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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.

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.

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.

Abstract Recent advances in the surgical techniques and postoperative intensive care have led to a decrease in the mortality rates after major pancreatic procedures, which now ranges from 1 to 3%. However, the morbidity rates are still high, resulting in longer hospital stays and greater cost. Imaging plays a fundamental role in the postoperative assessment. Specially, multidetector computed tomography scans (MDCT) is the modality of choice in the postoperative settings. Early diagnosis of the postoperative complications and differentiating them from being normal or expected postoperative findings is crucial to offer the best possible care for patients and to decrease the morbidity and mortality associated with surgery. In this article, we will briefly review the normal pancreatic anatomy, discuss the main types of pancreatic surgeries, and illustrate the imaging findings during the early postoperative period and of the main postsurgical complications in both acute and chronic postoperative settings.

PurposeSocial entrepreneurship courses are among the fastest growing category of course offerings to entrepreneurship students (Brock and Kim, 2011) because both high growth potential- and steady growth-social ventures can create value and help solve social issues effectively and efficiently. As knowledge disseminators, entrepreneurship educators are in prime position to develop the knowledge, skills and abilities of students, which, in turn, increases their intentions to start a social venture and their ability to manage and grow their venture. Students gain an understanding about the role of entrepreneurship in addressing social opportunities, as well as knowledge related to starting, managing and growing social entrepreneurship ventures. This paper is divided into three parts. First, the authors broadly discuss the concept of social entrepreneurship. Second, the authors present an overview of the field of social entrepreneurship education (SEE) and its evolution. Finally, the authors supplement this review with an analytical examination of SEE, in which the authors present results of a cross-country analysis survey of over 200 entrepreneurship education programs in the USA and Canada. This paper aims to present information about: student enrollment in social entrepreneurship courses in comparison to other entrepreneurship courses; the frequency of offering social entrepreneurship courses and programs compared to other entrepreneurship courses and programs; and future trends in SEE. The results revealed a strong demand for social entrepreneurship from students, room for improvement in terms of the supply of course offerings, and a strong belief in the continued growth of social entrepreneurship. The authors conclude with suggestions about the future of SEE.Design/methodology/approachAnalysis of secondary data derived from the oldest and most-frequently cited sources regarding entrepreneurship education in the USA and a novel data set examining entrepreneurship education in Canada. Both data sets were collected using an online self-report survey.FindingsDemand for SEE continues to rise in both the USA and Canada. However, course and program offerings have not kept pace. Prominent trends in social entrepreneurship such as cross-campus programs and addressing the evolving demographics of students in higher education institutions need more attention.Originality/valueA cross-cultural study of SEE that provides a high-level view of the state of the field today. In addition, the paper outlines the potential of the field of knowledge management for the future of SEE.

Introduction Nuclear protein of the testis (NUT) carcinoma (formerly NUT midline carcinoma) is an aggressive tumor with characteristic BRD4-NUTM1 translocation and a poor prognosis. The primary objective of this study was to describe the clinical and radiologic features, treatment response, and survival of NUT carcinoma (NC). Materials and methods This retrospective single-center study was based on the review of medical records of NC patients with a specific genetic rearrangement or positive anti-NUT nuclear staining. Overall survival (OS) was analyzed according to primary tumor location. Results This series of 22 patients had a mean age of 36.27 ± 2.68 years with 68% women and 32% men. The median age at diagnosis was 34 years (range, 17-55 years). The primary tumor was located in the chest (n = 12/22; 55%), head and neck (n = 9/22; 40%), and 1 patient had a renal tumor. About 68% (n = 15/22) patients presented with regional lymph nodal involvement and 77% (n = 17/22) had distant metastases. All the bone metastases were lytic (100%) with mixed lytic and sclerotic metastases in 5 patients. Only 18% (n = 4/22) of the patients showed response to treatment, with progression in the remaining 18 patients. The median OS was 7 months. The OS was significantly (P = 0.024) more in patients with primary head and neck NC (n = 9; OS, 16 months) versus those with pulmonary and other locations (n = 13; OS, 6 months). Conclusions Nuclear protein of the testis carcinoma is an aggressive disease refractory to conventional therapy. Imaging with the complementary use of computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography is important for staging, guiding management, assessing the treatment response, and surveillance.

