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External program manager involvement can provide professional and systematic management services to owners. It can help to manage and coordinate different subprojects and ensure the achievement of the overall strategic goals of large projects. The promotion of external program manager involvement is not only efficiency-driven, but the institutional environment also has a significant impact. This study developed a theoretical model to explain how external program manager involvement is influenced by external institutional forces (coercive, mimetic, and normative pressures) and internal top management support. Based on a questionnaire survey, this study tested the research model through partial least-squares structural equation modeling. The empirical results revealed that coercive pressures have no significant impact on external program manager involvement; owners' top management support acts as a complete mediator between the mimetic pressures and external program manager involvement; normative pressures have the greatest impact on top management support and external program manager involvement, and top management support plays a key but partially mediating role. A direct contribution of this study is to reveal how different types of isomorphic pressures can be better exercised to facilitate the involvement of external program managers. Going further, by incorporating both external institutional pressures and internal top management support into the research model, this study provides insight into how organizations are influenced by external institutions to apply tools or approaches internally.

Turbomolecular pumps with ultrahigh vacuum performances are a desired technology among modern vacuum systems, which requires the pump to synchronously possess the wide pumping speed and high vacuum. This paper describes a systematic design methodology for a magnetically levitated turbomolecular pump with consideration of multiphysics constraints, such as the mechanical strength, rotor dynamics, electromagnetic losses, and thermal characteristic. These variables will directly decide the acquisition of high vacuum performances. The design process for such high-performance pumps requires multidisciplinary and highly iterative due to the complex interaction of the many design variables involved. The structure of the bladed rotor is determined in terms of the material selection and mechanical verification. In this paper, an effective modeling method is presented to achieve accurate bending modes of the bladed rotor. An assessment on the loss level and the thermal limit is performed to ensure the temperature rise of the pump within the acceptable range. The measured results show that the pump can achieve the high vacuum performance with the pumping speed of 4370 l/s and the lowest working pressure of 10–8 magnitude. The proposed design process described in this paper provides the general guidelines for the multidisciplinary design of high-performance turbomolecular pumps.

The normal functions of genomes depend on the precise expression of messenger RNAs and noncoding RNAs (ncRNAs) such as transfer RNAs and microRNAs in eukaryotes. These ncRNAs and functional RNA structures (FRSs) act as regulators or response elements for cellular factors and participate in transcription, posttranscriptional processing, and translation. Knowledge discovery of these FRSs in huge DNA/RNA sequence databases is a very important step to reach our goal of going from genomic sequence data to biological knowledge for understanding RNA-based regulation. Analyses of a large number of FRSs have indicated that the FRS can be well characterized by some quantitative measures such as significance and well-ordered scores of the local segment. Various data mining tools have been developed and successfully applied to FRS discovery in genomic sequence databases. Here, we summarize our efforts in the computational discovery of structured features of ncRNAs and FRSs within complex genomes by EDscan and SigED. © 2011 John Wiley & Sons, Inc. WIREs Data Mining Knowl Discov 2011 1 88–95 DOI: 10.1002/widm.13

In infrastructure project practice, balancing and maximizing the combined effect of exploratory and exploitative innovation have attracted increasing attention, but it is still unclear how to foster ambidextrous innovation in infrastructure projects. To address this gap, we draw on the differentiation-integration framework of ambidexterity theory to deconstruct tactics for fostering ambidextrous innovation in infrastructure projects. A total of 313 observations were collected from infrastructure under construction, and the path hypotheses were tested by hierarchical regression. The findings suggest that in infrastructure projects, task conflict and expertise integration of diverse cross-functional teams provide powerful and complementary tactics for fostering ambidextrous innovation. The moderating effect of team autonomy support on the impact of team diversity on differentiation and integration tactics presents three different results. This study not only enriches the literature on how to foster ambidextrous innovation in infrastructure projects but also expands the ambidexterity research at the cross-functional team level and in infrastructure project contexts.

The results of structure and phase composition change in tungsten after compression plasma flow and high-intensive pulsed ion beams impacts are discussed. The compression plasma flows with the absorbed energy in range 35–70 J/cm2 were used for the sub-surface modification. The preliminary Ti coating deposition on the tungsten surface allowed us to form W-Ti alloys by plasma flows treatment. The layer of the W-Ti alloy consists of solid solutions W(Ti) and β-Ti(W) as well as nitride phase (Ti,W)N. The high-intensive pulsed ion beam impact provides the tungsten carbide W2C formation in the sub-surface layer. When forming the W-Ti alloy the carbon ions implanted into the tungsten take part in the carbo-nitride (Ti,W)(N,C) formation without brittle W2C phase.

