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Purpose This paper aims to shed some light on the history of the Chinese videogames industry, to document the growth of the leading companies and reveal how they have been morphing into platforms delivering constellations of apps and digital content (audiovisual, films, music, literature, video streaming […]). The paper tracks the development of digital services through the prism of videogames thereby showing how this industry emerged out of the deployment of the internet. Design/methodology/approach The paper provides an overview and a synthesis of what is known about the Chinese game industry, particularly based on consultancy documents and publications from firms. The paper is based on desk research, a review of literature and trade press and the analysis of the annual reports of the leading players (NetEase, Tencent […]). Findings The rise of videogames and the creation of specific company’s “ecosystems” illustrate the capacity of the industry to innovate and its significance for the Chinese economy. It reveals that gaming has been a cornerstone of many Chinese technology companies. The (young) companies came up with the innovative business models (FTP, virtual items) that were required to further expand the market. They found new ways to interact with their customers through communities and various tools. Research limitations/implications The paper relies on consultancy documents and publications from firms on heterogeneous data from industry and consultants. This approach comes with some limitations from a methodological viewpoint. It allows documenting the historical trends and describing the industrial landscape but not to qualify the relationships among players. Besides, the use of these sources leads to a greater focus on business models and a more limited one on the policy dimension. The latter is often perceived only through the glasses of the companies. Practical implications The data provided are meant to be useful to become familiar with the Chinese games industry. Social implications The paper indicates that the online game industry is a complex web of activities with tensions and contradictions between stakeholders (industry, government and consumers). In the case of China, there is a conflict between the willingness to liberalize the economy and the will to maintain an ideological monopoly through cultural industries. Originality/value Little research has been devoted to the role of videogames in emerging economies, to its specific features and to the relationships with the media industry and the information and communications technology sector. The contribution of this “digital native” to the production and distribution of digital content remains less studied. The paper provides an up-to-date overview of the Chinese case.

Background: In locally advanced head-and-neck cancers (HNCs), definitive chemoradiation therapy has emerged as the treatment of choice due to the benefit of organ preservation. Radiation therapy is known to cause significant acute and late toxicities when it is used at radical doses. Studies have shown that more severe toxicities such as mucositis were observed in patients who received radiation therapy with concurrent chemotherapy. Incidental radiation exposure to buccal mucosa during radiation therapy for HNCs contributed to acute radiation-induced oral mucositis (RIOM). Objective: The objective of the study was to dosimetrically evaluate the dose received by buccal mucosa in patients with HNC patients undergoing sequential intensity-modulated radiotherapy technique (SEQ-IMRT) and simultaneous integrated boost intensity-modulated radiotherapy technique (SIB-IMRT). Materials and Methods: Forty patients with histologically proven squamous cell carcinoma of head and neck excluding nasopharyngeal and oral cavity cancers, who received radical chemoradiation therapy by SEQ-IMRT or SIB-IMRT were retrospectively analyzed. The total prescribed dose to the planning target volume was 70 Gy delivered in 2 Gy daily fractions in SEQ-IMRT and 66 Gy in 30 fractions in SIB-IMRT. All patients received concurrent weekly injection cisplatin (35 mg/m2). Dosimetric parameters of right and left buccal mucosa (V 15 Gy, V 30 Gy, and V 45 Gy) were recorded and correlated with grades of RIOM and weight loss as per CTCAE v5.0. Results: Mucositis and weight loss were accessed from week 1 to 7 in the SEQ-IMRT arm and week 1–6 for SIB-IMRT arm. Grade 3 mucositis was observed among 2 patients (10%) and 3 (15%) patients in the SIB-IMRT and none in SEQ-IMRT arm. Grade 2 Weight loss was observed among 35% of patients in SIB-IMRT arm and 5% patients in SEQ-IMRT arm. Conclusion: This study assessed the occurrence of several RIOM as predictive factor with respect to dose received to buccal mucosa in HNC patients, except nasopharyngeal and oral cavity cancer. Our data demonstrated relationship between V30 Gy of buccal mucosa and oral mucosal toxicity with associated weight loss in patients with HNCs undergoing radical chemoradiation therapy.

SummaryThe pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeutic option in patients with severe heart or lung failure. Although only a limited proportion of COVID-19 patients develop respiratory or circulatory failure that is refractory to conventional treatment, it is of utmost importance to clearly define criteria for the use of ECMO in this steadily growing patient population. The ECMO working group of the Medical University of Vienna has established the following recommendations for ECMO support in COVID-19 patients.

Zusammenfassung Die aktuelle COVID-19-Pandemie, die durch das SARS-CoV‑2 ausgelöst wird, hat bereits in vielen betroffenen Ländern zu gravierenden Ressourcenengpässen der jeweiligen Gesundheitssysteme geführt. Obwohl sehr viele COVID-19-Patienten nur moderate Symptome zeigen, entwickelt eine Subgruppe ein schweres respiratorisches oder auch kardiales Versagen. Die extrakorporale Membranoxygenierung (ECMO) stellt eine wertvolle Therapieoption für Patienten mit therapierefraktärem Lungen- oder Herzversagen dar. Es bedarf klarer Empfehlungen, die den ECMO-Einsatz in dieser zahlenmäßig stetig steigenden Patientenpopulation regeln. Die ECMO-Arbeitsgruppe der Medizinischen Universität Wien hat daher die folgenden Empfehlungen für eine ECMO-Unterstützung bei COVID-19-Patienten formuliert.

Purpose This paper aims to provide a synthesis of the evolution of the global internet markets through an assessment of their economic strength. It is an attempt to describe the various segments of the internet value chain and the evolution of the markets. It aims at briefly summing up the very dynamics of the sector, of the various subsectors while looking at the business models and the market capitalization. Design/methodology/approach The paper is a descriptive paper, presenting market trends, based on desk research and trade press. It is not meant to provide any theoretical contribution but attempting to reconstruct the views from the industry as documented by trade literature. Hence, the paper relies mostly on industry and consultancy data. The paper builds on a database collected by the author over the past 30 years and the selection of the relevant data to document and identify the trends and offer a synthesis of the views of the industry. Findings The paper shows how over the past 30 years the internet has changed dramatically from both a quantitative (reaching more and more users worldwide and witnessing a dramatic growth of all markets) and qualitative (offering an array of innovative products and services enabled by the deployment of new networks) and the availability of new devices. The paper reveals how each technological wave ushered in a series of innovation and new services, boosted the foundation and the growth of pioneering companies. Research limitations/implications Taking into account the lack of official data, the industry data used should be treated as just signals of potential trends, but sufficient to give an overview of the evolution of the global internet markets. Furthermore, detailed studies should complement this descriptive approach. The approach does have obvious methodological and theoretical limits, not providing a robust methodological framework just offering a reconstruction of the trends as documented by the trade publications. However, it concludes highlighting some of the tensions and contradictions. Practical implications The paper closes with a summary of the main transformations and considers some future developments. The paper draws some lessons from some failures and from the strategies of firms. Social implications The paper hints at the way users developed “unique” behaviors using social media, taking advantage of the new opportunities to exchange with others. The paper hints at some regulatory issues and challenges. Originality/value The paper briefly sums up the very dynamics of the global internet market(s). It attempts to characterize some of the main features of their evolution and of the main segments. If offers a comprehensive overview of available data.

