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Inventory management plays a crucial role in every business organization that works on production. Appropriate control mechanism of inventory is essential to ensure stock levels of all the raw materials that are required for production of good. With the application of emerging technologies like IoT and sensors, the management of the stock levels has become more efficient in both industrial and domestic level. This has not only reduced the man power that is required for supervision of inventory, but also made the lifestyle of people more comfortable and easier.

Scalp masses are often the initial presentation of a widely disseminated malignancy. Fine-needle aspiration (FNA) is an optimal method for obtaining an accurate tissue diagnosis, in these patients with initial presentation and those with a known malignancy.We reviewed all FNAs of skin and soft tissue lesions from the scalp at our institution over a period of 31 years (1990-2021). Relevant clinical information was obtained from the review of computerized patient record. The histologic type, presentation, previous diagnoses, and survival after the diagnosis were correlated.Thirty patients with scalp masses were identified. All the patients were males with a median age of 61 years (27-81 years). The scalp masses ranged from 0.4 to 6 cm in size. Ten cases (33%) were benign, but the majority of cases (n = 20, 67%) were malignant. Of the malignant lesions sampled, 1 case was a primary squamous-cell carcinoma (SCC), and the remaining 19 cases were metastatic tumors. Of these, 13 cases (68.4%) had a previously diagnosed malignancy. Most of the 19 metastatic lesions were adenocarcinomas or poorly differentiated carcinomas (n = 12, 63.2%), followed by melanoma (n = 4), SCC (n = 1), alveolar soft part sarcoma (n = 1) and large cell lymphoma (n = 1). The most common site of primary was the gastrointestinal tract (6/19, 31.5%) and lung (6/19, 31.5%). The average survival after the diagnosis of these scalp metastases was around 6.3 months, signifying a poor prognosis.In our patient population, most scalp masses were metastatic tumors. Metastasis to the scalp signals advanced disease and is associated with a very poor prognosis. FNA is an easy, safe, rapid, cost effective and precise modality for diagnosing these masses. It can also yield material for molecular testing for newer directed therapies, if needed.

Due to an increased scalability, flexibility, and reduced cost complexity, the dynamic memory allocation models are highly preferred for the real-time embedded systems. For this purpose, the different types of dynamic models have been developed in the conventional works, which are highly focused on allocating the memory blocks with increased searching capability. However, it faced some of the problems and issues related to the factors of complex operations, high time consumption, memory overhead, and reduced speed of processing. Thus, this research work objects to design an advanced and intelligent dynamic memory allocation mechanism for the real-time embedded systems. Here, a Classy Memory Management System (CyM2S) is developed by using an Isolated Dynamic Two-Level Memory Allocation (ID2LMA) algorithm for efficiently allocating the memory blocks with simple searching. The CyM2S helps to reduce the fragmentation rate and time consumption by optimally allocating the memory blocks. In this model, the small buffer has been maintained for surplus pointers, and the allocated blocks comprise the metadata and payload data. During evaluation, the performance of the proposed CyM2S- ID2LMA technique is validated and compared by using the measures of memory allocation time, release time, execution, and processing speed.

Also referred to as "osteoclast-rich, clear cell sarcoma-like tumor of the gastrointestinal tract (CCSLGT)," malignant gastrointestinal neuroectodermal tumor is a newly described, rare, aggressive sarcoma that commonly arises in the small bowel, stomach, and colon. Histogenesis is likely from an autonomous nervous system-related primitive cell of neural crest origin. The hallmark genetic finding of EWS-CREB1 or EWS-ATF1 fusion transcripts clinches the diagnosis. Annular constrictive lesions tend to be smaller, show homogenous contrast enhancement on computed tomography, and may present with bowel obstruction. Larger, expansile masses tend to be exophytic and show heterogeneous contrast enhancement. Surgical resection is the mainstay of treatment. Frequent recurrences, metastases, and death from disease in 75% of patients portend a poor prognosis. Targeted chemotherapy based on specific tumor pathways is being developed.