This research studies the effects of the residual stress and strain on the microstructure, critical current density, transition temperature, and microwave surface resistance of REBa2Cu3O7−δ (RE, rare earth) thin films grown by trifluoroacetate metal organic deposition. Different concentrations of Dy are introduced into YBa2Cu3O7−δ superconducting thin films. The superconducting transition temperature increases with an increase in the internal strain, while the critical current density exhibits an inverse variation relationship with the residual stress and c-axis length. The current carrying capability of REBa2Cu3O7−δ thin films can be improved by doping with appropriate Dy concentrations, which can be determined based on the residual stress modulation in the REBa2Cu3O7−δ thin films. In addition, no apparent transition of tensile or compressive stresses is observed in the thin films during the residual stress measurements. This paper provides a useful theoretical guidance for effectively improving the superconductivity of REBa2Cu3O7−δ thin films.

Supplier development (SD) has become an emerging supply chain management practice for firms focusing on their core strategic advantages by outsourcing a significant portion of production or construction activities. Various incentive mechanisms are available for suppliers to improve their capabilities to meet owners’ expectations. However, a comparative analysis is needed to understand how successful they are. This paper investigates the incentive mechanisms for SD in a construction supply chain that consists of one owner and one supplier. Considering the owner's dominant position in the negotiation of a supply contract, a principal–agent model with the objective of optimizing the owner's profit and a Stackelberg game model designed to optimize the profits of both the owner and supplier are proposed and analyzed. Two commonly used incentive methods, including purchase price incentive and cost sharing, are analyzed and compared. The analysis and comparison are illustrated by a numerical example. The primary contribution of this paper is the analysis of the impact of incentive methods on quality improvement for the supplier and a sensitivity analysis of the supplier's internal and external factors, such as purchase quantity, market demand, and manufacturing cost structures, which are useful managerial insights for SD practices in mega construction projects.

This study presents a novel method based on stakeholder value network (SVN) to quantify and visualize value exchanges among primary stakeholders when using the building information modeling (BIM). After collecting data from 135 BIM experts from various capital projects in the mainland of China, 95 value flows among 7 BIM-related stakeholders were quantified, including 69% intangible value and 31% tangible value flows. Owners were then selected as focal organizations to analyze 49,775 value cycles starting from and ending with owners. 9 top-ranked value cycles, 3 most important stakeholders (BIM consultants, general contractors, and subcontractors), and 20 top value flows were identified and discussed to enable owners to formulate effective strategies to drive BIM value realization. These results can provide a visualized tool to quantify the perceived value of BIM stakeholders and to formulate value-based strategies to encourage the “buy-in” decisions by stakeholders.

Cyclic adenosine monophosphate (cAMP) response element-binding protein (CREB) is overexpressed and has an oncogenic role in hepatocellular carcinoma (HCC). Interleukin enhancer binding factor 2 (ILF2) has become research hotspot in liver cancer recently. However, it is still unclear whether and how CREB and ILF2 interact with each other. And how this interaction exerts its role in occurrence and development of liver cancer is still unclear. Here, we found that ILF2 directly bound with CREB, and this binding was essential for the malignant phenotypes of liver cancer cells. Moreover, we found that ILF2 acted as one of the upstream proteins of CREB and promoted CREB only in the protein level, whereas ILF2 expression was not regulated by CREB. Mechanistically, ILF2 bound to the pKID domain of CREB and stimulated its phosphorylation at Ser133. Taken together, our study finds a novel interaction between CREB and ILF2 in liver cancer, and this interaction might play a role in the diagnosis and remedy of liver cancer.

Background. The prognostic value of lactate dehydrogenase (LDH) in colorectal cancer patients has remained inconsistent between non-metastatic and metastatic settings. So far, very few studies have included LDH in the prognostic analysis of curative-intent surgery for colorectal liver metastases (CRLM).Patients and Methods. 580 consecutive metastatic colorectal cancer patients who underwent curative-intent CRLM resection from Blinded for peer review (434 patients) and Blinded for peer review (146 patients) treated in 2000-2019 were enrolled. Overall survival (OS) was the primary endpoint. Cox regression model was performed to identify the prognostic values of preoperative serum LDH levels and other clinicopathology variables. A modification of the established Fong CRS scoring system comprising LDH was developed within this Chinese population.Results. At the median follow-up time of 60.5 months, and median OS was 59.5 months in the pooled cohort. In the multivariate analysis, preoperative LDH > upper limit of normal (250 U/L) was the strongest independent prognostic factor for OS (HR 1.73, 95% confidence interval [CI], 1.22-2.44; P < .001). Patients with elevated LDH levels showed impaired OS than patients with normal LDH levels (27.6 months vs. 68.8 months). Five-year survival rates were 53.7% and 22.5% in the LDH-normal group and LDH-high group, respectively. Similar results were also confirmed in each cohort. In the subgroup analysis, LDH could distinguish the survival regardless of most established prognostic factors (number and size of CRLM, surgical margin, extrahepatic metastases, CEA and CA19-9 levels, etc.). Integrating LDH into the Fong score contributed to an improvement in the predictive value. Conclusion. Our study implicates serum LDH as a reliable and independent laboratory biomarker to predict the clinical outcome of curative-intent surgery for CRLM. Composite of LDH and Fong score is a potential stratification tool for CRLM resection. Prospective, international studies are needed to validate these results across diverse populations.

Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass.We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups.Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease.Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.

BACKGROUND The utility of minimally-invasive liver resection (MILR) for deep centrally located tumours (CLT) remains controversial. We aimed to review our institution's experience and outcomes with minimally invasive central hepatectomy (CH) and right anterior sectionectomy (RAS) for CLT in a propensity score-matched (PSM) analysis. METHODS Retrospective review of a prospectively maintained surgical database revealed 23 patients who underwent MILR (6 CH, 17 RAS) and 53 patients who underwent open liver resection (OLR; 24 CH, 29 RAS) for CLT. PSM in a 1:1 ratio identified two groups of patients with similar baseline clinicopathological characteristics. Peri-operative outcomes were then compared. RESULTS There was one laparoscopic-assisted, one robot-assisted and two laparoscopic-converted-open procedures in the MILR cohort. Across the unmatched cohort, there was only one mortality (MILR) and five patients with major morbidity (all OLR). MILR was associated with a longer operating time (P

In emerging economies, infrastructure projects are in full swing. There is a wealth of replicable experience for exploitation. Simultaneously, more technologies and methodologies require further exploration. This makes fostering ambidextrous innovation strategies (i.e., the tradeoff between exploitative and exploratory innovation strategies) a common and vital practical issue. Large infrastructure projects are unique one-off endeavors but have somewhat repetitive and persistent characteristics. It is a particular “intermediate” form between temporary projects and permanent organizations. Previous research on fostering ambidextrous innovation strategies cannot simply be replicated in large infrastructure projects. To address this issue, this article investigates the relationship between team heterogeneity and ambidextrous innovation strategies and also the role of team learning and identification in large infrastructure projects. Data were collected from 269 responses from 31 large infrastructure project delivery teams in China. The findings show that team heterogeneity has a positive linear effect on exploratory and ambidextrous innovation strategies and an inverted U-shaped effect on exploitative innovation strategies; team heterogeneity can better foster ambidextrous innovation strategies through improving team learning; the moderating role of team identification in the overall mechanism differs from the usual assumptions in permanent organizations. Overall, this article extends the existing ambidexterity research in the “intermediate” form between temporary projects and permanent organizations. It provides insights and guidance on fostering ambidextrous innovation strategies in large infrastructure projects.

The management of post-liver resection recurrence is often the life-limiting factor in HCC treatment. While much has been published on intrahepatic recurrence and lung metastasis, there is a relative lack of data on intraabdominal extrahepatic metastasis (EHM). We sought to evaluate the outcomes of patients post-resection of intraabdominal EHM and assess preoperative factors predictive of early recurrence post-metastasectomy.We performed a retrospective review of 25 consecutive patients who underwent metastasectomy for intraabdominal EHM from 2003 to 2016 at our institution.Of the 25 cases of EHM, 16 were in the peritoneum, 3 in the adrenal glands, 3 in the large bowel, 1 in the spleen, 1 in the pancreas and 1 in the omentum. Median overall survival was 27 months (IQR 15-89 months). Twenty-one patients (84%) developed recurrence post-metastasectomy of EHM of which 12 patients experienced early recurrence within 12 months. The median time to recurrence post-metastasectomy was 11(IQR 15.5) months. Multivariate analysis demonstrated both hepatitis B (11 (91.6%) versus 4 (44.4%), p = 0.00) status and high tumour grade (8 (66.6%) versus 3 (25%), p = 0.004) to be significant independent predictors of early recurrence. Patients who experienced early recurrence had a significantly shorter median overall survival (18 months (95% CI 12.9-23.0)) compared to those who did not (89 months (95% CI 24.8-153.1), p = 0.004).Patients with EHM who underwent metastasectomy had a median overall survival of 27 months. Hepatitis B positivity and high primary tumour grade were preoperative predictors of futile surgery. All 7 patients who had both hepatitis B and high tumour grade experienced early recurrence post-metastasectomy.