OBJECTIVES: Little is known about the epidemiology of ventilator-acquired pneumonia among coronavirus disease 2019 patients such as incidence or etiological agents. Some studies suggest a higher risk of ventilator-associated pneumonia in this specific population. DESIGN: Cohort exposed/nonexposed study among the REA-REZO surveillance network. SETTING: Multicentric; ICUs in France. PATIENTS: The coronavirus disease 2019 patients at admission were matched on the age, sex, center of inclusion, presence of antimicrobial therapy at admission, patient provenance, time from ICU admission to mechanical ventilation, and Simplified Acute Physiology Score II at admission to the patients included between 2016 and 2019 within the same surveillance network (1:1). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The overall incidence of ventilator-associated pneumonia, the cumulative incidence, and hazard rate of the first and the second ventilator-associated pneumonia were estimated. In addition, the ventilator-associated pneumonia microbiological ecology and specific resistant pattern in coronavirus disease 2019 exposed and nonexposed patients were compared. Medication data were not collected. A total of 1,879 patients were included in each group. The overall incidence of ventilator-associated pneumonia was higher among coronavirus disease 2019 exposed patients (25.5; 95% CI [23.7-27.45] vs 15.4; 95% CI [13.7-17.3] ventilator-associated pneumonia per 1,000 ventilation days). The cumulative incidence was higher for the first and the second ventilator-associated pneumonia among the coronavirus disease 2019 exposed patients (respective Gray test p < 0.0001 and 0.0167). The microbiological ecology and resistance were comparable between groups with a predominance of Enterobacterales and nonfermenting Gram-negative bacteria. The documented resistance pattern was similar between groups, except for a lower rate of methicillin-resistant Staphylococcus aureus in the coronavirus disease 2019 exposed patient (6% vs 23%; p = 0.013). CONCLUSIONS: There was a higher incidence of ventilator-associated pneumonia occurring among coronavirus disease 2019 patient compared with the general ICU population, with a similar microbiological ecology and resistance pattern.

Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.

Background The choice of aortic valve replacement needs to be decided in an interdisciplinary approach and together with the patients and their families regarding the need for re-operation and risks accompanying anticoagulation. We report long-term outcomes after different AVR options. Methods A chart review of patients aged Results From May 1985 to April 2020 fifty-five patients received sixty AVRs: 33 mechanical AVRs and 27 biological AVRs. In over half of the fifty-three AVRs performed after 1991 (58.5%; 31/53) a contraindication for Ross procedure was present. Early mortality was 5% (3/60). All early deaths occurred in patients aged p Conclusions Re-operation was less frequent in the mechanical AVR cohort than in the biological AVR cohort. For mechanical AVR, the risk for thromboembolic and bleeding events was considerable with a composite linearized event rate per valve-year of 3.2%.

Aims/hypothesis Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction could lead to timely intervention and better outcomes. Genetic information can be used to enable early detection of risk. Methods We developed a multi-polygenic risk score (multiPRS) that combines ten weighted PRSs (10 wPRS) composed of 598 SNPs associated with main risk factors and outcomes of type 2 diabetes, derived from summary statistics data of genome-wide association studies. The 10 wPRS, first principal component of ethnicity, sex, age at onset and diabetes duration were included into one logistic regression model to predict micro- and macrovascular outcomes in 4098 participants in the ADVANCE study and 17,604 individuals with type 2 diabetes in the UK Biobank study. Results The model showed a similar predictive performance for cardiovascular and renal complications in different cohorts. It identified the top 30% of ADVANCE participants with a mean of 3.1-fold increased risk of major micro- and macrovascular events (p = 6.3 × 10−21 and p = 9.6 × 10−31, respectively) and a 4.4-fold (p = 6.8 × 10−33) higher risk of cardiovascular death. While in ADVANCE overall, combined intensive blood pressure and glucose control decreased cardiovascular death by 24%, the model identified a high-risk group in whom it decreased the mortality rate by 47%, and a low-risk group in whom it had no discernible effect. High-risk individuals had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. Conclusions/interpretation This novel multiPRS model stratified individuals with type 2 diabetes according to risk of complications and helped to target earlier those who would receive greater benefit from intensive therapy. Graphical abstract

Polycytemia vera (PV) is a rare myeloproliferative neoplasm associated with microcirculatory disturbances, thrombosis and bleeding. Patients suffering from PV have a high risk of perioperative adverse events, but the literature regarding on‐pump procedures in PV patients is scarce. We report two cases of acute and severe oxygenator failure during cardiopulmonary bypass and present valid exit scenarios.

PurposeThis paper aims to clarify the notion of artificial intelligence (AI), reviewing the present scope of the phenomenon through its main applications. It aims at describing the various applications while assessing the markets, highlighting some of the leading industrial sectors in the field. Therefore, it identifies pioneering companies and the geographical distribution of AI companies.Design/methodology/approachThe paper builds upon an in-depth investigation of public initiatives focusing mostly on the EU. It is based on desk research, a comprehensive review of the main grey and scientific literature in this field.FindingsThe paper notes that there is no real consensus on any definition for this umbrella term, that the definition does fluctuate over time but highlights some of the main changes and advances that took place over the past 60 years. It stresses that, in spite of the hype, on both the business and consumer sides, the demand appears uncertain. The scope of the announced disruptions is not easy to assess, technological innovation associated with AI may be modest or take some time to be fully deployed. However, some companies and regions are leading already in the field.Research limitations/implicationsThe paper, based on desk research, does not consider any expert opinions. Besides, the scientific literature on the phenomenon is still scarce (but not the technical one in the specific research sectors of AI). Most of the data come from consultancies or government publications which may introduce some bias, although the paper gathered various, often conflicting viewpoints.Originality/valueThe paper gives a thorough review of the available literature (consultancies, governments) stressing the limitations of the available research on economic and social aspects. It aims at providing a comprehensive overview of the major trends in the field. It gives a global overview of companies and regions.