Background: Mortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these measures are highly variable, and validity is often unclear. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid measures of mortality, morbidity, and organ failure for use in perioperative clinical trials. Methods: Three domains of endpoints (mortality, morbidity, and organ failure) were explored through systematic literature review and a three-stage Delphi consensus process using methods consistently applied across the StEP initiative. Reliability, feasibility, and patient-centredness were assessed in round 3 of the consensus process. Results: A high level of consensus was achieved for two mortality time points, 30-day and 1-yr mortality, and these two measures are recommended. No organ failure endpoints achieved threshold criteria for consensus recommendation. The Clavien–Dindo classification of complications achieved threshold criteria for consensus in round 2 of the Delphi process but did not achieve the threshold criteria in round 3 where it scored equivalently to the Post Operative Morbidity Survey. Clavien–Dindo therefore received conditional endorsement as the most widely used measure. No composite measures of organ failure achieved an acceptable level of consensus. Conclusions: Both 30-day and 1-yr mortality measures are recommended. No measure is recommended for organ failure. One measure (Clavien–Dindo) is conditionally endorsed for postoperative morbidity, but our findings suggest that no single endpoint offers a reliable and valid measure to describe perioperative morbidity that is not dependent on the quality of deli-vered care. Further refinement of current measures, or development of novel measures, of postoperative morbidity might improve consensus in this area.

The Internet of Things (IoT) has become an emerging technology and is expected to connect billions of more devices to the internet in the near future. With time, more and more devices like wearables, intelligent home systems, and industrial automation devices are getting connected to the internet. IoT devices primarily transfer data using wireless communication networks, introducing more vulnerabilities like man-in-the-middle-attacks and eavesdropping. These security concerns are customary for any device communicating over the internet because of its intrinsic open nature. These problems are usually subdued by conventional cryptographic algorithms used in typical systems that are power-hungry and computationally intensive, making them infeasible to be used in IoT devices since they run on low-powered chips, limiting performance, memory, and bandwidth. Hence, there is a requirement to adopt lightweight cryptographic algorithms that can abate the security issues while using low computational resources, which is the constraint in the given scenario. Hence, we propose an end-to-end secured IoT system that ensures the system’s integrity is never compromised using lightweight cryptographic algorithms. We propose a three-module system, where the first module handles user authentication using a time-based one-time password, the second secures communication using lightweight enhanced RSA, and the third performs data encryption using Feistel-based enhanced SIT. This kind of system is designed to deal with security challenges in IoT devices, ensuring adequate data security while reducing the computational footprint using lightweight cryptography.

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide and it may present initially with extrahepatic spread in 5%-15% cases. It most commonly metastasizes to lungs, lymph nodes and adrenal glands. Skeletal metastases from HCC are uncommon and carry a very poor prognosis.We retrospectively reviewed all fine needle aspiration (FNA) specimens of metastatic HCC at our institution from January 1994 to March 2021 using the SNOMED search computer option. Relevant clinical information was obtained from the review of patient's electronic medical records.There were 36 FNAs of metastatic HCC over a period of 27 years. Six patients (16.7%) were found to have skeletal metastases. All six patients were males with a median age of 59 years (54-71 years) and their lesions were osteolytic. The most common site of metastases was vertebra (3/50%). Most patients (67%) had bone metastases as an initial presentation, without prior history of HCC. The mean survival after the diagnosis of skeletal metastases was only 8 months.Detection of extrahepatic HCC to bone is important to avoid any unwanted surgical intervention. In our patient population, the most common site of skeletal metastases from HCC was vertebra, therefore in FNAs of vertebral lytic masses, metastatic HCC should be considered. On FNA, extrahepatic metastases of HCC can mimic other poorly differentiated tumors. They behave in an aggressive fashion, resulting in a grim prognosis. Cytological substrates can be used for future molecular testing, if needed.

In this paper, we will control the Robotic car using the Dual Tone Multi Frequency (DTMF) technology. DTMF technology is useful technique in the present days. It works on the methods digital signal processing. Wireless control robots will use RF circuit that has many drawbacks like limited working range and limited control. This DTMF will have advantage over the RF; it will increases the range of working and also gives the good results in case of motion and direction of robot using the mobile phone through a micro controller. This type of wireless communication gives an remote handling operation of Robot using the DTMF. An robot is a electro-mechanical machine which has been guided by the computer, Mobile phone or programming, and is able to do the tasks by its own. The Robot Institute of America had defined A robot is an reprogrammable multifunctional manipulator -designed to move material parts, tools , specialized device through a variable programmed motions for an performance of many variety of tasks. Conventionally, wireless controlled robots will uses the RF circuits, which has the drawbacks of limited working of range & frequency range, use of mobile phones can be overcomed by this limitation. Keywords: DTMF, arduino, motor driver, mobile phone.

