-based breast reconstruction.A single-center, retrospective, case-control study was performed from January 1, 2012, to December 31, 2013, by enrolling 206 breast reconstructions performed in 196 patients after oncologic (n = 200) or prophylactic (n = 6) mastectomy. Group A included 63 patients who underwent 70 immediate Surgimesh-PET-assisted breast reconstructions, and group B included 133 patients who underwent 136 standard breast reconstructions.No significant differences between groups occurred for early postoperative complications (p = 0.610), major complications that required surgical revision (p = 0.887), volume (p = 0.498) or width of the prosthesis (p = 0.201), skin-sparing mastectomy (p = 0.315), or axillary surgery (p = 0.265). Multivariate logistic regression showed that prior radiotherapy was the only significant variable for early postoperative complications in both whole series (p = 0.011) and group B (p = 0.046), whereas body mass index greater than 25 was an independent predictor in group A (p = 0.041). Prior radiotherapy was the only variable that reached statistical significance in the multivariate model for major complications in the whole series (p = 0.005).Short-term outcomes of Surgimesh-PET-based alloplastic breast reconstruction are promising. Further studies are needed to evaluate the long-term results of this surgical approach.Therapeutic, III.

This paper aims to explore the nature, the role and the main features of business planning and management accounting processes in strategic networks, with particular reference to alliances formalized through the network "agreement" recently defined by the Italian government with law n. 122/2010. Despite the theoretical importance of the issues above mentioned, there has been little empirical research specifically related to these topics. In addition no theoretical and empirical research is still available to evaluate the managerial and accounting implications of the new legal framework established by the Italian government. After having defined the theoretical and institutional framework, this study performs a comparative case study on fifty network "agreements" formalized under the new law, with the purpose of exploring the theoretical and practical implications of an emerging phenomenon in its preliminary stage.

Longitudinal-torsional vibration is used and proposed for a variety of ultrasonic applications including motors, welding, and rock-cutting. To obtain this behavior in an ultrasonic step horn one can either, (i) couple the longitudinal and torsional modes of the horn by incorporating a ring of diagonal slits in the thick base section or, (ii) place helical flutes in the thin stem section to degenerate the longitudinal mode into a modified behavior with a longitudinal-torsional motion. This paper compares the efficacy of these two design approaches using both numerical and experimental techniques.

Among the green technologies that are currently investigated in industry, power ultrasound constitutes an emerging one with a good potential to produce and/or enhance a variety of processes. Lately, a series of power ultrasound systems for applications in the food industry, environment and manufacturing have been developed at laboratory and semi-industrial scales. In order to scale up these systems and their associated processes, elimination and/or control of detrimental modal couplings between tuned and undesired modes are necessary. In this study, the vibration behaviour of a tuned system for defoaming made up of a sandwich transducer of the Langevin-type driving an amplitude concentrator attached to a circular radiating plate was experimentally investigated. A three-mode interaction affecting the performance of the studied power ultrasound system was detected, characterized and classified. The information gathered through this study may be useful for the development of more efficient ultrasonic devices and processes.

Objective: To test the cutting performance of 2 commercially available oscillating saws designed for use during tibial plateau leveling osteotomy (TPLO) and to evaluate the influence of saline irrigation on cutting performance. Study Design: In vitro experimental study. Sample Population: Composite polyurethane test blocks (n=40); 24 mm TPLO saw blades. Methods: Controlled force cutting tests were performed using custom-made laminated bone substitute blocks to model the canine proximal tibia. Half of the trials were irrigated with 0.9% saline solution. Outcome measures were test block temperature (measured 1.5 mm from the cutting zone), cutting rate, and cutting surface wear. Durability was measured by recording change in performance over multiple consecutive trials. Results: The Synthes blade cut the test blocks with ∼64% less heat generation and at a 63% faster cutting rate compared with the Slocum blade. Although wear of the Synthes blade was ∼50% greater after 19 uses, this did not negatively impact cutting performance. Saline irrigation produced no significant effect on peak cutting temperature but significantly reduced cutting rate for both saws. Conclusions: Our results favor the Synthes blade in terms of cutting performance and the Slocum blade in terms of wear resistance.

Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs. The authors discuss a study that examined factors that contribute to adverse working relationships between nursing education and practice, effective strategies to foster civility, essential skills to be taught in nursing education, and how education and practice can work together to foster civility in the profession.