Objective: Recent data suggest that the incidence of Type II diabetes mellitus (DM2) is on a rise and is a major cause for health-care costs, morbidity and mortality. The major problem with DM II is the secondary complications such as retinopathy, nephropathy, diabetic foot disease, cardiovascular complications and neuropathy which severely hamper the afflicted individual's resources and quality of life (QOL). In the present study, we have attempted at understanding the QOL using the QOL instrument for Indian diabetic patients (QOLID). Aim: The principal objective of the study is to ascertain the QOL is DM II with and without complications in patients visiting a hospital on an outpatient basis. The QOLID is of advantage herewith as the eight domains address all relevant aspects afflicting the QOL of the patients. Materials and Methods: Depending on the complications and prevalence, we included six groups; diabetics without complications (Group I, n = 89), retinopathy (Group II, n = 72), nephropathy (Group III, n = 53), diabetic foot disease (Group IV, n = 86), cardiovascular complications (Group V, n = 25) and neuropathy (Group VI, n = 57). The demographic information, diabetes history, medication and QOLID were collected using a structured questionnaire. The collected data were analysed using the analysis of variance followed by Bonferroni post-multiple comparison test. A value of P < 0.05 was considered statistically significant. Results: In this study, 238 (62.3%) males and 144 (37.7%) females with a mean age of 58.5 years. The overall QOLID score was the highest (126.60 ± 18.54) in Group I and least (59.67 ± 13.4) in Group III. Role limitation due to physical health, physical endurance, financial worries, diet satisfaction and the overall score were lower among the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant. General health, treatment satisfaction, symptom botherness and emotional/mental health scored lower in the groups with diabetic complications (Groups II–VI) compared to Group I and this was statistically significant in all except with diabetic retinopathy. Conclusion: When compared to people without any complications, patients with complications had reduced QOL. Individuals with diabetic neuropathy and nephropathy had very reduced QOL compared to other diabetic complications. Prevention or delay of onset of complications through better management of diabetes may help improve the QOL.

Nano-scaled thermoelectric materials attract significant interest due to their improved physical properties as compared to bulk materials. Well-shaped nanoparticles such as nano-bars and nano-cubes were observed in the known thermoelectric material PbTe. Their extended two-dimensional nano-layer arrangements form directly in situ through electron-beam treatment in the transmission electron microscope. The experiments show the atomistic depletion mechanism of the initial crystal and the recrystallization of PbTe nanoparticles out of the microparticles due to the local atomic-scale transport via the gas phase beyond a threshold current density of the beam.

Abstract: In the treatment of cancer, the use of ionizing radiation is an important modality. However, on the downside, radiation, when used for curative purposes, causes acute dermatitis or radiodermatitis at the site of radiation in most individuals. From a clinical viewpoint, severe dermatitis causes a burning and itching sensation is very painful and severely affects the quality of life of the individual undergoing treatment. In worse situations, acute radiation dermatitis can cause gaps or breaks in the planned treatment and this can adversely affect the treatment objective and outcome. Background: In various traditional and folk systems of medicine, plants and plant products have been used since time immemorial for treating various skin ailments. Further, many cosmeceutical creams formulated based on knowledge from ethnomedicinal use are marketed and used to treat various ailments. In the current review, an attempt is made at summarizing the beneficial effects of some plants and plant products in mitigating acute radiation dermatitis in humans undergoing curative radiotherapy. Additionally, emphasis is also placed on the mechanisms responsible for the beneficial effects. Objective: The objective of this review is to summarize the clinical observations on the prevention of radiodermatitis by plant products. In this review, the protective effects of Adlay (Coix lachryma-jobi L.) bran extract, Aloe vera, Calendula officinalis, Cucumis sativus, green tea constituent the epigallocatechin-3-gallate, honey, Achillea millefolium, Matricaria chamomilla, olive oil, and some polyherbal creams are addressed by also focusing on the mechanism of action for the beneficial effects. Methods: Two authors’ data mined for information in Google Scholar, PubMed, Embase, and the Cochrane Library for publications in the field from 1901 up to July 2020. The focus was on acute radiation dermatitis, ionizing radiation, curative radiotherapy, human cancer. The articles were collected and analyzed. Results: For the first time, this review addresses the usefulness of natural products like adlay bran, Aloe vera, Calendula officinalis, Cucumis sativus, green tea constituent the epigallocatechin-3-gallate, honey, Achillea millefolium, Matricaria chamomilla, olive oil, and some experimentally constituted and commercially available polyherbal creams as skincare agents against the deleterious effects of ionizing radiation on the skin. The protective effects are possibly due to the free radical scavenging, antioxidant, anti-inflammatory, wound healing and skin protective effects. Conclusion: The authors suggest that these plants have been used since antiquity as medicinal agents and require in-depth investigation with both clinical and preclinical validated models of study. The results of these studies will be extremely useful to cancer patients requiring curative radiotherapy, the dermatology fraternity, agro-based and pharmaceutical sectors at large.

Abstract: Ionising radiation has been an important modality in cancer treatment and its value is immense when surgical intervention is risky or might debilitate/adversely affect the patient. However, the beneficial effect of radiation modality is negated by the damage to the adjacent healthy tissue in the field of radiation. Under these situations, the use of radioprotective compounds that can selectively protect normal tissues against radiation injury is considered very useful. However, research spanning over half a century has shown that there are no ideal radioprotectors available. The United States Food and Drug Administration (FDA or USFDA) approved amifostine, or WR-2721 (Walter Reed-2721) [chemically S-2-(3-aminopropyl-amino) ethyl phosphorothioic acid] is toxic at their optimal concentrations. This has necessitated the need for agents that are safe and easily acceptable to humans. Background: Dietary agents with beneficial effects like free radical scavenging, antioxidant and immunomodulatory effects are being recognized as useful and have been investigated for their radioprotective properties. Studies in these lines have shown that the fruits of Aegle marmelos (stone apple or bael), Emblica officinalis or Phyllanthus emblica (Indian gooseberry/amla), Eugenia jambolana or Syzygium jambolana (black plum/jamun), Mangifera indica (mango) and Grewia asiatica (phalsa or falsa) that are originally reported to be indigenous to India have been investigated for their usefulness as radioprotective agents. Objective: The objective of this review is to summarize the beneficial effects of the Indian indigenous fruits, stone apple, mango, Indian gooseberry, black plum, and phalsa, in mitigating radiation-induced side effects, emphasize the underlying mechanism of action for the beneficial effects and address aspects that merit detail investigations for these fruits to move towards clinical application in the near future. Methods: The authors data-mined Google Scholar, PubMed, Embase, and the Cochrane Library for publications in the field from 1981 up to July 2020. The focus was on the radioprotection and the mechanism responsible for the beneficial effects, and accordingly, the articles were collated and analyzed. Results: This article emphasizes the usefulness of stone apple, mango, Indian gooseberry, black plum, and phalsa as radioprotective agents. From a mechanistic view, reports are suggestive that the beneficial effects are mediated by triggering free radical scavenging, antioxidant, anti-mutagenic and anti-inflammatory effects. Conclusion: For the first time, this review addresses the beneficial effects of mango, Indian gooseberry, black plum, stone apple and phalsa as radioprotective agents. The authors suggest that future studies should be directed at understanding the selective radioprotective effects with tumor-bearing laboratory animals to understand their usefulness as radioprotective drug/s during radiotherapy and as a food supplement to protect people from getting exposed to low doses of radiation in occupational settings. Phase I clinical trial studies are also required to ascertain the optimal dose and the schedule to be followed with the standardized extract of these fruits. The most important aspect is that these fruits, being a part of the diet, have been consumed since the beginning of mankind, are non-toxic, possess diverse medicinal properties, have easy acceptability, all of which will help take research forward and be of benefit to patients, occupational workers, agro-based sectors and pharma industries.

