Search

Background: Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy. Method: This was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale. Results: Out of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19–75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p < 0.05). The total operative time, level of difficulty in surgery, rate of help needed from colleagues or replacement as the main surgeon, bile spillage, drain placement, gallbladder decompression, and conversion rate all increased with an increase in scale (p < 0.05). There was a significant increase in the development of post-operative fever, and post-operative hospital stay as the scale increased (p < 0.05). The Tukey-Kramer test for all pair-wise comparisons revealed that each grade was significantly different from each other (p < 0.05) on the difficulty of surgery except for grade 4 from 5. Conclusion: Parkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery. An increase in scale is associated with an increased difficulty level of the surgery. [ABSTRACT FROM AUTHOR]

Commons theory is one of the influential economic theories that study the governance of shared resources, including knowledge. This paper provides a comprehensive view of the application of the concept of the commons towards supporting innovation in the Knowledge Management (KM) literature. A systematic literature review identified forty-four (44) relevant research papers discussed the commons published in twenty-three (23) high-impact KM journals. The research found that the application of commons in KM literature covers diverse areas, including Intellectual Property, Knowledge Cities, and Industrial Commons, that are related to innovation. The study found that extant literature does not adequately address innovation-centric knowledge. To address the gap, a conceptual model is presented to apply the Institutional Analysis and Development (IAD) framework to Open Innovation. [ABSTRACT FROM AUTHOR]

Background: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury. Method: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT. Results: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86–0.98) and of ALT was 0.92 (95% confidence interval 0.83–0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively. Conclusion: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center. [ABSTRACT FROM AUTHOR]

Steroid receptor coactivator-3 (SRC-3) regulates the activity of both nuclear hormone receptors and a number of key transcription factors. It is implicated in the regulation of cell proliferation, inflammation and in the progression of several common cancers including breast, colorectal and lung tumors. Phosphorylation is an important regulatory event controlling the activities of SRC-3. Serine 857 is the most studied phospho-acceptor site, and its modification has been reported to be important for SRC-3-dependent tumor progression. In this study, we show that the stress-responsive p38MAPK-MK2 signaling pathway controls the phosphorylation of SRC-3 at S857 in a wide range of human cancer cells. Activation of the p38MAPK-MK2 pathway results in the nuclear translocation of SRC-3, where it contributes to the transactivation of NF-kB and thus regulation of IL-6 transcription. The identification of the p38MAPK-MK2 signaling axis as a key regulator of SRC-3 phosphorylation and activity opens up new possibilities for the development and testing of novel therapeutic strategies to control both proliferative and metastatic tumor growth. [ABSTRACT FROM AUTHOR]

Managing processes remain a key challenge for most organizations which need to preserve competitiveness. Process assessment frameworks can help by providing instruments guiding process improvement and regulation alignment. Several process assessment frameworks such as TIPA® are based on the ISO Process assessment standard series ISO/IEC 15504, currently revised in the ISO/IEC 330xx family of standards. Following a Design Science Research (DSR) methodology, this paper visits the TIPA Framework evolution throughout iterative cycles in terms of design, rigour and relevance. It investigates how original and new artefacts are being developed and improved, in particular the new strategic move towards the automation of the assessment process represented by a new software artefact. By demonstrating the evolution of the TIPA framework using a DSR perspective combined with Action Design Research for the new software artefact, this paper explicates design knowledge regarding the role and value of the framework within the ISO standards community and in practice. [ABSTRACT FROM AUTHOR]