There is variation in care quality and outcomes for children undergoing emergency abdominal surgery, such as appedectomy. Addressing this requires paediatric-specific quality metrics. The aim of this study was to identify perioperative structure and process measures that are associated with improved outcomes for these children.We performed a systematic review searching MEDLINE, Embase, CINAHL, Cochrane Library, and Google Scholar for articles published between January 1, 1980 and September 29, 2020 about the perioperative care of children undergoing emergency abdominal surgery. We also conducted secondary searching of references and citations, and we included international professional publications.We identified and analysed 383 peer-reviewed articles and 18 grey literature publications. High-grade evidence pertaining to the perioperative care of this patient group is limited. Most of the evidence available relates to improving diagnostic accuracy using preoperative blood testing, imaging, and clinical decision tools. Processes associated with clinical outcomes include time lapse between time of presentation or initial assessment and surgery, and the use of particular analgesia and antibiotic protocols. Structural factors identified include hospital and surgeon caseload and the use of perioperative care pathways.This review summarises the structural and process measures associated with outcome in paediatric emergency abdominal surgery. Such measures provide a means of evaluating care and identifying areas of practice that require quality improvement, especially in children with appendicitis.PROSPERO CRD42017055285.

There is a wide spectrum of benign and malignant mesenchymal neoplasms of the prostate, which account for less than 1% of all prostatic tumors. These include distinctive tumors that arise from the specialized prostatic stroma and site-agnostic neoplasms such as smooth muscle tumors, fibrous or myofibroblastic neoplasms, neurogenic tumors, vascular tumors, and a plethora of sarcomas. Select tumors show classic sites of origin within the prostate. While stromal tumors of uncertain malignant potential (STUMPs) commonly involve the peripheral zone at the prostate base, leiomyomas typically originate from the central prostate toward the apex. Some "prostatic" neoplasms such as gastrointestinal stromal tumors, solitary fibrous tumor (SFT), paragangliomas, and neurogenic tumors arise primarily from periprostatic soft tissues. Most mesenchymal tumors of the prostate and seminal vesicles manifest as large tumors that cause nonspecific symptoms; prostate-specific antigen level is not typically elevated. Diverse mesenchymal neoplasms demonstrate characteristic histopathologic and immunocytochemical features and variable cross-sectional imaging findings. While leiomyoma and SFT typically display low signal intensity on T2-weighted images, synovial sarcomas commonly show hemorrhage. Diagnosis is difficult because of the rarity and lack of awareness of the tumors and the significant overlap in histopathologic features. Select tumors show characteristic genetic abnormalities that allow the diagnosis to be established. For example, more than 90% of SFTs are characterized by a unique

Additional file 1: Appendix 3. LOGISTICS of delivery.

Additional file 3. Statistical Analysis Plan v4 - FINAL [2021-10-21].

Additional file 2. Case Report Form.

Introduction: Surgical techniques in open appendicectomy has been evolving with most centers following simple ligation of appendix stump as the most preferred approach including the laparoscopic approach. Invagination of stump of the appendix is also practiced as a traditional approach. Aim: To compare and evaluate the outcomes and postoperative morbidity of simple ligation and invagination appendicectomy techniques. Materials and Methods: This was a prospective observational study conducted from October 2016 to July 2018 and included a total of 100 patients of acute appendicitis undergoing emergency open appendectomy surgery. The method of surgery of simple ligation and invagination appendectomy was allotted alternatively with 50 patients in each category. Both techniques of surgery were compared in terms of operating time, duration of hospital stay and postsurgical complications. Relevant data was collected and entered in Microsoft excel and p-value was calculated using Chi-square test. Results: A total of 100 patients were included with a mean age of 27 years. Both the groups with 50 patients each, were equivalent with age and gender distribution. It was observed that both the techniques had similar outcomes in respect to mean duration of surgery, duration of hospital stay and morbidities (p-value>0.05) with no statistically significant difference. The morbidity and the rate of postoperative complications were similar in both the groups. Conclusion: Appendicular stump management after appendectomy can be treated either by simple ligation or by invagination method, both techniques being equally effective and safe. Hence, it is surgeons preference to choose among the two techniques.