Background Major surgery accounts for a substantial proportion of health service activity and resource consumption, due not only to the primary procedure, but also the short and long-term implications of perioperative complications. It is likely that both compliance with best practice processes and outcomes from major surgery vary substantially between hospitals and therefore could be targets for quality improvement. Methods The Perioperative Quality Improvement Programme (PQIP) patient study is a multi-centre prospective cohort study which recruits participants undergoing major inpatient non-cardiac surgery with three main aims: to measure and improve processes of care and outcome from major surgery; to implement and evaluate a complex intervention aiming to enhance the use of data for improvement by clinical teams; and to create a national database to support collaborative research and efficient study design. The prospective dataset combines variables for risk adjustment, process measures and both objective and patient reported outcome data. Longer-term outcomes are collected through linkage to national administrative datasets (mortality and readmissions). PQIP deploys a theoretically underpinned improvement methodology to support the use of data for improvement by perioperative clinicians, incorporating action research principles to enable changes to be made in response to user feedback. Dissemination of interim findings (non-inferential) form a part of the improvement methodology and are provided to participating centres at regular intervals, including near-real-time feedback of key process measures. Inferential analyses will be published in the peer-reviewed literature, supported by a multi-modal communications strategy to patients, public, policy makers and academic audiences as well as clinicians. Discussion PQIP is the first national effort in the UK to measure and report risk-adjusted complications, patient-reported outcome and mortality rates for patients undergoing major surgery across multiple surgical specialties in the UK. Its main limitation is the risk of sampling bias due to the requirement for patient consent, and because local resource constraints may lead hospitals to recruit a convenience sample, rather than a truly random sample. We will evaluate this risk by using Hospital Episode Statistics (HES) to identify all patients undergoing PQIP eligible procedures, and undertaking sensitivity analyses comparing common data points in the PQIP sample and the HES population. As the purpose of PQIP is to support quality improvement and research as opposed to quality assurance or institutional comparisons, even if they exist, such sampling biases are unlikely to materially affect the ability of the programme to achieve its aims.

ObjectivesTo review how National Health Service (NHS) Secondary Care Trusts (NSCTs) are using the Learning from Deaths (LfDs) programme to learn from and prevent, potentially preventable deaths.IntroductionPotentially preventable deaths occur worldwide within healthcare organisations. In England, inconsistencies in how NSCTs reviewed, investigated and shared LfDs, resulted in the introduction of national guidance on ‘LfDs’ in 2017. This guidance provides a ‘framework for identifying, reporting, investigating and LfDs’. Amendments to NHS Quality Account regulations, legally require NSCTs in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended NSCTs would share this learning and take measurable action to prevent future deaths.MethodWe undertook qualitative and quantitative secondary data, document analysis of all NSCTs LfDs reports within their 2017/2018 Quality Accounts (n=222).ResultsAll statutory elements of LfDs reporting were reported by 98 out of 222 (44%) NSCTs. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of NSCTs (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 NSCTs (48%) have shared or plan to share the learning within their own organisation. The majority of NSCTs (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 NSCTs (17%) mentioned involvement of bereaved families.ConclusionsThe wide variation in reporting demonstrates that some NSCTs have engaged fully with LfDs, while other NSCTs appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfDs reports have previously been identified by national and international reports and inquiries.

Background Outcome selection underpins clinical trial interpretation. Inconsistency in outcome selection and reporting hinders comparison of different trials' results, reducing the utility of research findings. Methods We conducted an iterative consensus process to develop a set of Core Outcome Measures for Perioperative and Anaesthetic Care (COMPAC), following the established Core Outcome Measures for Effectiveness Trials (COMET) methodology. First, we undertook a systematic review of RCTs in high-impact journals to describe current outcome reporting trends. We then surveyed patients, carers, researchers, and perioperative clinicians about important outcomes after surgery. Finally, a purposive stakeholder sample participated in a modified Delphi process to develop a core outcome set for perioperative and anaesthesia trials. Results Our systematic review revealed widespread inconsistency in outcome reporting, with variable or absent definitions, levels of detail, and temporal criteria. In the survey, almost all patients, carers, and clinicians rated clinical outcome measures critically important, but clinicians rated patient-centred outcomes less highly than patients and carers. The final core outcome set was: (i) mortality/survival (postoperative mortality, long-term survival); (ii) perioperative complications (major postoperative complications/adverse events; complications/adverse events causing permanent harm); (iii) resource use (length of hospital stay, unplanned readmission within 30 days); (iv) short-term recovery (discharge destination, level of dependence, or both); and (v) longer-term recovery (overall health-related quality of life). Conclusions This core set, incorporating important outcomes for both clinicians and patients, should guide outcome selection in future perioperative medicine or anaesthesia trials. Mapping these alongside standardised endpoint definitions will yield a comprehensive perioperative outcome framework.

