Earnings management and audit quality:stakeholders’ perceptions

This paper examines the perceptions of Libyan Commercial Banks’ (LCBs) stakeholders regarding the role of the external auditor in relation to earnings management (EM). A total of 28 semi-structured interviews were carried out with a range of LCB stakeholders comprising preparers of financial statements, users, regulators and academics. A questionnaire survey of stakeholders which yielded 102 Responses (response rate 53%) was also carried out. A variety of views were held which varied to some extent according to stakeholder group. A widely held perception amongst interviewees was that the auditor has the ability to detect EM practices but may not be able to prevent it. However questionnaire respondents were, in aggregate, more confident of the auditor’s ability to deter EM due to the influence of the audit report. The paper provides insights into stakeholders’ perceptions of the quality of bank audits. The findings are of particular relevance to regulators, and specifically, the Central Bank of Libya. Perceptions of audit quality raise questions about its guidance and regulations especially in connection with audit firm rotation. Perceptions of audit quality, and therefore, of the credibility of financial statements should be of interest to all stakeholders. The importance of the banking sector for society has been amply demonstrated in recent years. A well-functioning audit function is a key component of its regulation. To the best of our knowledge, this paper is the first to examine issues related to banks’ audit quality and audit firm rotation in Libya

Cyp26b1 Regulates Retinoic Acid-Dependent Signals in T Cells and Its Expression Is Inhibited by Transforming Growth Factor-β

The vitamin A metabolite, retinoic acid (RA), plays important roles in the regulation of lymphocyte properties. Dendritic cells in gut-related lymphoid organs can produce RA, thereby imprinting gut-homing specificity on T cells and enhancing transforming growth factor (TGF)-β-dependent induction of Foxp3+ regulatory T cells upon antigen presentation. In general, RA concentrations in cells and tissues are regulated by its degradation as well. However, it remained unclear if T cells could actively catabolize RA.We assessed the expression of known RA-catabolizing enzymes in T cells from mouse lymphoid tissues. Antigen-experienced CD44+ T cells in gut-related lymphoid organs selectively expressed Cyp26b1, a member of the cytochrome P450 family 26. However, T cells in the spleen or skin-draining lymph nodes did not significantly express Cyp26b1. Accordingly, physiological levels of RA (1-10 nM) could induce Cyp26b1 expression in naïve T cells upon activation in vitro, but could not do so in the presence of TGF-β. Overexpression of Cyp26b1 significantly suppressed the RA effect to induce expression of the gut-homing receptor CCR9 on T cells. On the other hand, knocking down Cyp26b1 gene expression with small interfering RNA or inhibiting CYP26 enzymatic activity led to enhancement of the RA-induced CCR9 expression.Our data demonstrate a role for CYP26B1 in regulating RA-dependent signals in activated T cells but not during TGF-β-dependent differentiation to Foxp3+ regulatory T cells. Aberrant expression of CYP26B1 may disturb T cell trafficking and differentiation in the gut and its related lymphoid organs

Impact ionization mass spectra of anorthite cosmic dust analogue particles

Anorthite, the Ca-rich end-member of plagioclase feldspar, is a dominant mineral component of the Lunar highlands. Plagioclase feldspar is also found in comets, meteorites and stony asteroids. It is therefore expected to contribute to the population of interplanetary (and circumplanetary) dust grains within the solar system. After coating micron- and submicron-sized grains of Anorthite with a conductive layer of Platinum, the mineral was successfully accelerated to hypervelocity speeds in the Max Planck Institut für Kernphysik’s Van de Graaff accelerator. We present impact ionization mass spectra generated following the impacts of anorthite grains with a prototype mass spectrometer (the Large Area Mass Analyser, LAMA) designed for use in space, and discuss the behavior of the spectra with increasing impact energy. Correlation analysis is used to identify the compositions and sources of cations present in the spectra, enabling the identification of several molecular cations (e.g., CaAlO2, CaSiO2, Ca2AlO3/CaAlSi2O2) which identify anorthite as the progenitor bulk grain material

Phosphonates as P-31-NMR markers of extra- and intracellular space and pH in perfused rat liver

We evaluated phosphonates (Po) as markers of the extra-and intracellular space in perfused rat liver, (i) In-and outwash behaviour of phenylphosphonate (PhePo), 3-amino-propylphosphonate (NProPo) and methyl phosphonate (MePo) was compared with that of creatine phosphate (CrP), a marker of the extracellular space, and of dimethyl methylphosphonate (MePoMe2), a marker of the total water-accessible space, In-and outwash of CrP was accurately predicted by the time constant (similar to 12 s) for the in-and outwash of inulin, a standard marker of the extracellular space, MePoMe2 rapidly distributed over the total liver volume (about three times the CrP accessible space), PhePo, NProPo and MePo washed rapidly into the extracellular space with CrP, and then steadily spilled over into the MePoMe2-accessible space, Upon outwash, Po signals rapidly declined in phase with that of CrP. Residual Po (PhePo much greater than NProPo similar or equal to MePo) reflected the amount internalized during prolonged (60 min) inwash, Proportional amounts of residual Po were found in extracts of livers harvested after outwash of perfusate and extracellular markers, Consistent with exclusion from the cells, CrP went undetected in these extracts, (ii) The resonance frequency of residual PhePo after outwash of the extracellular fraction corresponded with the pH reported by cytosolic Pi and responded to transient changes of the intracellular pH, induced by perfusion with and withdrawal of 20 mM NH4Cl, (iii) MePoMe2 homogeneously distributed over perfusate, parenchyma and bile, consistent with unrestricted permeability, Other Po were transported transcellularly and excreted in bile. CrP was virtually excluded from the bile, attesting to a minimal role for 'bulk-phase pinocytotic' transcellular transport, or for 'paracellular' leakage, In summary, charged Po can be used as extracellular markers in liver, provided experimental conditions are adjusted to minimize their internalization. Some Po (e.g. PhePo) can reach intracellular concentrations which suffice for the compound to act as a reporter molecule of the cytosolic pH. (C) 1997 John Wiley & Sons, Ltd