Background Assessment of exercise capacity is an important component of risk assessment before major surgery. Cardiopulmonary exercise testing (CPET) provides comprehensive assessment but is resource-intensive, limiting widespread adoption. Measurement of a patient’s peak power output (PPO) using a simplified test on a cycle ergometer has the potential to identify patients likely to have abnormal CPET findings and to be at increased perioperative risk. The aim of this study was to investigate the potential for PPO to identify those with abnormal CPET and to determine whether PPO predicted the risk of adverse postoperative outcomes. Methods In a retrospective analysis of a single-centre cohort, the ability of PPO to predict a high-risk CPET result in patients undergoing major cancer surgery was analysed. The assessment was validated in patients undergoing major abdominal surgery from a UK national multicentre cohort. The association between PPO and adverse postoperative outcomes to traditional CPET-derived variables were compared. Results In 2262 patients from a single centre, PPO was an excellent discriminator of high-risk CPET, with an area under the receiver operating characteristic curve (AUROC) of 0.901 (95 per cent c.i. 0.888 to 0.913). In the national cohort of 2742 patients, there was excellent discrimination, with an AUROC of 0.856 (0.842 to 0.871). A PPO cut-off of 1.5 W/kg may be appropriate for use in screening, with a sensitivity of 90 per cent in both cohorts. PPO and traditional CPET-derived predictors demonstrated similar discrimination of major postoperative complications and death. The association between PPO and major postoperative complications persisted on multivariable analysis. Conclusion These results suggest a role for the PPO test in preoperative screening and risk stratification for major surgery. Prospective evaluation is recommended.

Background: Postoperative hypotension is common after major non-cardiac surgery, due predominantly to vasodilatation. Administration of infused vasopressors postoperatively may often be considered a surrogate indicator of vasodilatation. The incidence of postoperative vasopressors and outcomes associated with their use has never been described. We hypothesise that there is variation across centres in using vasopressors after surgery. There may also be a variation in the incidence of organ dysfunction, organ support use, and clinical outcomes in patients treated with postoperative vasopressor therapy. Method: The primary objective of this study is to determine what proportion of patients receive postoperative vasopressor infusions. We will identify factors in variation of care (patient, condition, surgery, and intraoperative management) associated with the receipt of postoperative vasopressor infusions. We will also assess the incidence of associated organ dysfunction and clinical outcomes among those who receive vasopressors. This will be accomplished with a prospective, international, multicentre cohort study that includes all adult (≥18 years) non-cardiac surgical patients in participating centres. Patients undergoing cardiac, obstetric or day-case surgery will be excluded. We will recruit two cohorts of patients: Cohort A will include all eligible patients admitted to participating hospitals for seven consecutive days. Cohort B will include 30 sequential patients per hospital, with the single additional inclusion criterion of postoperative vasopressor usage. We expect to collect data on approximately 40,000 patients for cohort A and 12,800 patients for cohort B. Discussion: While in cardiac surgery, clinical trials have informed the choice of vasopressors used to treat postoperative vasoplegia, there remains equipoise over the best approach in non-cardiac surgery. Our study will represent the first large-scale assessment of the use of vasopressors after non-cardiac surgery. These data will inform future studies, including trials of different vasopressors and potential management options to improve outcomes and reduce resource use after surgery. Trial registration: ClinicalTrials.gov Identifier: NCT03805230, 15th January 2019