Objectives Aberrant expression of the mesenchymal epithelial transition factor (MET) gene has been observed in several malignancies, and drugs targeting the MET gene have been implicated in clinical trials with promising results. Hence, MET is a potentially targetable oncogenic driver. We explored the frequency of MET gene high copy number in melanomas and carcinomas. Methods The study group included 135 patients. Tissue microarrays were constructed with 19 melanomas and 116 carcinomas diagnosed from 2010 to 2012. We screened MET gene copy number by fluorescence in situ hybridization analysis using probes for MET gene and CEP7 as control. Results We found MET gene amplification in 2 (11%) of 19 melanoma cases, whereas 5 (26%) of 19 melanoma cases showed polysomy. For carcinomas, there was no MET gene amplification identified. However, 8 (7%) of 116 cases showed polysomy. Conclusions In our study, MET gene amplification was identified in 11% of melanomas and is relatively concordant with few reported studies. However, about 26% of the additional melanoma cases showed MET gene polysomy, which has not been reported as per our knowledge. If these results are validated with further orthogonal studies, more of the melanoma cases could potentially benefit from targeted therapy with MET tyrosine kinase inhibitors.

The spectrum of adrenal masses in the pediatric population markedly differs from that in the adult population. Imaging plays a crucial role in detecting adrenal masses, differentiating malignant from benign lesions, recognizing extra-adrenal lesions in the suprarenal fossa, and directing further management. Ultrasound is the primary imaging modality of choice for the evaluation of adrenal masses in the neonatal period, whereas MRI or CT is used as a problem-solving tool. In older children, computed tomography or magnetic resonance imaging is often required after initial sonographic evaluation for further characterization of a lesion. Herein, we discuss the salient imaging features along with pathophysiology and clinical features of pediatric adrenal masses.

Background : Recent data suggest that beta blockers are associated with increased perioperative risk in hypertensive patients. We investigated whether beta blockers were associated with an increased risk in elderly patients with raised preoperative arterial blood pressure. Methods We conducted a propensity-score-matched cohort study of primary care data from the UK Clinical Practice Research Datalink (2004–13), including 84 633 patients aged 65 yr or over. Conditional logistic regression models, including factors that were significantly associated with the outcome, were constructed for 30-day mortality after elective noncardiac surgery. The effects of beta blockers (primary outcome), renin–angiotensin system (RAS) inhibitors, calcium-channel blockers, thiazides, loop diuretics, and statins were investigated at systolic and diastolic arterial pressure thresholds. Results Beta blockers were associated with increased odds of postoperative 30-day mortality in patients with systolic hypertension (defined as systolic BP >140 mm Hg; adjusted odds ratio [aOR]: 1.92; 95% confidence interval [CI]: 1.05–3.51). After excluding patients for whom prior data suggest benefit from perioperative beta blockade (patients with prior myocardial infarction or heart failure), rather than adjusting for them, the point estimate shifted slightly (aOR: 2.06; 95% CI: 1.09–3.89). Compared with no use, statins (aOR: 0.35; 95% CI: 0.17–0.75) and thiazides (aOR: 0.28; 95% CI: 0.10–0.78) were associated with lower mortality in patients with systolic hypertension. Conclusions These data suggest that the safety of perioperative beta blockers may be influenced by preoperative blood pressure thresholds. A randomised controlled trial of beta-blocker withdrawal, in select populations, is required to identify a causal relationship.

Comprehensive Geriatric Assessment (CGA) is being employed in the perioperative setting to improve outcomes for older surgical patients. Traditionally CGA is delivered by a geriatrician led multidisciplinary team but with the acknowledged workforce challenges in geriatric medicine, it has been suggested that non-geriatricians may be able to deliver CGA. HOW-CGA developed a toolkit to facilitate the delivery of CGA by non-geriatricians in the perioperative setting. Across two hospital sites uptake and implementation of this toolkit was limited by a potential lack of face validity, behavioural and cultural barriers and an acknowledgement that geriatric medicine expertise is key to CGA and optimisation. In-keeping with this finding there has been an observed expansion in geriatrician led CGA services for older surgical patients in the UK. In order to demonstrate the effectiveness of perioperative CGA services, implementation science should be combined with health services research methodology and the use of big data through linked national audit.

Scholarly impact is typically conceptualized and measured as an internal exchange that occurs among researchers in the form of citations in journal articles. We offer an expanded conceptualization ...