A Proposal to Evolving Towards Digital Twins in Healthcare

The main objective in this proposal is to orchestrate an ecosystem of manipulation of reliable and safe data, applied to the field of health, specifically lung cancer, by introducing the creation of digital twins for personalised healthcare about the behaviour of this disease on patients. Digital twins is a very popular and novel approach in digitisation units in industry which will be used by both kind of experts: (i) data analysts, who will design expert recommender systems and extract knowledge – explainable Artificial Intelligence (AI); and (ii) professionals in medicine, who will consume that knowledge generated with their research for better diagnosis. This knowledge generation/extraction process will work in the form of a lifelong learning system by iterative and continuous use. The produced software platform will be abstracted so it can be applied like a general purpose service tool in other domains of knowledge, specially health and industry. Furthermore, a rule extraction module will be made available for explainability issues.Ministerio de Ciencia, Innovación y Universidades PGC2018-102145-B-C21Ministerio de Ciencia, Innovación y Universidades PGC2018-102145-B-C2

Reconstruction du ligament croisé antérieur du genou: simple ou double faisceau?

Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) consists of two distinct bundles, the anteromedial (AM) and posterolateral. Each bundle has its specific role during the motion of the knee. ACL reconstruction techniques have focused on the restauration of the anteroposterior stability by substituting the more isometric AM bundle. Although these ligamentoplasties provide overall good results, in the last ten years double-bundle ACL reconstruction techniques have been developed, to better replicate the ligament anatomy. Despite the growing number of published studies, including randomized controlled trials comparing single bundle and double bundle reconstructions, there is still a lack of evidence of any superiority of the double-bundle technique. Furthermore, many series are criticized for their poor assessement of rotational stability, using most of the time subjective pivot shift clinical testing. Among the methods available to measure tibial rotation, 3-D optoelectronic evaluation is an attractive tool and has been used in some studies reporting rotational mesurements after ACL single-bundle reconstruction. Our Department of Orthopaedics and Traumatology has been using double-bundle techniques for a few years. We conducted a preliminary prospective randomized study, in order to compare single and double-bundle techniques by clinical and optoelectronic evaluations.English AbstractJournal ArticleRandomized Controlled TrialSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study

Background Postpartum haemorrhage (PPH) may be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VEPOCT) and clinical assessment. Methods Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL. If Fibtem A5 remained >15 mm, or bleeding stopped, FFP was withheld. If Fibtem A5 was ≤15 mm and bleeding ongoing women were randomised into an interventional study as previously reported. Clinical and laboratory outcomes were recorded. Results The study recruited 605 women and 98% had FFP withheld. The median (25th-75th centile) total blood loss was 1500 (1300-2000) mL with 300 (50-545) mL occurring after enrolment. Total blood loss was >2500 mL in 40/605 (6.6%) women. RBCs were transfused in 141/605 (23.3%) cases and 11 (1.8%) received ≥4 units. At least one invasive procedure was performed in 283/605 (46.8%) women. Level 3 care was required for 10/605 (1.7%) women. No women developed clinically significant haemostatic impairment. Conclusions A restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with a targeted use of FFP based on VE-POCT

Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial

Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. We hypothesized that early fibrinogen replacement, guided by viscoelastometric testing, reduces blood product usage and bleed size. Methods: Women with PPH 1000–1500 ml were enrolled. If Fibtem A5 was ≤15 mm and bleeding continued, subjects were randomized to fibrinogen concentrate or placebo. The primary outcome compared the number of units of red blood cells, plasma, cryoprecipitate and platelets transfused. Results: Of 663 women enrolled 55 were randomized. The adjusted incidence rate ratio (IRR) (95% CI) for the number of allogeneic units transfused in the fibrinogen group compared with placebo was 0.72 (0.3–1.7), P=0.45. In pre-specified subgroup analyses, subjects who had a Fibtem A5 ≤12 mm at the time of randomization and who received fibrinogen concentrate received a median (25th–75th centile) of 1 (0–4.5) unit of allogeneic blood products and had an additional 300 (100–350) ml blood loss whereas those who received placebo also received 3 (0–6) units of allogeneic blood products and had 700 (200–1550) ml additional blood loss; these differences were not statistically significantly different. There was one thrombotic event in each group. Conclusions: Infusion of fibrinogen concentrate triggered by Fibtem A5 ≤15 mm did not improve outcomes in PPH. Pre-specified subgroup analyses suggest that fibrinogen replacement is not required if the Fibtem A5 is > 12 mm or Clauss fibrinogen >2 g litre−1, but an effect below these levels cannot be excluded. The raised fibrinogen at term appears to be a physiological buffer rather than required for haemostasi