We reviewed the endocrine assessment, chemotherapy, and rehabilitation of the osteoporotic vertebral fractures (OVF) to create recommendations for the disease.A PubMed and Medline search between 2011 and 2021 was conducted using key words. Case reports, experimental studies, papers other than the English language, and unrelated studies were excluded. Up-to-date information on endocrine assessment, medical and nonsurgical treatment, and rehabilitation for osteoporotic spine fractures were reviewed, and statements were produced to reach a consensus in two separate virtual consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and achieved a positive or negative consensus using Delphi method.Endocrine assessment of osteoporosis is necessary if it is diagnosed in premenopausal women or men less than 50 years of age. Dual X-Ray absorptiometry (DXA) alone may not be predictive of fracture. Endocrine causes of osteoporosis must also be evaluated if the Z-score ≤-2.0. In case of a vertebral fracture in postmenopausal women and men aged 50 years and above, pharmacologic treatment for osteoporosis must be started. Strengthening exercise, balance and gait training, and assistive devices are recommended to prevent and reduce falls in the elderly. In addition, rehabilitation must be a part of the overall treatment to help patients return to function.Nonsurgical management helps treat OVF. Although there is weak evidence on the type of medical treatment and usage of braces, bed rest, and other measures, current literature supports endocrinological management, medical treatment, and rehabilitation after osteoporotic vertebral fractures.

Squamous cell carcinoma (SCC) arising from an epidermal inclusion cyst (EIC) is uncommon. We present a case of a 70-year-old man with a scalp nodule with persistent discharge that was resected based on the clinical impression of an EIC. Histopathologic exam showed an infundibular EIC with an epidermal type of squamous epithelium; however, some of the cyst lining and lumen was replaced by squamous proliferation with malignant features. There are 56 cases of SCC arising in EICs reported in the English literature. Though suspected EICs are commonly benign, a thorough pathologic evaluation is required to rule out malignancy.

Complications following surgery are common, predictable and often preventable. New preoperative assessment and optimisation guidance recommends clear pathways with triggers for interventions, patient involvement, shared decision making and team education, to help both patients and service efficiency.

Increasing numbers of older people are undergoing surgery with benefits including symptom relief and extended longevity. Despite these benefits, older people are more likely than younger patients to experience postoperative complications, which are predominantly medical as opposed to surgical. Comprehensive Geriatric Assessment and optimisation offers a systematic approach to risk assessment and risk modification in the perioperative period. Clinical evidence shows that Comprehensive Geriatric Assessment and optimisation reduces postoperative medical complications and is cost effective in the perioperative setting. These benefits have been observed in patients undergoing elective and emergency surgery. Challenges in the implementation of perioperative Comprehensive Geriatric Assessment and optimisation services are acknowledged. These include the necessary involvement of a wide stakeholder group, limited available geriatric medicine workforce and ensuring fidelity to Comprehensive Geriatric Assessment methodology with adaptation to the local context. Addressing these challenges needs a cross-specialty, interdisciplinary approach underpinned by evidence-based medicine and implementation science with upskilling to facilitate innovative use of the extended workforce. Future delivery of quality patient-centred perioperative care requires proactive engagement with national audit, collaborative guidelines and establishment of networks to share best practice.

Clinical prediction models typically make point estimates of risk. However, values of key variables are often missing during model development or at prediction time, meaning that the point estimates mask significant uncertainty and can lead to over-confident decision making. We present a model of mortality risk in emergency laparotomy which instead presents a distribution of predicted risks, highlighting the uncertainty over the risk of death with an intuitive visualisation. We developed and validated our model using data from 127134 emergency laparotomies from patients in England and Wales during 2013–2019. We captured the uncertainty arising from missing data using multiple imputation, allowing prospective, patient-specific imputation for variables that were frequently missing. Prospective imputation allows early prognostication in patients where these variables are not yet measured, accounting for the additional uncertainty this induces. Our model showed good discrimination and calibration (95% confidence intervals: Brier score 0.071–0.078, C statistic 0.859–0.873, calibration error 0.031–0.059) on unseen data from 37 hospitals, consistently improving upon the current gold-standard model. The dispersion of the predicted risks varied significantly between patients and increased where prospective imputation occurred. We present a case study that illustrates the potential impact of uncertainty quantification on clinical decision making. Our model improves mortality risk prediction in emergency laparotomy and has the potential to inform decision-makers and assist discussions with patients and their families. Our analysis code was robustly developed and is publicly available for easy replication of our study and adaptation to predicting other outcomes.