IntroductionPotentially preventable deaths occur worldwide within healthcare organisations. Organisational learning from incidents is essential to improve quality of care. In England, inconsistencies in how NHS secondary care trusts reviewed, investigated and shared learning from deaths, resulted in the introduction of national guidance on ‘Learning from Deaths’ (LfDs) in 2017. This guidance provides a ‘framework for identifying, reporting, investigating and learning from deaths’. Amendments to NHS Quality Account regulations, legally require NHS trusts in England to report quantitative and qualitative information relating to patient deaths annually. The programme intended trusts would share this learning and take measurable action to prevent future deaths.MethodWe undertook qualitative and quantitative secondary data analysis of all NHS secondary care trust LfDs reports within their 2017/18 Quality Accounts, to review how organisations are using the LfDs programme to learn from and prevent, potentially preventable deaths.ResultsAll statutory elements of LfDs reporting were reported by 98 out of 222 (44%) trusts. The percentage of deaths judged more likely than not due to problems in healthcare was between 0% and 13%. The majority of trusts (89%) reported lessons learnt; the most common learning theme was poor communication. 106 out of 222 trusts (48%) have shared or plan to share the learning within their own organisation. The majority of trusts (86%) reported actions taken and 47% discussed or had a plan for assessment of impact. 37 out of 222 trusts (17%) mentioned involvement of bereaved families.ConclusionsThe wide variation in reporting demonstrates that some trusts have engaged fully with LfDs, while other trusts appear to have disengaged with the programme. This may reveal a disparity in organisational learning and patient safety culture which could result in inequity for bereaved families. Many themes identified from the LfD reports have previously been identified in national and international reports and inquiries. Further work is needed to strengthen the LfDs programme.

Socioeconomic deprivation is associated with health inequalities. We explored relationships between socioeconomic group and outcomes after elective surgery in the UK National Health Service (NHS).We combined data from two observational studies in 115 NHS hospitals and determined socioeconomic group using the Index of Multiple Deprivation (IMD) quintiles based on place of residence. Postoperative complications and 3-yr survival were assessed using logistic and Cox regression. Univariate analyses were adjusted for age differences between IMD quintiles. Multivariable analyses were used to account for other baseline risk factors including sex and comorbid disease. Results are reported as n (%), hazard ratios (HR) or odds ratios (OR) with 95% confidence intervals.Postoperative complications developed in 971/9051 patients (10.7%) and 1597/9043 patients (17.7%) died within 3 yr. Complication rates increased with deprivation (reference group least-deprived IMD5): IMD1 (OR=1.44 [1.17-1.78]; P0.001), IMD2 (OR=1.38 [1.12-1.70]; P0.01), IMD3 (OR=1.09 [0.88-1.35]: P=0.44), IMD4 (OR=0.89 [0.71-1.11]; P=0.30). More patients from the most deprived quintile died (IMD1) (n=349, 18.8%) compared with the least deprived (IMD5) (n=297, 15.9%) with a trend across the socioeconomic spectrum (P=0.01). After age adjustment, patients in the most deprived areas experienced reduced 3-yr survival: IMD1 (HR=1.43 [1.23-1.67]; P0.0001), IMD2 (HR=1.35 [1.15-1.57]; P0.001), IMD3 (HR=1.04 [0.89-1.23]; P=0.60), and IMD4 (HR=1.11 [0.95-1.30]; P=0.19). This finding persisted in risk-adjusted analyses. Increased complication rates only partially explained this reduced survival.Socioeconomic deprivation is associated with worse long-term outcomes after elective surgery. This risk factor should be considered when planning perioperative care for patients from deprived areas.

Background The use of RNA-based next-generation sequencing (NGS) assays to detect gene fusions for targeted therapy has rapidly become an essential component of comprehensive molecular profiling. For cytology specimens, the cell block (CB) is most commonly used for fusion testing; however, insufficient cellularity and/or suboptimal RNA quality are often limiting factors. In the current study, the authors evaluated the factors affecting RNA fusion testing in cytology and the added value of smears in cases with a suboptimal or inadequate CB. Methods A 12-month retrospective review was performed to identify cytology cases that were evaluated by a targeted RNA-based NGS assay. Samples were sequenced by targeted amplicon-based NGS for 51 clinically relevant genes on a proprietary platform. Preanalytic factors and NGS quality parameters were correlated with the results of RNA fusion testing. Results The overall success rate of RNA fusion testing was 92%. Of the 146 cases successfully sequenced, 14% had a clinically relevant fusion detected. NGS testing success positively correlated with RNA yield (P = .03) but was independent of the tumor fraction, the tumor size, or the number of slides used for extraction. CB preparations were adequate for testing in 45% cases, but the inclusion of direct smears increased the adequacy rate to 92%. There was no significant difference in testing success rates between smears and CB preparations. Conclusions The success of RNA-based NGS fusion testing depends on the quality and quantity of RNA extracted. The use of direct smears significantly improves the adequacy of cytologic samples for RNA fusion testing for predictive biomarkers.