OBJECTIVES The Ross procedure is an attractive option for the management of aortic valve disease in paediatric patients. We reviewed our experience with the paediatric Ross procedure to determine survival and freedom from reoperation in the third decade after surgery. METHODS We reviewed the data of 124 paediatric patients [71% male, median age at time of surgery 11.1 years (interquartile range 6–14.8 years); 63.7% bicuspid aortic valve], who underwent the Ross procedure at 2 tertiary centres from April 1991 to April 2020. The Ross-Konno procedures were performed on 14 (11.3%) patients. Deaths were cross-checked with the national health insurance database, and survival status was available for 96.8% of the patients. The median follow-up time was 12.1 years (interquartile range 3–18 years). RESULTS There were 3 early and 6 late deaths. All early deaths occurred in patients aged CONCLUSIONS The Ross and the Ross-Konno procedures are associated with good outcomes in paediatric patients. Reoperation of the RVOT is frequent and associated with younger age.

Background: In the treatment of head and neck cancer (HNC), ionizing radiation is an important modality in achieving curative objectives. However, the effective use of radiation is compromised by the side effects resulting from the damage to the adjacent normal tissue. Preclinical studies carried out in the recent past have shown that the age-old dietary agent honey, which also possesses myriad medicinal use, is beneficial for mitigating diverse radiation-induced side effects like mucositis, xerostomia, fatigue, weight loss and promoting healing of refractory wounds. Objective: The objective of this memoir is to review the beneficial effects of honey in mitigating radiation-induced side effects in HNC and to emphasize on the underlying mechanisms of action for inducing the beneficial effects. Methods: Two authors searched Google Scholar, PubMed, Embase, and the Cochrane Library for publications up to December 2019 to assess the capability of honey for reducing the severity of radiation-induced ill effects in the treatment of HNC. Subsequently, the adjunct pharmacological effects and mechanism/s responsible were also searched for and appropriately used to substantiate the underlying mechanism/s of action for the beneficial effects. Results: The existing data is suggestive that honey is beneficial in mitigating the radiation-induced mucositis, xerostomia, amd healing of recalcitrant wounds in radiation-exposed regions, and that the multiple pathways mediate the beneficial effects, especially free radical scavenging, antioxidant, wound healing, anticancer, analgesic, anti-inflammatory, anabolic, anti-fatigue and anti-anaemic effects that add additional value to the use of honey as an adjunct in cancer therapy. Conclusion: For the first time, this review addresses the underlying pharmacological related to the beneficial effects of honey in radiation-induced damage, and attempts at emphasizing the lacunae that need further studies for optimizing the use of honey as an adjunct in radiotherapy of HNC. The authors suggest that future studies should be directed at understanding the detailed molecular mechanisms responsible for the beneficial effects using validated cell culture and animal models of study. Large multicentric clinical trials with standardised honey also needed to understand the clinical use of honey.

Mid-infrared (MIR) solid state lasers based on thulium and holmium-doped crystals are of increasing interest in applications in medicine, material processing and particle physics. Thulium-doped lasers can be efficiently pumped at wavelengths around 780 nm and diode laser pumps with high conversion efficiency and high intensity are sought at this wavelength. Diode lasers integrated in laser stacks suitable for high duty cycle pumping are of particular interest for high energy class applications, especially when realizable without need for the additional cost and reliability hazard of microchannel cooling. However, high efficiency and reliable power is more challenging to realize at 780 nm than around 940…980 nm, due to limitations on the capability of the available semiconductor materials. Progress is therefore presented here in the design, realization and test of 780 nm pump sources suitable for high energy class pump applications, using GaAs-based TM-polarized diode lasers. We show how power per device can be increased from 4 W for conventional single emitters (90…100 μm) up to 60 W at high duty cycle (10%) and long pulse length (10 ms) for high brightness large aperture emitters (with 1200 μm aperture, equivalent to around 500 W per bar), at the cost of reduced operating efficiency (from 60 to 50%). We show progress in integrating these large aperture emitters into novel passively (macro-channel) edge-cooled stacks, that are then suitable for use in pumping high energy class Th:YAG laser systems.

Previous exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinical presentation of circulating IgG antibodies against heparin/platelet factor 4 complexes and heparin/protamine complexes after cardiac surgery. Ensuing purpura and skin necrosis (blisters) at the injection sites of LMWH and clinical symptoms improved rapidly after replacement of LMWH by an alternative anticoagulant. The aim of this report is to draw attention to the several different clinical manifestations of heparin- and/or protamine-induced thrombocytopenia and shows a possible course of treatment and recovery.

Purpose This paper aims to shed some light on the role of video games within the media industry and IT sector, on its contribution to the production and distribution of digital content in emerging economies. It offers a case study on the role of mobile devices as a factor of transformation and shows how under changing socio–economic conditions, the transformations enabled the creation of digital ecosystems and innovative business models. Design/methodology/approach The paper is based on desk research, a review of literature and trade press and comments from experts and industry players. Findings The paper argues that as the internet is going mobile, driven by data – mostly video – the new mobile platforms are becoming the key for the distribution of content and mobile games. Whether it is the history of browser games in China, mobile games in India or PC games in Russia, each national gaming industry has required a unique strategy for making money, building on some prominent cultural factors and adapting to the local economic conditions. The paper reveals that video games are now clearly a vital part of digital content production in these countries, while stressing upon the role of public policies. Research limitations/implications The paper relies mostly on industry and consultancy data, as in such a fast-changing environment official data even when accessible are in most cases too old to remain relevant to identify the trends and the fast changing stakes. This calls for some caution about the data. Therefore, the data used should be treated as just signals of potential trends, sufficient to provide an appropriate overview of the evolution of the global mobile ecosystem. Practical implications This paper shows that the video games industry can serve as a pivot for the ICT industry. Besides, this prompts upstream and downstream industries of the entire digital entertainment market to thrive. Social implications The paper shows that companies from emerging markets companies have been betting on a combination of factors: the development of the economies, the growth of the mobile market, emerging middle-classes and young customers. It provides a growth model that appears to be close to a “regular” industrial growth model. Originality/value Although there is a growing academic literature on the video games industry, few research have been devoted to specific issues of emerging economies and to the role of video games within the media industry and IT sector.

Type 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction can lead to timely intervention and better outcomes. Through summary statistics of meta-analyses of published genome-wide association studies performed in over 1.2 million of individuals, we combined 9 PRS gathering genomic variants associated to cardiovascular and renal diseases and their key risk factors into one logistic regression model, to predict micro- and macrovascular endpoints of diabetes. Its clinical utility in predicting complications of diabetes was tested in 4098 participants with diabetes of the ADVANCE trial followed during a period of 10 years and replicated it in three independent non-trial cohorts. The prediction model adjusted for ethnicity, sex, age at onset and diabetes duration, identified the top 30% of ADVANCE participants at 3.1-fold increased risk of major micro- and macrovascular events (p=6.3×10−21 and p=9.6×10−31, respectively) and at 4.4-fold (p=6.8×10−33) increased risk of cardiovascular death compared to the remainder of T2D subjects. While in ADVANCE overall, combined intensive therapy of blood pressure and glycaemia decreased cardiovascular mortality by 24%, the prediction model identified a high-risk group in whom this therapy decreased mortality by 47%, and a low risk group in whom the therapy had no discernable effect. Patients with high PRS had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. This novel polygenic prediction model identified people with diabetes at low and high risk of complications and improved targeting those at greater benefit from intensive therapy while avoiding unnecessary intensification in low-risk subjects.