The reinforcement particles present in a metal matrix is a key factor to improve the strength of weld joints. In the present work, in-situ Titanium diboride (TiB2) and ex-situ Boron carbide (B4C) particles were separately reinforced with Al 4043 matrix by ultrasonic cavitation assisted stir casting process. The fabricated composites were cut into composite filler rods to the required size and shape from the reinforced nanocomposites using wire-cut EDM. The TIG welding process was performed on Al 6061 plates using Al 4043 composite filler rod under optimized welding conditions. The tensile strength and microhardness of both type of particle reinforced weldment were compared. Addition of 2 wt% of TiB2 and 2 wt% B4C particles separately produced 59% and 41% higher microhardness compared to base metal weldment respectively. An increase in tensile strength of 201% and 128% respectively was observed when compared to base metal weldment. The High Resolution Transmission Electron Microscopy (HRTEM) and Field Emission Scanning Electron Microscopy (FESEM) were used to characterize the microstructure of B4C and TiB2 reinforced weldments. The re-melting behaviour of TIG welded joints was also investigated for the formulated nanocomposites.

The use of Amazon’s Mechanical Turk (MTurk) in management research has increased over 2,117% in recent years, from 6 papers in 2012 to 133 in 2019. Among scholars, though, there is a mixture of excitement about the practical and logistical benefits of using MTurk and skepticism about the validity of the data. Given that the practice is rapidly increasing but scholarly opinions diverge, the Journal of Management commissioned this review and consideration of best practices. We hope the recommendations provided here will serve as a catalyst for more robust, reproducible, and trustworthy MTurk-based research in management and related fields.

To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral potentially malignant disorders.Databases Medline, Embase, Evidence-Based Medicine, and Web of Science were searched with articles screened and included if their primary objective was the use of a confocal microscope in diagnosis of oral cancer or epithelial dysplasia, in vivo or ex vivo.Twenty-eight relevant studies were identified of which 21 studies included oral squamous cell carcinoma specimens. Fifteen studies included in vivo use. The studies included both qualitative and fluorescence confocal microscope and reflectance confocal microscope analysis along with quantitative analysis of carcinoma and dysplasia. Thirteen studies reported the predictive value of their confocal device in the diagnosis of dysplasia and carcinoma. The quantitative software-based studies show promise in objectifying the diagnostic process for identifying abnormalities within the microstructure of the oral mucosa.There was heterogeneity in the criteria for diagnosis of dysplasia and oral squamous cell carcinoma with experience levels of assessors impacting method efficacy. Both qualitative and quantitative confocal assessment methodologies have been explored, the latter highlighting the potential of future machine-augmented diagnostic precision.

Mesenchymal neoplasms of the urinary bladder are exceedingly rare and display remarkable diversity. These tumors demonstrate distinct pathological features as well as variable biological behavior and cross-sectional imaging findings. The rarity of tumors, nonspecific symptoms and seemingly normal cystoscopic findings (particularly with small and exophytic tumors) frequently lead to misdiagnosis or missed diagnosis. While some tumors display characteristic cross-sectional imaging findings that may suggest a diagnosis, imaging findings are mostly nonspecific. Histopathological examination is required for accurate diagnosis, management and prognostication. The purpose of this article is to review the cross-sectional imaging findings of a diverse spectrum of mesenchymal tumors of the urinary bladder.

The filtered basis functions (FBF) approach is gaining interest for feedforward tracking control of linear, especially, nonminimum phase systems. It expresses the control input to the plant as a linear combination of basis functions with unknown coefficients. The basis functions are forward filtered through the plant dynamics and the coefficients are selected such that the tracking error is minimized. This article proposes a robust FBF approach for tracking control of linear time invariant systems with known uncertainty. A robust filter is formulated as the inverse of an optimal controller that minimizes a frequency-domain cost function over the known uncertainty. The proposed robust FBF approach filters the basis functions using the robust filter in lieu of the nominal plant dynamics. Stability issues associated with the robust filter are discussed, as are the incorporation of dynamic uncertainty into the robust filter. Applied to a vibration-prone desktop 3-D printer with dynamic uncertainty, significant improvements in tracking accuracy are demonstrated using the robust FBF approach compared to the standard FBF approach.