Background:Laparoscopic living-donor nephrectomy is the current epitome of living kidney donation surgery. We review our experience in living-donor nephrectomies over the last 19 years, transitioning from open surgery to hand-assisted laparoscopy to full laparoscopic techniques.Methods:We retrospectively identified all living-donor nephrectomies performed at our institution from 1976 to 2018. The donors were categorised according to surgical techniques: open (ODN), hand-assisted laparoscopy (HALDN) and full laparoscopy (LDN). We reviewed changes in donor demographics over the years. Surgical outcomes between groups were compared from 2000 to 2018. We also compared the outcomes of LDN between different time periods to evaluate our learning curve.Results:A total of 214 living-donor nephrectomies were performed between 2000 and 2018. The majority were left sided (93%) and had single renal artery anatomy (90%). There were 22 ODN, 20 HALDN and 163 LDN cases. The mean operating time was 84±43, 151±32 and 179±37 minutes for ODN, HALDN and LDN, respectively ( pConclusion:This study confirms the safety of living-donor nephrectomies performed at our institution, a centre with a modest volume of kidney transplants.

The trio of perineal soft tissue tumour, anorectal malformation (ARM) and external genitalia abnormality is exceedingly rare. We present a case of a three-month-old infant who presented with bilateral undescended gonads, ARM and perineal mass. Chromosomal study showed a male profile and ultrasound of his groin suggested right intra-abdominal testis, with the left gonad not visualised. He underwent a period of rectal washouts via the perineal fistula before undergoing elective limited posterior sagittal anorectoplasty. He subsequently underwent left single stage orchidopexy, right first stage orchidopexy and excision of the perineal lump at 10 month of age. Histology revealed lobules of adipocytes with intervening fibrous septae with focal areas of myxoid stroma, suggestive of a lipoblastoma. He then underwent second stage right orchidopexy six month later and no recurrence was noted. Only two cases of perineal soft tissue tumour associated with ARM and external genital abnormality were previously reported. It is likely that the large size of the perineal mass contributed to mal-descent of both testes. We postulate that the constellation of anomalies in our patient falls into the category of the urorectal septum malformation sequence.

BackgroundAs the COVID-19 pandemic sweeps across the world, healthcare departments must adapt to meet the challenges of service provision and staff/patient protection. Unlike elective surgery, Acute care surgery (ACS) workloads cannot be artificially reduced providing a unique challenge for administrators to balance healthcare resources between the COVID-19 surge and regular patient admissions. MethodsAn extended ACS (eACS) model of care is described with the aim of limiting COVID-19 healthcare worker and patient cross-infection as well as providing 24/7 management of emergency general surgical (GS) and trauma patients. The eACS service comprised 5 independent teams covering a rolling 1:5 24-hr call. Attempts to completely separate eACS teams and patients from the elective side were made. The service was compared to the existing ACS service in terms of clinical and efficiency outcomes. Finally, a survey of staff attitudes towards these changes, concerns regarding COVID-19 and psychological well-being was assessed.ResultsThere were no staff/patient COVID-19 cross-infections. Compared to the ACS service, eACS patients had reduced overall length of stay (2-days), time spent in the Emergency Room (46 minutes) and time from surgery to discharge (2.4-hours). Mortality was decreased during this time. The eACS model of care saved financial resources and bed-days for the organisation. The changes were well received by team-members who also felt that their safety was prioritised.ConclusionIn healthcare systems affected by COVID-19, an eACS model may assist in preserving psychological well-being for healthcare staff whilst providing 24/7 care for emergency GS and trauma patients.

Purpose While endovascular repair of aortic aneurysm (EVAR) has become the mainstay treatment for abdominal aortic aneurysm (AAA), it is not without its disadvantages. Feared complications include graft infections, fistulation and endoleak, the outcomes of which may be life limiting. Case Report We present a case of a 57 year-old patient with human immunodeficiency virus (HIV) previously treated with EVAR for AAA complicated by endoleak post treatment. He developed an aorto-psoas abscess 2 years later which harboured Mycobacterium avium complex, and medical therapy was unsuccessful. He eventually underwent an extra-anatomical bypass and graft explant, for which an aortoenteric fistula was also discovered and repaired. Conclusion Infection of endografts post EVAR is relatively rare, and there are presently no guidelines concerning its management. The concomittance of aorto-psoas abscess and aortoenteric fistula is even more uncommon, and necessitated surgical explant for source control purposes in our patient. Lifelong surveillance is required for complications of the aortic stump and bypass patency.