Background: The Polyskope 1.0 Multiplex Assay is a novel test to simultaneously detect Escherichia coli O157, non-O157 Shiga Toxin-Producing E. coli (STEC), Listeria monocytogenes, and Salmonella species in a single enrichment using real-time PCR. Objective: A Performance Tested MethodSM study was conducted to validate Polyskope 1.0 for inclusivity and exclusivity as well as a matrix comparison study. Method: This assay was evaluated in an unpaired independent validation study compared with reference methods according to AOAC INTERNATIONAL validation guidelines. Polyskope 1.0 evaluated raw ground beef (25 g), deli turkey (25 g), baby spinach (25 g), and stainless-steel environmental surface sponges (4 × 4 in. test area) after inoculation with a suspension of the three target microorganisms. All matrices were compared with appropriate reference methods from the U.S. Food and Drug Administration Bacteriological Analytical Manual, U.S. Department of Agriculture Food Safety and Inspection Service Microbiology Laboratory Guidebook, or International Organization for Standardization standards. Results: Polyskope 1.0 demonstrated no statistically significant differences between candidate and reference method results or between presumptive and confirmed results for three food matrices and one environmental surface. Results from inclusivity and exclusivity evaluations indicated the test method can accurately detect the target analytes and excluded all nontarget organisms. No differences were observed with the stability or lot-to-lot evaluations. Polyskope 1.0 demonstrated robustness by remaining unaffected by small variations in method parameters, which had no statistically significant effect on the results for all eight variations. Conclusions and Highlights: Polyskope 1.0 was shown to be a specific, highly accurate, and robust method for the detection of Listeria monocytogenes, Salmonella species, non-O157 STECs, and E. coli O157 across four matrices.

Purpose The paper aims at dealing with the role of users in the creation (or curation) and distribution of digital contents. User generated contents (UGCs) refer to a variety of media such as Wikis, question-answer databases, digital video, blogging, podcasting, forums, review sites, social networking, social media and mobile phone photograph. It attempts assessing their potential role as co-innovators. The paper follows the progressive creation of a new space for users, tracking its specific forms in each subsector of the media and content industries. Each subsector reveals a disruption in the production and circulation of new content. Design/methodology/approach The paper is based on desk research, a review of literature, review of the technical journals, and analysis of annual reports. The paper is part of an on-going research project on media and content industries. Findings The paper argued that since 2007 (release of iPhone and Kindle) the landscape went through a dramatic change, scaling up. It illustrates how the entire value chain of content (production/distribution/consumption) has opened up. The amount of UGC produced triggered a qualitative jump, ushering in new modes of interaction between the customers and creators, without necessarily turning the consumer into a full-fledge producer. The UGC model adds another source of production, thereby increasing diversity, ushering in new ways for talent scouting. It reveals various forms of co-creation and the role of a community model while also showing its limits. Research limitations/implications This paper concentrates on digital media and does not deal with any other aspect such as knowledge sharing (Wikis). The paper does not cover the reactions of traditional industry players to UGC (some elements are given for newspaper), neither possible policy and regulatory responses The paper relies mostly on reports from news agencies, consultancies or annual reports from companies so as to delineate the main trends. Practical implications It shows that the role of customers did change within this context. The new channels offer novel ways to produce, curate and disseminate contents. It offers a range of examples from different industries. Social implications The paper documents the participation of consumers in the production of content. it hints at the evolution of labour, alludes to the issue of diversity and of creativity, but does not address other societal issues. Originality/value Some reports were devoted to UGC in 2007 (OECD) and 2008 (Idate-IVIR-TNO) but in spite of the major changes that took place over the past decade, the research has been scarce, or has concentrated on a specific segment of the media industry. The paper is trying to offer a comprehensive overview of the various segments. Each sub-segment of the media industry illustrates a specific dimension.

Purpose The purpose of this paper is to provide an interpretative framework for the high market capitalisation companies (unicorns) universe, especially with the deployment of the mobile internet. The paper attempts to account for this global trend and to describe its global setting (global data), and its various components. Design/methodology/approach This paper originates from a research meant to document the phenomenon of high market capitalisation companies (unicorns) through the investigation of a qualitative sample of companies. The paper is based on desk research, a review of literature, review of the technical journals and analysis of annual reports. Going beyond the observations gathered from the sample, the research found that the transformations of the mobile communications ecosystem could provide an adequate framework to understand and put in perspective this phenomenon. Findings The paper defined unicorns as information technology (IT)-based (software mostly but hardware as well) start-ups that bridge pent-up demand and supply through innovative services and products mostly rooted in the mobile internet wave and the opportunities it brings along. The paper shows that smartphones as games changers facilitate the entry of new players in the mobile markets coming either from the IT sector or from Asia, much to the detriment of the European Union (EU) industry grappling with legacy business models. These companies derived the most from a mobile-first approach and have an outstanding number of unicorns. The paper identifies a potential telecom policy failure especially in the EU: policies have been tilted towards the supply side, without enough consideration of demand. The paper suggests that the EU, after having lead the previous wave, may have missed the last one (mobile broadband) not only from a policy but also from an industry viewpoint. Research limitations/implications More research should be done to better investigate what might have been the causes of this apparently missed mobile turn in Europe. The paper deals mostly with the cases of Asia and the USA. As the paper concentrates on the issue of unicorns and mobile technology, some other aspects of the mobile markets may not be taken into account. Practical implications The paper suggests reconsidering some policies in the field, to better take into account the role of consumers and to improve the link with other policies like innovation policies. Social implications The paper attempts at giving a better understanding of the evolution of demand and its role in the making of some new services. The paper does not deal with other societal issues like privacy or data. Originality/value The main assumption about the role of the mobile internet can shed some light not only about related developments such as the app economy but also about the business and technological environment of an array of start-ups, some of them having reached impressive market capitalisation. The paper reveals how this mobile wave is reshuffling companies, sectors, and geographies. The paper provides one of the first analysis of the unicorn phenomenon.

Background and Objectives: Snakebite is a common medical emergency requiring immediate medical attention. This study was conducted to understand snakebite cases, with particular attention given to where the lacunae lie in current management so that remedial steps may be undertaken. Materials and Methods: This was a cross-sectional, descriptive study and was carried out in Davangere, Karnataka, India. Snakebite cases (729) were included in the study and all the victims were interviewed using a prestructured questionnaire. Victims were evaluated for the nature of bites, first aid measures, treatment modalities, and treatment outcome. Results: The majority of the snakebite victims were from villages, were farmers, and belonged to the 20-40 years age group. Viper bites were the most frequently reported, and an overwhelming number of victims resorted to first aid measures with tourniquet application at the site. Most victims reached a peripheral health institution (PHI) first following the bite, and a small fraction received only one vial of anti-snake venom (ASV). The longest referral pathway to a tertiary hospital was as follows: Bite-traditional healer- primary health center (PHC)-tertiary hospital; fatality was 2%. Most victims had signs of envenomation and received ASV, of whom 32% administered with ASV had developed hypersensitivity reaction. Conclusion: This study showed that PHCs were inadequate in terms of providing optimal treatment and that measures are needed to upgrade these facilities.