One critical challenge in IT Service Management (ITSM) process assessment is the issue of transparency in the way ITSM processes are assessed. A Design Science Research (DSR) project was executed to design, develop and evaluate an artefact in order to conduct software-mediated process assessments in ITSM. International Standards were used to validate the design, development and evaluation of the research artefact in order to demonstrate that the artefact is relevant to practice. Studies relating to the use of International Standards to validate DSR artefacts are scant regardless of broader adoption of the DSR studies and acceptance of the International Standards in practice. DSR studies in particular are required to maintain a balance between research rigor and relevance by reporting artefacts that solve a class of problems based on scientific justification and practical evidence. International Standards provide bodies of knowledge that ensure products, services and processes are of acceptable quality and relevant to practice. Our DSR project confirmed that the external validity of an artefact can be improved with the use of International Standards. Using three International Standards, process assessment ISO/IEC 15504-330xx series, IT Service Management ISO/IEC 20000 series, and System and Software Quality Models from ISO/IEC 25010, this manuscript presents an account of a DSR project with three evaluation sites where the artefact was tested in real organizational contexts. The project demonstrated the significant role of International Standards to confirm research relevance during artefact design, development and evaluation. [ABSTRACT FROM AUTHOR]

Distance field from a surface geometry is used in several scientific algorithms and applications from computer graphics, visualization, computational fluid dynamics and more. Distance field can be calculated efficiently by solving the eikonal equation at each grid point using the fast-sweeping method. There has been an increased interest to develop parallel algorithms for the fast-sweeping method to accelerate its computational turnaround time. Most parallel strategies have focused on shared-memory parallelism and do not readily extend to distributed-memory parallelism to handle large-scale problems. To address this issue, we propose a domain-decomposition strategy to enable distributed-memory parallelism for the fast-sweeping method on heterogeneous computing clusters with accelerators. In our strategy, we make use of the Cuthill-McKee ordering for both fine- and coarse-grain parallelism such that parallel computations proceed in direction of solution characteristics. We consider both CUDA and OpenACC implementations to compute the distance field from arbitrarily complex geometries and demonstrate parallel computations of large-scale problems that necessitate distributed-memory parallelism. We also discuss the implications of the proposed strategy for scalability of the fast-sweeping method. [ABSTRACT FROM AUTHOR]

Aims Adiponectin has been shown to possess potent anti-oxidative properties in various experimental conditions. However, its anti-oxidative effects and underlying mechanisms have not been reported in liver cells. Herein, we investigated the effects of globular adiponectin (gAcrp) on LPS-stimulated reactive oxygen species (ROS) production and its mechanisms underlying in human hepatic cells (HepG2). Main methods Intracellular ROS production was determined by fluorescence of 5-chloromethyl-2,7-dichlorodihydrofluorescein diacetate (CM-H2DCFDA). NADPH oxidase-dependent ROS formation was determined by lucigenin-derived chemiluminescence. Messenger RNA expression level of target genes was determined by quantitative RT-PCR and protein expression was measured by Western blot analysis. Key findings LPS-induced increase in ROS production was prevented by pretreatment with gAcrp in HepG2 cells. Furthermore, gAcrp treatment suppressed LPS-induced activation of NADPH oxidase and increase in mRNA and protein expression of Nox-4. We also found that adiponectin increased expression of FoxO3A and HO-1 and ablation of either of these genes partially restored suppression of LPS-induced ROS production and NADPH oxidase activation by gAcrp, indicating the vital role of FoxO3A and HO-1 signaling in the inhibition of ROS production and NADPH oxidase activation by gAcrp. Significance These results suggest that gAcrp prevents LPS-induced ROS production and NADPH oxidase activity in HepG2 cells via FoxO3A and HO-1 signaling-dependent mechanisms. The present study demonstrated a suppressive effect of adiponectin on ROS production in liver cells and presented a novel mechanism underlying suppression of ROS production by adiponectin. [ABSTRACT FROM AUTHOR]