Coronary artery aneurysm (CAA) is described as a localized dilatation of a coronary artery segment by more than 1.5-fold compared with the adjacent normal segments. The incidence of CAA varies from 0.3 to 5.3% with atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention (PCI) being the common etiologic factors. Owing to its varying presentation and absence of robust treatment guidelines, management of CAA is a challenge. Management of every patient must be tailored according to the presentation and expertise of the cardiac team available. Here, we present case reports of two patients with CAA who presented with acute coronary syndrome. As a result of unstable presentation, both patients underwent immediate intervention (CABG and PCI respectively) with successful revascularization having no complication and mortality.

Nuclear protein of the testis (NUT) carcinoma (NC) (formerly known as NUT midline carcinoma) is an aggressive pleomorphic squamous cell carcinoma with a dismal prognosis. Primary NC tumors are commonly located in the chest or head and neck regions. Imaging plays an indispensable role in the staging, management, treatment response assessment, and surveillance of NC. Primary pulmonary NC usually presents as a large mass with lymphadenopathy and pleural involvement. Primary head and neck NC presents as a large expansile necrotic mass in the sinonasal region with locoregional destruction and occasional cervical lymph node involvement. These imaging features are relatively non-specific but are consistent among patients. Currently, there are no standardized guidelines for the treatment of NC. Because of its rarity, paucity of reports in the medical literature, and the lack of awareness among radiologists, NUT carcinoma (NC) has been largely underdiagnosed and misdiagnosed. Clinical aggressive features and pleomorphic/undifferentiated squamous cell carcinoma should prompt genetic evaluation for NUT translocation to diagnose NC. In this article, we discuss NC's clinicopathologic and imaging features and treatment options, including emerging new treatments.

The Women in Anaesthesia Research Symposium (Prato, Italy; 4 June, 2019), supported by the British Journal of Anaesthesia in collaboration with Monash University, was organised to discuss challenges facing women in anaesthesia clinical practice and research. We provide an overview of institutional or departmental measures that were proposed during the symposium that may empower women in anaesthesia today.

ObjectiveTo identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery.DesignSystematic review and meta-analysis of randomised controlled trials.Data sourcesMedline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017.Eligibility criteriaRandomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded.Data extraction and synthesisReviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared.Results117 trials enrolled 21 940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18 062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions.ConclusionsPredominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions.Study registrationProspero CRD42016035662.

Our effort is to analyze the effect of the rampant over the economies of 10 affected nations by studying their stock market values during the COVID-19 episode. We have endowed the nations with their respective stock markets stated in brackets - Brazil(Ibovespa), Canada (S&P/TSX Composite), France (AEX), Germany (DAX 30), India (NIFTY 50), Italy (FTSE MIB), Russia (IMOEX), Spain (IBEX 35), U.K. (FTSE 100), U.S.A. (DOW JONES INDUSTRIAL AVERAGE). We have gathered the indices of stock per country from 2 March to 23rd June, collected from official website of respective stocks. In order to collect data, we had to inculcate the fundamental lessons of Statistics. R-software aided us to plot the curves of stock values providing an ease to master our project. We also formulated a Python 3.7 language program code to solidify analysis on various aspects of economy of the countries and comparison between these aspects.

Latent fingerprints (LFPs) are the major physical evidences for the identification of individuals during crime spot investigation. Till date, numerous methods were followed to visualize LFPs. However, simple, accurate, and cost-effective method has wide scope in advanced forensic field. In our work, Ca2SiO4:Dy3+ nanopowders (NPs) were fabricated via solution combustion route. The optimized sample was employed for the visualization of overlapped LFPs by the cost effective powder dusting method. The obtained results reveals the complete three levels of ridge characteristics with high sensitivity, reproducibility, selectivity, and reliability on various complex surfaces. The photoluminescence (PL) spectra consist of intense peaks at ∼ 480 and 574 nm owing to 4F9/2 → 6H15/2 and 4F9/2 → 6H13/2 4f transitions of Dy3+ ions, respectively. The photometric properties confirm that the samples exhibit intense white emission with high color purity. Therefore, the prepared NPs could be a definitive choice as an advanced luminescent NPs for forensic, solid state lighting and portable FED devices.

We review the literature on evidence-based best practices on how to enhance methodological transparency, which is the degree of detail and disclosure about the specific steps, decisions, and judgme...