Technologic advances in chromosomal analysis and DNA sequencing have enabled genome-wide analysis of cancer cells, yielding considerable data on the genetic basis of malignancies. Evolving knowledge of tumor genetics and oncologic pathways has led to a better understanding of histopathologic features, tumor classification, tumor biologic characteristics, and imaging findings and discovery of targeted therapeutic agents. Radiogenomics is a rapidly evolving field of imaging research aimed at correlating imaging features with gene mutations and gene expression patterns, and it may provide surrogate imaging biomarkers that may supplant genetic tests and be used to predict treatment response and prognosis and guide personalized treatment options. Multidetector CT, multiparametric MRI, and PET with use of multiple radiotracers are some of the imaging techniques commonly used to assess radiogenomic associations. Select abdominal malignancies demonstrate characteristic imaging features that correspond to gene mutations. Recent advances have enabled us to understand the genetics of steatotic and nonsteatotic hepatocellular adenomas, a plethora of morphologic-molecular subtypes of hepatic malignancies, a variety of clear cell and non-clear cell renal cell carcinomas, a myriad of hereditary and sporadic exocrine and neuroendocrine tumors of the pancreas, and the development of targeted therapeutic agents for gastrointestinal stromal tumors based on characteristic

Acral lentiginous melanoma (ALM) is a rare tumor that occurs on non-sun exposed skin areas of the hands and feet. Reports suggest that ALM exhibits poor prognosis, although mechanisms driving this remain poorly understood. Alterations in TERT and the Wnt/β-catenin (Wnt) pathway have been suggested to correlate with prognosis of ALM. Thus, immunohistochemical expression of β-catenin and LEF1 along with TERT amplification by FISH was investigated in 34 primary ALMs, 20 metastatic ALMs, 10 primary non-ALMs, and 15 acral nevi. Foot/toe was the most common primary tumor location (85%) for ALM. TERT amplification was detected in 6 of 28 (21.4%) primary ALM, 2 of 8 (25%) primary non-ALM, and 8 of 18 (44.4%) metastatic ALM, the latter showing significantly higher frequency compared with primary melanomas (P = 0.043). Most metastatic ALMs positive for TERT amplification lacked BRAF V600E (87.5%). Cytoplasmic and nonnuclear expression of β-catenin was variably detected in all cases. Metastatic ALM revealed lower expression of β-catenin compared with primary ALM (P = 0.017). No differences in LEF1 expression were detected among the groups; however, acral nevi showed decreased labeling with dermal descent, in contrast to melanoma. No molecular-genetic alteration correlated with prognosis. TERT amplification by FISH is a frequent finding in primary ALM and appears to increase in metastatic tumors, suggesting a role in tumor progression to metastasis. Although TERT amplification has been reported to be infrequent in primary non-ALM, it showed comparable frequency with ALM in our series. Our immunohistochemical findings are not fully supportive of activation of either canonical or noncanonical Wnt cascades in ALM. TERT amplification by FISH and LEF1 immunohistochemistry may help in the differential diagnosis between primary ALM and acral nevus. TERT amplification appears to be a promising target for therapy in patients with metastatic ALM.

Purpose of review To discuss the importance of validated tools that measure patient-reported outcomes and their use in ambulatory surgery. Recent findings Sustained increases in ambulatory surgical care reflect advances in surgical techniques and perioperative anaesthetic care. Use of patient-reported outcomes allows identification of minor adverse events that are more common in this population compared with traditional endpoints such as mortality. Variability in reported outcomes restricts research potential and limits the ability to benchmark providers. The standardized endpoints in perioperative medicine initiative's recommendations on patient-reported outcomes and patient comfort measures are relevant to evaluating ambulatory care. Combining validated generic and disease-specific patient-reported outcome measures (PROMs) examines the widest spectrum of outcomes. Technological advances can be used to facilitate outcome measurement in ambulatory surgery with digital integration optimizing accurate real-time data collection. Telephone or web-based applications for reviewing ambulatory patients were found to be acceptable in multiple international settings and should be harnessed to allow remote follow-up. Summary Use of validated tools to measure patient-reported outcomes allows internal and external quality comparison. Tools can be combined to measure objective outcomes and patient satisfaction. These are both key factors in driving forward improvements in perioperative ambulatory surgical care.