Adiponectin predominantly secreted from adipose tissue has exhibited potent anti-proliferative properties in cancer cells via modulating cell cycle and apoptosis. FoxO3A, a Forkhead box O member of the transcription factor, plays a critical role in modulating expression of genes involved in cell death and/or survival. In this study, we investigated the role of FoxO3A signaling in anti-cancer activities of adiponectin. Herein, we have shown that treatment with globular adiponectin (gAcrp) increases p27 but decreases cyclinD1 expression in human hepatoma (HepG2) and breast (MCF-7) cancer cells. Gene ablation of FoxO3A prevented gAcrp-induced increase in p27 and decreased in cyclin D1 expression, and further ameliorated cell cycle arrest by gAcrp, indicating a critical role of FoxO3A in gAcrp-induced cell cycle arrest of cancer cells. Moreover, treatment with gAcrp also induced caspase-3/7 activation and increased Fas ligand (FasL) expression in both HepG2 and MCF-7 cells. Transfection with FoxO3A siRNA inhibited gAcrp-induced caspase-3/7 activation and FasL expression, suggesting that FoxO3A signaling also plays an important role in gAcrp-induced apoptosis of cancer cells. We also found that gene silencing of AMPK prevented gAcrp-induced nuclear translocation of FoxO3A in HepG2 and MCF-7 cells. In addition, suppression of AMPK also blocked gAcrp-induced cell cycle arrest and further attenuated gAcrp-induced caspase-3/7 activation, indicating that AMPK signaling plays a pivotal role in both gAcrp-induced cell cycle arrest and apoptosis via acting as an upstream signaling of FoxO3A. Taken together, our findings demonstrated that AMPK/FoxO3A axis plays a cardinal role in anti-proliferative effect of adiponectin in cancer cells. J. Cell. Physiol. 231: 357-369, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Adiponectin and leptin, both produced from adipose tissue, cause cell cycle arrest and progression, respectively in cancer cells. Ubiquitin specific protease-2 (USP-2), a deubiquitinating enzyme, is known to impair proteasome-induced degradation of cyclin D1, a critical cell cycle regulator. Herein, we investigated the effects of these adipokines on USP-2 expression and its potential role in the modulation of cell cycle. Treatment with globular adiponectin (gAcrp) decreased, whereas leptin increased USP-2 expression both in human hepatoma and breast cancer cells. In addition, overexpression or gene silencing of USP-2 affected cyclin D1 expression and cell cycle progression/arrest by adipokines. Adiponectin and leptin also modulated in vitro proteasomal activity, which was partially dependent on USP-2 expression. Taken together, our results reveal that modulation of USP-2 expression plays a crucial role in cell cycle regulation by adipokines. Thus, USP-2 would be a promising therapeutic target for the modulation of cancer cell growth by adipokines. [ABSTRACT FROM AUTHOR]

• A two-stage stochastic programming model is developed to investigate the carbon emissions issue in cold supply chains under uncertain demand. • A matheuristic algorithm based on the Iterated Local Search (ILS) algorithm and a mixed integer programming is developed. • Optimal replenishment policies and transportation schedules are considered to minimize both operational and emissions costs. • The proposed model is applied to a real-world case study in Queensland, Australia. • It was found that high emissions price does not necessarily lead to an improvement in efficiency of the cold supply chain system. Increasing awareness of sustainability in supply chain management has prompted organizations and individuals to consider environmental impacts when managing supply chains. The issues concerning environmental impacts are significant in cold supply chains due to substantial carbon emissions from storage and distribution of temperature-sensitive product. This paper investigates the impact of carbon emissions arising from storage and transportation in the cold supply chain in the presence of carbon tax regulation, and under uncertain demand. A two-stage stochastic programming model is developed to determine optimal replenishment policies and transportation schedules to minimize both operational and emissions costs. A matheuristic algorithm based on the Iterated Local Search (ILS) algorithm and a mixed integer programming is developed to solve the problem in realistic sizes. The performance and robustness of the matheuristic algorithm are analyzed using test instances in various sizes. A real-world case study in Queensland, Australia is used to demonstrate the application of the model. The results highlight that higher emissions price does not always contribute to the efficiency of the cold supply chain system. Furthermore, the analyses indicate that using heterogeneous fleet including light duty and medium duty vehicles can lead to further cost saving and emissions reduction. [ABSTRACT FROM AUTHOR]