Improvements in outcome measurement are needed to produce quality improvement in perioperative care. However, problems with the collection and use of outcome data persist in research and clinical practice. This is being addressed by several national programmes and initiatives to standardize and integrate outcome measurement. The use of different outcome measures is changing and there has been a transition towards patient-focused measures. Traditional measures of quality in perioperative care include mortality, morbidity and resource utilization measures. Patient-focused measures include patient-reported outcome measures and measures of patient experience. Each of these has advantages and disadvantages in different situations. The routine collection, analysis and dissemination of data relating to perioperative outcome is beneficial to patients, clinicians, hospitals, commissioners, regulators and researchers.

Most future industrial and organizational (I-O) psychology practitioners and researchers initially enroll in an introductory I-O psychology course during their junior or senior year of undergraduate studies, making introductory textbooks their first in-depth exposure to the field and an important knowledge base. We reviewed and analyzed the 6,654 unique items (e.g., journal articles, book chapters) published in 1,682 unique sources (e.g., scholarly journals, edited books, popular press publications) and authored by 8,603 unique individuals cited in six popular I-O psychology textbooks. Results showed that 39% of the top-cited sources are not traditional academic peer-reviewed journals, 77% of the top-cited articles were published in cross-disciplinary journals, and 58% of the top-cited authors are affiliated with business schools and not psychology departments. These results suggest that the science–practice divide in I-O psychology may develop later—perhaps after graduates obtain employment as either practitioners or researchers. Also, results suggest I-O psychology is closer to business and management than social psychology and psychology in general. We discuss additional implications for the science–practice divide, how to define and measure scholarly impact, and the future of I-O psychology as a field, including the movement of I-O psychologists to business schools and the sustainability of I-O psychology programs in psychology departments.

Purpose of Review This article offers an overview of the history and features of Improvement Science in general and some of its applications to Anaesthesia in particular. Recent Findings Improvement Science is an evolving discipline aiming to generate learning from quality improvement interventions. An increasingly common approach to improving Anaesthesia services is to employ large-scale perioperative data measurement and feedback programmes. Improvement Science offers important insights on questions such as which indicators to collect data for; how to capture that data; how it can be presented in engaging visual formats; how it could/should be fed back to frontline staff and how they can be supported in their use of data to generate improvement. Summary Data measurement and feedback systems represent opportunities for anaesthetists to work with multidisciplinary colleagues to help improve services and outcomes for surgical patients. Improvement Science can help evaluate which approaches work, and in which contexts, and is therefore of value to healthcare commissioners, providers and patients.

Introduction Pheochromocytomas are rare catecholamine-producing neuroendocrine tumors. They are surgically curable but can be lethal if remain undiagnosed. We report a patient earlier diagnosed with malignant hyperthermia but later found to have pheochromocytoma on autopsy. Case report After a preprocedural pain block for elective right shoulder arthroscopy, a 53-year-old hypertensive white man developed chest pain. In the operating room, he had increased blood pressure. Postoperatively, his blood pressures dropped from 220/100 to 80/30 mm Hg. He later developed high fever with core temperature reaching a peak of 42.2°C, rapid breathing, and died after unsuccessful attempts to stabilize him. Autopsy Autopsy revealed a tumor in his right adrenal gland, measuring 10 cm in greatest dimension and weighing 530 g. It was red brown with a hemorrhagic and cystic cut surface. A thin rim of yellow-orange adrenal cortex was visible at the margin of the tumor, indicating that it originated from the underlying adrenal medulla. The left adrenal gland was unremarkable.Sections showed hypercellular tumor with zellballen architecture. The tumor cells were round to oval with finely granular basophilic cytoplasm and mild pleomorphism. A 24-hour urine sample collected before his death showed greater than 22727 μg/g Ratio to Creatinine metanephrines and normetanephrine, indicating that the tumor was active and secreted high levels of catecholamine. The cause of death was established as the complications of pheochromocytoma in the settings of general anesthesia for shoulder arthroscopy. The manner of death was natural. Conclusions Pheochromocytoma can mimic malignant hyperthermia, and it should always be considered and managed appropriately in such scenarios to avoid untoward consequences. Pathologists must also be aware of this when conducting an autopsy in cases with a previous clinical diagnosis of malignant hyperthermia.

Graphical models have emerged as a tool to map out the interplay between multiple measured and unmeasured variables, and can help strengthen the case for a causal association between exposures and outcomes in observational studies. In Part 1 of this methods series, we will introduce the reader to graphical models for causal inference in perioperative medicine, and set the framework for Part 2 of the series involving advanced methods for causal inference.