BACKGROUND: Welding work is considered to be an occupational hazard and welders are exposed to a range of metal fumes that are toxic to the blood system. Regular inhalation of the welding toxic fumes alters the hematological, antioxidant, and trace element levels and therefore an attempt is made at understanding these changes in the welders. AIM OF THE WORK: In this case–control study, an attempt is made at understanding the general health, hematological, antioxidant, and trace elements status of welders by comparing with age-matched office workers from the same area. MATERIALS AND METHODS: This was a purposive, case–control prospective study and was carried out in healthy volunteers devoid of any chronic or acute systemic ailments in Mangalore, India. The sociodemographic details were collected in a structured questionnaire, while a detailed clinical examination was carried out by the senior clinicians. The blood collected as per the standard laboratory procedure was analyzed for hematological parameters, antioxidant, and trace elements status. The data were subjected to frequency, percentage, and analyzed using the unpaired ttest. P < 0.05 was considered statistically significant. RESULTS: The results suggest that when compared to the controls, the welders showed significantly lower neutrophil count (53.45 ± 6.11 vs. 46.68 ± 6.12; P = 0.0003) and platelet count (267409.1 ± 42329.4 vs. 199142.9 ± 73735.1; P = 0.0002), and significantly higher counts of eosinophils (5.86 ± 4.12 vs. 9.86 ± 2.76; P = 0.0004) and monocytes (2.45 ± 1.63 vs. 4.89 ± 1.17; P < 0.0001). The levels of lipid peroxidation were high (225.73 ± 56.88 vs. 255.82 ± 30.26; P = 0.04), whereas total antioxidant capacity was less (3.00 ± 0.91 vs. 2.16 ± 1.04; P = 0.004) in the welders. When compared to controls, the serum iron (84.09 ± 6.18 vs. 94.46 ± 8.44; P ≤ 0.0001), copper (104.68 ± 40.63 vs. 148.93 ± 34.18; P = 0.0002), and lead (8.53 ± 5.49 vs. 14.18 ± 8.05; P = 0.005) were all significantly high in welders. There was no significant difference in the serum zinc and glutathione levels between the controls and welders. CONCLUSIONS: The results of the study indicate that occupational exposure to welding fumes among welders disturbs the homeostasis of trace elements in systemic circulation and induces oxidative stress.

Background: Lactate dehydrogenase (LDH) is an important enzyme and is recently being investigated in various orodental pathologies. The present study was carried out to investigate whether there is any correlation between LDH with the various histopathological gradings. Materials and Methods: Saliva was collected between 9 and 10 AM from patients of head and neck cancers (HNCs). Concomitantly, saliva was also collected from age matched healthy volunteers for comparing the results of the study population. Saliva collected from both the cohorts were processed and evaluated for LDH levels using standard kit. The data were analyzed using analysis of variance and with Bonferroni multiple comparison. A value of P < 0.05 was considered statistically significant. Results: The results indicate that when compared to the healthy individuals, a significant increase was observed in the salivary LDH of cancer patients (280.55 ± 17.48 vs. 353.58 ± 30.19; P < 0.001). A significant difference was also observed with differentiation, size, nodal status and metastasis (P < 0.0001). Conclusions: The results indicate that salivary LDH is helpful as an adjunct to the standard histopathological grading in the diagnosis and prognosis of HNCs.

Background Few reports have described associations between a bleeding revision and outcomes after implantation of a continuous-flow left ventricular assist device (LVAD). Methods We retrospectively analyzed all adult recipients of a continuous-flow LVAD who were operated on between January 2006 and December 2016 at the Division of Cardiac Surgery, Medical University of Vienna (N = 257). LVAD types were HeartWare HVAD (Medtronic, Minneapolis, MN), HeartMate II (Abbott [Thoratec], Abbott Park, IL), and HeartMate 3 (Abbott [Thoratec]). The primary outcome variable was survival during LVAD support. Secondary outcome variables were rates of prolonged ventilation, intensive care unit stay, hospital stay, renal replacement therapy, and stroke. We additionally investigated risk factors for a bleeding revision. Results Thirty-six patients (14%) underwent surgical revision for bleeding. In a multivariable Cox proportional hazards model, bleeding revision was associated with significantly reduced survival during LVAD support (3 months: hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20 to 3.48; 6 months: HR, 1.63; 95% CI, 0.95 to 2.82; 12 months: HR, 1.30; 95% CI, 0.69 to 2.46; 24 months: HR, 1.04; 95% CI 0.48 to 2.26; overall p = 0.007). Rates of secondary outcome variables were substantially higher in the revision group compared with patients who survived the hospital stay without a bleeding revision. Concomitant implantation of a temporary right ventricular assist device (p = 0.002) and age (p = 0.028) were independent risk factors for a bleeding revision. Conclusions A bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Preoperative, intraoperative, and postoperative prophylactic strategies may help to prevent this life-threatening complication.

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.

An elastofibroma is a rare, benign, slow-growing, progressive soft tissue neoplasm with distinct histopathological features consisting of collagen and coarse elastic fibers. When it occurs, it has a propensity for the subscapular region in elderly female patients. It can occur less commonly at other anatomical sites, and its exact etiology is unclear. The incidence of elastofibroma, especially in the foot, has been sporadically reported; however, the presentation of elastofibroma in the rearfoot has not been previously described in the literature. We present the first report of a 79-year-old female presenting with plantar heel pain secondary to an elastofibroma found at the insertion of the plantar fascia into the calcaneal tuberosity. The patient underwent surgical excision, and pathological analysis revealed the diagnosis of elastofibroma. We discuss the peculiar manifestation of elastofibroma in this case, the pathological diagnosis, and a review of the literature.

Green tea made from the leaves of Camellia sinensis (L) Kuntze has been consumed as a stimulant by humans for thousands of years. Further, regular consumption of green tea offers health benefits and is useful in mitigating/delaying inflammation, clastogenesis, diabetes, vomiting, diarrhea, cardiac ailments and several types of cancer. Green tea also possesses hepatoprotective effects and studies have shown it to reduce liver injury caused by alcohol, carbon tetrachloride, ischemic reperfusion, lead, viral hepatitis, phenobarbitol, microcystin, azathioprine, galactosamine, lipopolysaccharide, and cypermethrin. Additionally, studies have shown that tea prevents chemical-induced hepatocarcinogenesis against an array of carcinogens. This review summarizes the results related to the hepatoprotective properties of tea and also emphasizes the aspects that warrant future research to establish its utility in humans.