Cloud computing is gaining increasing interest as an enabling technology for improved productivity, efficiency and cost reduction. It also has the potential to add value to reliability and scalability of organisation’s systems, which would allow organisations to better focus on their core business and strategies. This research paper aimed at exploring the perceived potential for value creation from cloud computing in Australian Regional Governments. Using the Technology-Organization-Environment (TOE) framework, the Diffusion of Innovation (DOI) theory and Desires Framework (DF), a conceptual research model is devised. The key identified factors that are likely to influence adoption of cloud computing are identified along with the implications to current policies, anticipated benefits and challenges of adoption of cloud computing. The research employed a qualitative approach involving 21 in-depth interviews with Australian local councils’ IT managers. The findings of this research are mapped to the research model factors, thereby presenting and validating a number of value-adding concepts that are expected to contribute to investment decisions on cloud computing adoption. [ABSTRACT FROM AUTHOR]

The major metropolitan airports in Australia have become increasingly congested, resulting in substantial increases in operational costs and waiting time at these airports. This paper assesses the effectiveness of subsidy programs in shifting airfreight from metropolitan airports to regional airports assuming the vehicle routing problem approach is used to optimise the downstream (i.e., road) logistics. We analyse the freight distribution network structure and logistics decisions under two (government) subsidy scenarios. We develop a mixed integer linear programming model incorporating the time-window and release-time constraints. A case study in Australia is used to illustrate the application of the proposed framework. The results show that introducing subsidies can effectively reduce the total costs from the prospective of industries involved in the airfreight distribution. The subsidy program under a non-linear subsidy provides a better performance from the economic and delivery time perspectives. However, if the primary goal is to reduce the volume of cargo traffic at the metropolitan airport, a linear subsidy program is preferred. • Subsidy programs are proposed to shift airfreights from metropolitan airports to regional airports. • The vehicle routing problem model is used to evaluate the effects of the subsidy schemes. • A case study of Australia is presented. • A non-linear subsidy provides a better performance from the economic and delivery time perspectives. • A linear subsidy is preferred to reduce cargo traffic at metropolitan airports. [ABSTRACT FROM AUTHOR]

This paper investigates the impacts of increasing Internet penetration on airfares and price dispersion in the Chinese airline market. It is found that an increase in Internet penetration is associated with higher average airfares and lower price dispersion between the major Chinese carriers. It appears that the increase in Internet penetration seems to have strengthened the major airlines' ability to maintain price stability, which is an indication of the existence mutual forbearance among the major carriers confirmed in other studies. Higher prices and lower price dispersion are mostly to occur in the most heavily markets. This research also finds that if carriers possess similar degree of market power, the price dispersion between the airline pair is smaller. The findings can generate important policy insights, and inform anti-trust policies in the post-Covid period, when more consumers use Internet for search and inquiries, and when big data and artificial intelligence technologies mature. [ABSTRACT FROM AUTHOR]

Loss of the epithelial intermediate filament protein keratin 8 (K8) in murine ß cells leads to irregular insulin vesicles and decreased insulin levels. Because mitochondria are central in glucose-stimulated insulin secretion, the relationship between keratins and β-cell mitochondrial function and morphology was investigated. β cells in murine K8-knockout (K8-/-) islets of Langerhans have increased numbers of mitochondria, which are rounder and have diffuse cristae, as seen by electron microscopy. The mitochondrial network in primary cultured K8-/- β cells is more fragmented compared with K8+/+ mitochondria, correlating with decreased levels of mitofusin 2 and the mitofusin 2- and keratin-binding protein trichoplein. K8-/- β-cell mitochondria have decreased levels of total and mitochondrial cytochrome c, which correlates with a reduction in electron transport complexes I and IV. This provokes loss of mitochondrial membrane potential and reduction of ATP and insulin amount, as seen in K8-/- β cells. Mitochondria in K8 wild-type β cells and MIN6 insulinoma cells overexpressing K8 and 18 are more stationary compared with mitochondria in keratin-deficient cells. In conclusion, keratins, likely through trichoplein-mitofusin interactions, regulate both structural and dynamic functions of β-cell mitochondria, which could have implications for downstream insulin secretion. [ABSTRACT FROM AUTHOR]