A vehicular ad-hoc network commonly known as VANET is one of the rapid growing division of mobile ad-hoc network. In VANET cluster of elegant vehicles equipped with OBU (On Board Unit) are behaves as mobile nodes on highways and it is capable in providing Mobile-to-stationary Road Side Unit (V-to-RSU) and Mobile-to-Mobile (V-to-V) communication. Vehicular network is promising several useful services on National Highway like shelter applications as well as amusement applications. However, a number of limitations can bang the consistency of vehicular networks. Mobile-to-Mobile communication is considered to be noteworthy to provide a high level safety and it is ease to handle by drivers and travelers. Steering in this network is a major confront; hence we find many research issues in VANET. Location based navigation protocol has been recognized to be appropriate to VANETs for the reason that often altered network topology and extremely dynamic nature of mobile nodes. Even though VANET can establish communication between vehicle to vehicle, still embedded with some tribulations like, how to validate the message broadcasted from various vehicle range, and to route the vehicle's message to different vehicle communication range. To overcome these issues we are proposed to design an AVANET (Autonomous vehicular ad-hoc network). The AVANET can competent the entities, which can behave autonomously and get into an appropriate, network topology to make advanced connectivity for both V-to-RSU and V-to-V transportation. The simulation output of the proposed AVANET is designating the robustness against network detachment and indicates the high secured authentication between vehicles.

Data generated in digital devices need to be secured for its use by the authorized users. Different security algorithms such as symmetric and asymmetric cryptosystems have been developed to secure the data while in transmission as well as at rest. However, data is not secure while processing. This paper explores the concept of Homomorphic Encryption (HE) based solution for secured functional evaluation of data. The proposed FHE-AES/DH cloud security model executes encryption on the data and encrypted data is transmitted to the cloud server. The functional evaluation is carried out on uploaded data by the third party without knowing the contents. These models hide the content of data in order to protect security and privacy. A banking data set has been used for the case study. The FHE-AES model takes less time for functional evaluation compared to FHE-DH model.

Background Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare the accuracy of freely available objective surgical risk tools with subjective clinical assessment in predicting 30-day mortality. Methods and findings We conducted a prospective observational study in 274 hospitals in the United Kingdom (UK), Australia, and New Zealand. For 1 week in 2017, prospective risk, surgical, and outcome data were collected on all adults aged 18 years and over undergoing surgery requiring at least a 1-night stay in hospital. Recruitment bias was avoided through an ethical waiver to patient consent; a mixture of rural, urban, district, and university hospitals participated. We compared subjective assessment with 3 previously published, open-access objective risk tools for predicting 30-day mortality: the Portsmouth-Physiology and Operative Severity Score for the enUmeration of Mortality (P-POSSUM), Surgical Risk Scale (SRS), and Surgical Outcome Risk Tool (SORT). We then developed a logistic regression model combining subjective assessment and the best objective tool and compared its performance to each constituent method alone. We included 22,631 patients in the study: 52.8% were female, median age was 62 years (interquartile range [IQR] 46 to 73 years), median postoperative length of stay was 3 days (IQR 1 to 6), and inpatient 30-day mortality was 1.4%. Clinicians used subjective assessment alone in 88.7% of cases. All methods overpredicted risk, but visual inspection of plots showed the SORT to have the best calibration. The SORT demonstrated the best discrimination of the objective tools (SORT Area Under Receiver Operating Characteristic curve [AUROC] = 0.90, 95% confidence interval [CI]: 0.88–0.92; P-POSSUM = 0.89, 95% CI 0.88–0.91; SRS = 0.85, 95% CI 0.82–0.87). Subjective assessment demonstrated good discrimination (AUROC = 0.89, 95% CI: 0.86–0.91) that was not different from the SORT (p = 0.309). Combining subjective assessment and the SORT improved discrimination (bootstrap optimism-corrected AUROC = 0.92, 95% CI: 0.90–0.94) and demonstrated continuous Net Reclassification Improvement (NRI = 0.13, 95% CI: 0.06–0.20, p < 0.001) compared with subjective assessment alone. Decision-curve analysis (DCA) confirmed the superiority of the SORT over other previously published models, and the SORT–clinical judgement model again performed best overall. Our study is limited by the low mortality rate, by the lack of blinding in the ‘subjective’ risk assessments, and because we only compared the performance of clinical risk scores as opposed to other prediction tools such as exercise testing or frailty assessment. Conclusions In this study, we observed that the combination of subjective assessment with a parsimonious risk model improved perioperative risk estimation. This may be of value in helping clinicians allocate finite resources such as critical care and to support patient involvement in clinical decision-making., Danny Wong and colleagues reveal measures for predicting mortality after surgery., Author summary Why was this study done? Over 3 million postoperative deaths occur worldwide per year. Some of these may be avoidable through risk-assessment–based modification of treatment pathways, such as postoperative critical care admission. There are multiple methods for predicting which patients are at high risk of death or complications from surgery, but these are not widely used, with clinicians instead usually relying on their subjective clinical judgement alone. Before this study, there was little information about whether clinical judgement was of better, worse, or equivalent accuracy to objective risk scores. What did the researchers do and find? We conducted a 1-week cohort study in 274 hospitals in the UK, Australia, and New Zealand, during which we collected data on risk and surgical outcome on every patient who had an operation requiring an overnight stay in hospital. The clinical team (surgeons, anaesthetists) looking after the patient were asked to provide a subjective assessment of risk. We compared these assessments with the results of 3 freely available objective risk-assessment tools. We included data from 22,631 patients in our analyses and found that subjective assessment was as accurate as the best of the objective risk tools (the Surgical Outcome Risk Tool or SORT) for predicting death in hospital within 30 days of surgery. However, combining subjective and objective measurement using the SORT provided an even more accurate estimate. What do these findings mean? The new SORT–clinical judgement calculator can be used by clinicians to risk-stratify patients and so identify which individuals are most likely to benefit from limited resources such as access to postoperative critical care. At the policy level, the tool can be used to plan surgical services, including the number of critical care beds required to serve a surgical population. This study is limited by being conducted solely in high-income countries, limiting its global generalisability.