We combine after-action review and needs-assessment frameworks to describe the four most pervasive contemporary methodological challenges faced by international business (IB) researchers, as identified by authors ofJournal of International Business Studiesarticles: Psychometrically deficient measures (mentioned in 73% of articles), idiosyncratic samples or contexts (mentioned in 62.2% of articles), less-than-ideal research designs (mentioned in 62.2% of articles), and insufficient evidence about causal relations (mentioned in 8.1% of articles). Then, we offer solutions to address these challenges: demonstrating why and how the conceptualization of a construct is accurate given a particular context, specifying whether constructs are reflective or formative, taking advantage of the existence of multiple indicators to measure multi-dimensional constructs, using particular samples and contexts as vehicles for theorizing and further theory development, seeking out particular samples or contexts where hypotheses are more or less likely to be supported empirically, using Big Data techniques to take advantage of untapped sources of information and to re-analyze currently available data, implementing quasi-experiments, and conducting necessary-condition analysis. Our article aims to advance IB theory by tackling the most typical methodological challenges and is intended for researchers, reviewers and editors, research consumers, and instructors who are training the next generation of scholars.

We categorized and content-analyzed 168 methodological literature reviews published in 42 management and applied psychology journals. First, our categorization uncovered that the majority of published reviews (i.e., 85.10%) belong in three categories (i.e., critical, narrative, and descriptive reviews), which points to opportunities and promising directions for additional types of methodological literature reviews in the future (e.g., meta-analytic and umbrella reviews). Second, our content analysis uncovered implicit features of published methodological literature reviews. Based on the results of our content analysis, we created a checklist of actionable recommendations regarding 10 components to include to enhance a methodological literature review’s thoroughness, clarity, and ultimately, usefulness. Third, we describe choices and judgment calls in published reviews and provide detailed explications of exemplars that illustrate how those choices and judgment calls can be made explicit. Overall, our article offers recommendations that are useful for three methodological literature review stakeholder groups: producers (i.e., potential authors), evaluators (i.e., journal editors and reviewers), and users (i.e., substantive researchers interested in learning about a particular methodological issue and individuals tasked with training the next generation of scholars).

ObjectivesTo evaluate whether distance and estimated travel time to hospital for patients undergoing emergency laparotomy is associated with postoperative mortality.DesignNational cohort study using data from the National Emergency Laparotomy Audit.Setting171 National Health Service hospitals in England and Wales.Participants22 772 adult patients undergoing emergency surgery on the gastrointestinal tract between 2013 and 2016.Main outcome measuresMortality from any cause and in any place at 30 and 90 days after surgery.ResultsMedian on-road distance between home and hospital was 8.4 km (IQR 4.7–16.7 km) with a median estimated travel time of 16 min. Median time from hospital admission to operating theatre was 12.7 hours. Older patients live on average further from hospital and patients from areas of increased socioeconomic deprivation live on average less far away.We included estimated travel time as a continuous variable in multilevel logistic regression models adjusting for important confounders and found no evidence for an association with 30-day mortality (OR per 10 min of travel time=1.02, 95% CI 0.97 to 1.06, p=0.512) or 90-day mortality (OR 1.02, 95 % CI 0.97 to 1.06, p=0.472).The results were similar when we limited our analysis to the subgroup of 5386 patients undergoing the most urgent surgery. 30-day mortality: OR=1.02 (95% CI 0.95 to 1.10, p=0.574) and 90-day mortality: OR=1.01 (95% CI 0.94 to 1.08, p=0.858).ConclusionsIn the UK NHS, estimated travel time between home and hospital was not a primary determinant of short-term mortality following emergency gastrointestinal surgery.

Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well-defined, relevant, and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified standardized endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC). Core outcome sets for pediatric perioperative care cannot be directly extrapolated from adult data. The type and weighting of endpoints within particular domains can be influenced by age-dependent differences in the indications for and/or nature of surgery and medical comorbidities, and the validity and utility of many measurement tools vary significantly with developmental stage and age. The involvement of parents/carers is essential as they frequently act as surrogate responders for preverbal and developmentally delayed children, parental response may influence child outcome, and parental and/or child ranking of outcomes may differ from those of health professionals. Here, we describe the formation of the international Pediatric Perioperative Outcomes Group, which aims to identify and create validated, broadly applicable, patient-centered outcome measures for infants, children, and young people. Methodologies parallel that of the StEP and COMPAC projects, and systematic literature searches have been performed within agreed age-dependent subpopulations to identify reported outcomes and measurement tools. This represents the first steps for developing core outcome sets for pediatric perioperative care.