Purpose – The purpose of this paper is to enquire into various forms of innovation and observable configurations in films are observable and document the specific technological fields in cinema, and innovations brought by young IT and digital companies. Design/methodology/approach – The paper is based on desk research, a review of literature, review of the technical journals, analysis of annual reports and meeting with experts and industry participants. Findings – It identifies in most cases the presence of information and communication technologies (ICT) companies, new middlemen of the digital age, that integrate in one or another way the core activity of the cinema industry. These companies (“specialized technological companies” with edge R & D) are playing the rather recent role of “new middlemen” liaising between the different layers of a transformed industrial environment described as the “new ICT ecosystem”. Research limitations/implications – The size of the sample (case studies) as the paper relies on some emblematic cases which come with some limits for any generalisation. Besides, most of the information is derived from company websites, complemented by trade press which clearly comes with some constraints in terms of accuracy. Social implications – The paper concludes delineating some potential policy interventions, and identifies the challenges ahead with a focus on the EU. Originality/value – Innovation is not so frequently dealt with in the studies of the cultural sectors. One very important issue is neglected both in the scientific literature and in the committed reports: the characteristic and the management of R & D in the creative industries, especially in the cultural sector. The paper shed some light on this issue.

Patients with a tracheostomy stoma experience compromised speech and function due to the associated changes in airflow patterns. Rehabilitation of a patient with tracheal stoma is a highly challenging task. The main objective is to design an inexpensive, easily fabricated stomal prosthesis for postlaryngectomy patients who require prolonged tracheotomy. This clinical case report describes a 29-year-old male patient who underwent for tracheotomy 3 months before for respiratory distress following a suicidal attempt. Hence tracheotomy was done, and the patient has been with the tracheostomal tube since surgery for the past 3 months. Laryngoscopy examination reported as restricted bilateral vocal cord movements, and the cords were in the adducted position with minimal glottic chink. No history of difficulty in swallowing. On examination, no scar or ulceration is seen around the stoma. The skin around the stoma is healthy. The patient was referred to the oral and maxillofacial Prosthodontics Department from the Department of ENT. The patient's old tracheostomal tube was used as the dimensions of the custom made tracheal prosthesis without making a functional impression of the mature stoma. A tracheal button was made with 2 mm polyethylene urethane sheet to maintain the airway patency of the mature stoma. Width and length of the old tracheostomal tube were measured and customized with polyurethane sheet by directly flaming over heat. The finished product was thin, flexible, maintains enhanced tear strength, require no tapes or adhesives and less technique sensitive. These properties of the prosthesis make more advantageous than the commercially available tracheal buttons. The result in this patient was excellent with no postoperative complications. An innovative approach for fabrication of tracheostomal prosthesis was discussed to increase its successful use in tracheostomal patients. The patient's old tracheostomal tube was used as the dimensions of the custom made tracheal prosthesis without making a functional impression of the mature stoma. The finished product was thin, flexible, maintains enhanced tear strength, require no tapes or adhesives and less technique sensitive. These properties of the prosthesis makes more advantageous than the commercially available tracheal buttons. The result in this patient was excellent with no postoperative complications.

Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.

Introduction: Diabetic Retinopathy (DR) is a well-known consequence of long standing and poorly controlled Diabetes Mellitus (DM). Several studies have demonstrated both a qualitative and quantitative reduction in health related quality of life in persons with DR. But no such study has been done in the Indian population. Aim: To assess health related and vision related quality of life in people with DR. Materials and Methods: The present study included two groups of patients with Type 1 and Type 2 diabetes. Cases included 97 patients with DR. The control group (n=26) consisted of diabetic cases with no clinically detectable DR changes. After taking informed consent, health and vision related quality of life was assessed using National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). Demographic information, social history and diabetic history were also obtained from all patients. DR was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Results: Of the 97 cases with DR, 42.3% were females. Of the 26 controls, 53.8% were females. The mean±SD age in years of the cases was 55.09±9.56 and controls were 54.12±13.01. The mean±SD of DM in years for the cases was 10.98±5.62 and for controls was 6.69±2.29. There were statistically significant (p

Background: The prevalence of diabetic nephropathy varies according to ethnicity. Environmental as well as genetic factors contribute to the heterogeneity in the presentation of diabetic nephropathy. Our objective was to evaluate this heterogeneity within the Caucasian population. Methods: The geo-ethnic origin of the 3409 genotyped Caucasian type 2 diabetes (T2D) patients of Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation was determined using principal component analysis. Genome-wide association studies analyses of age of onset of T2D were performed for geo-ethnic groups separately and combined. Results: The first principal component separated the Caucasian study participants into Slavic and Celtic ethnic origins. Age of onset of diabetes was significantly lower in Slavic patients (P = 7.3 x 10-20), whereas the prevalence of hypertension (P = 4.9 x 10-31) and albuminuria (5.1 x 10-9) were significantly higher. Age of onset of T2D and albuminuria appear to have an important genetic component as the values of these traits were also different between Slavic and Celtic individuals living in the same countries. Common and geo-ethnic-specific loci were found to be associated to age of onset of diabetes. Among the latter, the PROX1/PROX1-AS1 genes (rs340841) had the highest impact. Single-nucleotide polymorphism rs340841 CC genotype was associated with a 4.4 year earlier onset of T2D in Slavic patients living or not in countries with predominant Slavic populations. Conclusion: These results reveal the presence of distinct genetic architectures between Caucasian ethnic groups that likely have clinical relevance, among them PROX1 gene is a strong candidate of early onset of diabetes with variations depending on ethnicity.

International audience; How do media industries innovate? And how can they compete with powerful new competitors from the information technology world? Innovation is usually linked with high-tech, and "creativity" is associated to media and content industries (MCIs), even if these industries rely on various technologies. The article focuses on the video game and cinema industries. It presents the contrasting specific forms of innovation from these two selected industries. Cultural public policies have always been designed mainly to support the production of creative content and generate social welfare instead of focusing on technological innovations. In the last decades, all these industries underwent significant transformations of their production processes, not to mention the transformation due to the introduction of computers within the firms. The findings raised by recent studies provide a fresh understanding of the nature of innovation, and its place in these industries that does not boil down to simply creating new content. Instead, economic dynamics have recently been opened in creative and cultural companies: a regular capacity for innovation is observable. The paper blends a general outlook that sets the scene of the transformations these industries have gone through with some selected case studies to highlight some innovative elements. The evolution of the development models and the changes brought by technology raise questions about how to (re)consider the role of public intervention in the cultural and creative industries (CCIs).

Large cranial defects of complex geometric shapes are challenging to reconstruct. The cranial implants has to be fabricated prior to the cranioplastic surgery. The ideal material for cranial implant has to be inert, light weight, easy to fit and adaptable to the defect, offering the best aesthetic and functional results. Here is a clinical case report of a patient who was operated for osteomyelitis in the parieto-temporal region. The defect was reconstructed with heat cure polymethylmethacrylate (PMMA). Operative closure of the defect was facilitated with ligature titanium wires with minimal prosthesis contouring. The heat cure PMMA cranial implant is a safe, easy and economic alternative with great adaptability to cranial vault defects. The cosmetic results in this patient was excellent. No post-operative complications occurred.