Foy and colleagues summarise the challenges and opportunities for using audit and feedback to improve patient care.1 We agree that research should be embedded to improve the effect of national audits. In addition to the study designs described by Foy et al, an understanding of …

Pancreatic ductal adenocarcinoma (PDAC) is a genetically heterogeneous, biologically aggressive malignancy with a uniformly poor prognosis. While most pancreatic cancers arise sporadically, a small subset of PDACs develop in patients with hereditary and familial predisposition. Detailed studies of the rare hereditary syndromes have led to identification of specific genetic abnormalities that contribute to malignancy. For example, germline mutations involving BRCA1, BRCA2, PRSS1, and mismatch repair genes predispose patients to PDAC. While patients with Lynch syndrome develop a rare "medullary" variant of adenocarcinoma, intraductal papillary mucinous tumors are observed in patients with McCune-Albright syndrome. It is now well established that PDACs originate via a multistep progression from microscopic and macroscopic precursors due to cumulative genetic abnormalities. Improved knowledge of tumor genetics and oncologic pathways has contributed to a better understanding of tumor biology with attendant implications on diagnosis, management, and prognosis. In this article, the genetic landscape of PDAC and its precursors will be described, the hereditary syndromes that predispose to PDAC will be reviewed, and the current role of imaging in screening and staging assessment, as well as the potential role of molecular tumor-targeted imaging for evaluation of patients with PDAC and its precursors, will be discussed. Keywords: Abdomen/GI, Genetic Defects, Oncology, Pancreas Supplemental material is available for this article. © RSNA, 2020.

In modern health care environment, meliorations of the IoT based information and communication technologies are broadly utilized for the contraption of licensed medical practitioner and patients. The most difficult task is patient's health issues keying out and unriddling. This is due to weak force and misfortunate mobility of the existing healthcare systems. We propose an IOT based Remote patient's observatory System using Biomedical Sensor. The biomedical component is inclusive of Temperature Sensor, Heart rate sensors and BP sensors. Here in this work a more proficient machine to machine correspondence is accomplished for medicinal services data. This proposed individuals driven detecting framework is proficient in taking care of the issues looked by patients and doctor by checking human exercises and cooperating with the living condition. In this work, three parameter viz., heart beat rate, temperature and Blood Pressure are checked and transmitted. The medicinal services framework setup is mimicked utilizing Visual Studio programming, and the parameters are seen by remote wellbeing application tolerant observing screen.

Background: cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: we conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. Results: we analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure; contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92; 95% confidence interval (CI), 2.12–4.02; PConclusions: a significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.

This chapter offers some important conceptual and theoretical background information regarding entrepreneurship education. It provides a definition of entrepreneurship education and a historical context of the growth of entrepreneurship education. The chapter explains how entrepreneurship education differs from traditional business education. It distinguishes between two major types of entrepreneurship education courses - small business management courses and new venture courses. The chapter provides an overview of learning theories relevant to entrepreneurship. It presents a brief discussion about the impact of entrepreneurship education. The chapter provides the state of the art in United States entrepreneurship education and best practices based on the 2014 National Survey of Entrepreneurship Education. Social entrepreneurship is playing a bigger role in venture success, with many millennials giving increased attention and value to the social causes behind businesses. The chapter concludes with a view of future directions and areas of improvement in entrepreneurship education.