Background The vaccinations against human papilloma virus (HPV) are highly effective in preventing persistent infection. The level of knowledge about HPV and the consequences of an infection with this virus are low in the general population and in patients who suffer from HPV-associated diseases. We aimed to compare the level of knowledge about HPV and about the women's individual malignant disease between women with and without HPV-associated gynecologic cancer as well as the knowledge about individual malignant diseases. Methods In a pilot study, 51 women with HPV-related cancer (cervical cancer: n = 30; vulvar or vaginal cancer: n = 21) and 60 women with non-HPV associated gynecologic malignancies (ovarian cancer: n = 30; endometrial cancer, n = 30) were included. They answered a questionnaire including questions about personal medical history, risk factors for cancer development, and HPV. Results The general level of knowledge of the term "HPV" was low (29.7%, 33/111) and it was similar in patients with HPV-related and non-HPV-associated cancer (18/60, 30.0% vs. 15/51, 29.4%, respectively; p = 1.000). When asked about their disease, 80% (24/30) of women with ovarian cancer correctly named their diagnosis, followed by women with cervical cancer (73.3%, 22/30), endometrial cancer (70%, 21/30) and vaginal or vulvar cancer (42.9%, 9/21; p = 0.008). Conclusion The level of knowledge about HPV and the malignant diseases the patient suffered from was low. This applied even to patients with HPV associated malignancies. [ABSTRACT FROM AUTHOR]

Background: The vaccinations against human papilloma virus (HPV) are highly effective in preventing persistent infection. The level of knowledge about HPV and the consequences of an infection with this virus are low in the general population and in patients who suffer from HPV-associated diseases. We aimed to compare the level of knowledge about HPV and about the women's individual malignant disease between women with and without HPV-associated gynecologic cancer as well as the knowledge about individual malignant diseases. Methods: In a pilot study, 51 women with HPV-related cancer (cervical cancer: n = 30; vulvar or vaginal cancer: n = 21) and 60 women with non-HPV associated gynecologic malignancies (ovarian cancer: n = 30; endometrial cancer, n = 30) were included. They answered a questionnaire including questions about personal medical history, risk factors for cancer development, and HPV. Results: The general level of knowledge of the term "HPV" was low (29.7%, 33/111) and it was similar in patients with HPV-related and non-HPV-associated cancer (18/60, 30.0% vs. 15/51, 29.4%, respectively; p = 1.000). When asked about their disease, 80% (24/30) of women with ovarian cancer correctly named their diagnosis, followed by women with cervical cancer (73.3%, 22/30), endometrial cancer (70%, 21/30) and vaginal or vulvar cancer (42.9%, 9/21; p = 0.008). Conclusion: The level of knowledge about HPV and the malignant diseases the patient suffered from was low. This applied even to patients with HPV associated malignancies. [ABSTRACT FROM AUTHOR]

Background: The vaccinations against human papilloma virus (HPV) are highly effective in preventing persistent infection. The level of knowledge about HPV and the consequences of an infection with this virus are low in the general population and in patients who suffer from HPV-associated diseases. We aimed to compare the level of knowledge about HPV and about the women's individual malignant disease between women with and without HPV-associated gynecologic cancer as well as the knowledge about individual malignant diseases.Methods: In a pilot study, 51 women with HPV-related cancer (cervical cancer: n=30; vulvar or vaginal cancer: n=21) and 60 women with non-HPV associated gynecologic malignancies (ovarian cancer: n=30; endometrial cancer, n=30) were included. They answered a questionnaire including questions about personal medical history, risk factors for cancer development, and HPV.Results: The general level of knowledge of the term "HPV" was low (29.7%, 33/111) and it was similar in patients with HPV-related and non-HPV-associated cancer (18/60, 30.0% vs. 15/51, 29.4%, respectively; p=1.000). When asked about their disease, 80% (24/30) of women with ovarian cancer correctly named their diagnosis, followed by women with cervical cancer (73.3%, 22/30), endometrial cancer (70%, 21/30) and vaginal or vulvar cancer (42.9%, 9/21; p=0.008).Conclusion: The level of knowledge about HPV and the malignant diseases the patient suffered from was low. This applied even to patients with HPV associated malignancies. [ABSTRACT FROM AUTHOR]