Purpose–The purpose is to review public policies and government interventions in the book publishing industry, a sector where public policies have blossomed. The paper concentrates on five major issues: intellectual property rights and issue of infringements (piracy), the debate about the fixed price of books (vs free market) or the agency versus wholesale models, VAT discrimination between printed books and e-books, the role institutions like libraries and registration authorities, and competition issues.Design/methodology/approach–This article is based on an extensive set of research initiated by the EC JRC IPTS on the “Statistical, ecosystems and competitiveness analysis of the Media and Content Industries”. The research implied an extensive review of the literature, meetings with players and validation workshops. This paper focuses more on the analysis of policy documents and position of players.Findings–The paper shows a growing discrepancy between the leading position of the EU publishing industry and its position in on-line distribution and production of e-books. The EU leads the global publishing market, with companies like Bertelsmann, Hachette or Pearson. However, compared with the USA, in the EU, the e-book market is still negligible. The European e-book market is fragmented, expanding fast in the UK and lagging behind in other Member States. As digitisation of books and earlier on-line distribution of physical books are changing the landscape, the paper considers potential policies at EU level to coordinate, accompany and speed up the process of digitalisation.Research limitations/implications–The article stems from the research initiated by the IPTS on the “Statistical, ecosystems and competitiveness analysis of the Media and Content Industries” (MCI). This research was based on a review and synthesis of the available literature, desk research. The results were reviewed by experts from the book industry at dedicated meetings. The paper does not cover other important public policy issues such as the role in the functioning of democracies, triggering consequent rights and responsibilities with respect to human rights, democracy, and freedom of information and cultural diversity.Practical implications–To contribute to the debate about the policies needed for the economic health and development conditions that will support the future competitiveness of the book publishing industry. There is a need to better understand if policies designed for the physical world will be effective in a digital world. Distribution is very different in a digital world from physical distribution; these supply-side policies may reach their limits.Originality/value–In the media and entertainment markets, the book market is the only one where EU companies (Bertelsman, Hachette, Pearson, Wolters Kluwer) lead. However, this industry is one of the less covered segments of these markets. Besides, the paper combines a review of legacy policies such as copyright, fixed prices, and issues raised by the digital shift such as VAT discrimination between physical books and e-books.

OBJECTIVES: The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement. METHODS: All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population. RESULTS: A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P< 0.01) for patients with mechanical valves. A Cox regression analysis including patients’ age, gender and valve type revealed age and the type of aortic valve replacement as independent significant factors influencing survival (for age, hazard ratio = 1.1, 95% confidence interval = 1.0– 1.1, P= 0.03; and for valve type, hazard ratio = 2.6, 95% confidence interval = 1.2–5.8, P= 0.02). The observed survival was comparable to the expected standard survival for the Ross group but was significantly reduced in the mechanical valve group. CONCLUSIONS: In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement.

Evacuation modelling has traditionally been limited to prior analysis of the geometrical design of spaces. This approach is limited by the number of scenarios that can be tested. A scenario-independent evacuation model would rely on real-time information processing. This approach allows the generation of an optimum evacuation strategy that minimises evacuation time and crowd density, and is tailored to the current situation at hand. This paper describes the requirements and development of such a crowd model. Graph theory and network flow heuristics are combined with agent movement, based on the individual determination of speed by meso-scale density assessment.

This report presents an initial experience with the novel Abbott surgical enhancement tools for less invasive HeartMate 3 (Abbott, Chicago, IL) left ventricular assist system implantation. Three new devices are introduced: (1) a mini-apical cuff with (2) a cuff holder and (3) a newly designed coring knife, facilitating access through a left sided minithoracotomy.

This article examines the state of the art of early warning in Africa. It looks at the definitions of early warning, considers the historical evolution of conflict early warning systems, and takes a critical look at the debate about the link or the gap between early warning and early action. To this end, it tries to answer some important questions, particularly in relation to the purpose of early warning systems (EWSs) and their limitations so as to ensure that EWSs and early warning analysts are taken for what they are, and not criticised for what they are not or cannot do. In essence, it underscores the fact that the field of conflict early warning is not a fortune-telling business; an industry aimed at predicting socio-political events. The field and its different actors and mechanisms typically serve various purposes and rely on networks and open sources as well as cooperation. At times, some actions are indeed taken and potential conflicts prevented, but these actions do not come to the attention of ...

This chapter aims at providing a comprehensive overview of the mobile landscape. It bridges the global trends affecting the mobile industry as a whole, with the creation and distribution of contents, emphasizing the new patterns of production and distribution. It shed light on the drivers of the changes taking place. The first part of this chapter identifies and sums up the main trends in a global landscape, namely the role of mobile communications (devices, networks) combined with the rise of the “app economy”, the spread of “Big Data”, and the move toward a multiscreen / cross-media paradigm. It provides a synthesis of available data. The first section tracks the evolution of the global market and the emerging geography with the rise of Asia as a leading player in the mobile world. The second section analyses the smartphone phenomenon. The third section deals with the rise of the “app economy”. The fourth section reviews the new modes of data driven management, stemming from “Big Data”. The fifth section follows the move a multi-screen world. The second part investigates some of the impacts of this fast evolving environment on the production of an array of mobile contents (portable movies, video, video games…) tracking the way content industries, while standing at the nexus of technology and content, are rapidly changing. The section documents the way mobile industry is indeed an innovation platform for new services. The section delineates the growing role of the consumer in a mobile world, its various modes of involvement in the production and distribution of digital content. We conclude with some elements about the new challenges brought by these trends, by the entry of new players in both the content and the mobile field.

6 páginas, 4 figuras., The complex process of supercontinuum generation (SG) is known to be exploitable for designing spatially coherent white light sources emitting light simultaneously in the ultraviolet, visible, and infrared ranges. Herein the first natural material able to generate in laboratory conditions a supercontinuum similar to those known from man-made photonic crystal fibers is described. The ability resides in siliceous 20–50 cm long spicules of the glass sponge Sericolophus hawaiicus. By shedding into the spicules optical peak intensities ranging from 1 to 100 TW cm−2 the generation of a SG is revealed. The SG involves wavelengths between 650 and 900 nm and shows a maximum spectral spread for excitation at a wavelength of 750 nm. It is hypothesized that the SG is favored by spicules being a biocomposite that incorporates together isotopically pure biogenic silica (δ30Si = −3.28) and 15.2 ± 1.3 μg N-acetyl-glucosamine (chitin) per mg of silica. The internal organization of these spicules is distinguished by a solid silica core with a 1 μm wide axial channel as well as a highly ordered silica–chitin composite. Such a composition and organization pattern may be of potential interest for the design of low temperature synthesis of future materials for light guidance., This work was partially supported by the following research grants DFG Grant EH 394/3-1, Krüger Research School, Biohydrometallurgical Center for Strategic Elements (BHMZ) at TU Bergakademie Freiberg, BMBF within the project CryPhys Concept (03EK3029A), Germany, and a grant of the Spanish Government (CTM2015-67221-R) to M.M.