Hope for the best, prepare for the worst: barriers to service innovation

Purpose Despite the growing scholarly interest in service innovation and its associated benefits for organizations, research into the barriers to developing new services remains scant. In addition, most of these studies have been mainly conducted at the firm level, failing to incorporate macro forces in the industry. To fill this gap, this study aims to investigate major industry trends as well as organizational attributes that affect organizations’ capability in designing innovative services. Design/methodology/approach A qualitative approach was used. In all, 21 semi-structured interviews with senior executives in different banks were conducted to collect data. Data were analyzed through thematic analysis. Findings The results of this study suggest that privatization, technological shortcomings, legislative inefficiencies and deposit orientation instead of market orientation were major industry trends that affect service innovation. Furthermore, ambiguity in knowledge management regimes, silo mentality and the absence of a collaborative organizational culture, growing need to focus on human capital and risk aversion were the main organizational attributes that should be addressed for effective service innovation. Practical implications Service innovation is a strategic asset for organizations. To effectively leverage the benefits, managers should have an end-to-end approach toward the subject. The findings of this study would inform managers of different obstacles in the development of new services from an organizational and industry-wide perspective. Based on the outputs of the interviews and a thorough review of the literature, managerial implications are presented. Originality/value This study is one of the few studies that explores service innovation challenges at both macro and micro levels of analysis, providing a more holistic view of the phenomenon in the context of service organizations

Nerve growth factor receptors in dementia

Background/aim: Nerve growth factor (NGF) promotes the survival and differentiation of sensory and sympathetic neurons. Several studies have found that certain neuropathological factors stimulate NGF receptor expression and release the truncated nerve growth factor receptor (TNGFR) to biological fluids. The aim of this pilot study was to determine urine TNGFR levels in patients with dementia and to verify whether TNGFR can be used as a biomarker of dementia. Materials and methods: Twelve patients with dementia and 12 healthy individuals were asked to voluntarily participate in this study. Ages, sexes, and weights were matched. The first morning urine samples were collected and the concentrations of TNGFR in the urine samples were measured by fluoroimmunoassay. Results: The mean levels of TNGFR in the urine samples of the healthy control subjects and the patients with dementia were 164 +/- 23 and 341 +/- 66 ng / mg creatinine respectively. A positive relationship was found between the levels of TNGFR in different ages of both control and patient subgroups. This is consistent with the previous observations that pathological condition may stimulate the NGF receptor expression. Conclusion: These findings might be of assistance to evaluate the development of the memory loss associated with Alzheimer disease and other age-associated diseases

A YOLOv5-based network for the detection of a diffuse reflectance spectroscopy probe to aid surgical guidance in gastrointestinal cancer surgery

PURPOSE: A positive circumferential resection margin (CRM) for oesophageal and gastric carcinoma is associated with local recurrence and poorer long-term survival. Diffuse reflectance spectroscopy (DRS) is a non-invasive technology able to distinguish tissue type based on spectral data. The aim of this study was to develop a deep learning-based method for DRS probe detection and tracking to aid classification of tumour and non-tumour gastrointestinal (GI) tissue in real time. METHODS: Data collected from both ex vivo human tissue specimen and sold tissue phantoms were used for the training and retrospective validation of the developed neural network framework. Specifically, a neural network based on the You Only Look Once (YOLO) v5 network was developed to accurately detect and track the tip of the DRS probe on video data acquired during an ex vivo clinical study. RESULTS: Different metrics were used to analyse the performance of the proposed probe detection and tracking framework, such as precision, recall, mAP 0.5, and Euclidean distance. Overall, the developed framework achieved a 93% precision at 23 FPS for probe detection, while the average Euclidean distance error was 4.90 pixels. CONCLUSION: The use of a deep learning approach for markerless DRS probe detection and tracking system could pave the way for real-time classification of GI tissue to aid margin assessment in cancer resection surgery and has potential to be applied in routine surgical practice

Вивчення впливу комбінованої дії фотосенсибілізатора і низькоінтенсивного лазерного випромінювання на кількісний склад мікрофлори зубного нальоту

The effect of low-intensity laser radiation (LILR) on the background of a photosensitizer (ethacridine lactate) on selective elimination of pathogenic and conditionally pathogenic microorganisms has been studied. Taking into account antiseptic properties of ethacridine lactate the maximally possible time of influence of ethacridine lactate as a photosensitizer should be set. It has been found that after the influence of rivanol (ethacridine lactate) within 1.5-3 minutes the bactericidal action on microorganisms is observed. The effect of antiseptic in the interval from 30 to 60 seconds was not accompanied with the expressed quantitative change of the microbial population. The second stage of the research was identification of microorganisms sensitivity to various concentrations of the photosensitizer. As a photosensitizer the aqueous solution of ethacridine lactate in the concentrations of 0.1; 0.05; 0.01% was used. The results obtained allow to conclude that the concentration of 0.1% solution of ethacridine lactate increases the sensitivity of microorganisms to the effects of low-intensity laser radiation. During the experiment the combined impact of the antimicrobial activity of 0.1% solution of ethacridine lactate and blue spectrum laser radiation has been determined; it is manifested by decrease in the number of CFU/ml of the total microflora of the dental plaque. The number of CFU is reduced from 14.3 ± 0.12 . 103/ml up to 2.4 ± 0.3 . 102/ml after exposure (Table 1). Comparing the data of the control (the initial number of the colonies grown) and the experiment (the number of the colonies grown after the photoactivated disinfection) we have found that the antibacterial action of photoactivated disinfection depends directly on duration of exposure. Thus, the effectiveness of combined use of a photosensitizer with LILR is 1.2 times higher than that of ethacridine lactate (the exposure time is 60 seconds), and 2.0 times higher than the antimicrobial effect of the laser blue spectrum (the exposure time is 120 seconds).В проведенном исследовании изучали влияние НИЛИ на фоне фотосенсибилизатора (этакридина лактата) на селективную элиминацию патогенных и условно-патогенных микроорганизмов. Учитывая то, что этакридина лактату присущи свойства антисептика, следовало установить максимально возможное время воздействия этакридина лактата как фотосенсибилизатора. Установлено, что после воздействия риванола (этакридина лактата) в течение 1,5-3-х минут отмечалось бактерицидное действие на микроорганизмы. Воздействие антисептика в промежутке от 30 до 60 с не сопровождалось выраженным количественным изменением микробной популяции. Вторым этапом исследования стало определение чувствительности микроорганизмов к различным концентрациям фотосенсибилизатора. Использовали водный раствор этакридина лактата с концентрациями 0,1; 0,05; 0,01%. Полученные результаты позволяют сделать вывод, что раствор этакридина лактата в концентрации 0,1% повышает чувствительность микроорганизмов к действию низкоинтенсивного лазерного излучения. В ходе проведенного эксперимента было установлено антимикробное действие комбинированного влияния 0,1%-ого раствора этакридина лактата и лазерного излучения синего спектра, что проявляется снижением числа КОЕ/мл совокупной микрофлоры зубного налёта. Количество КОЕ снижается со значения 14,3±0,12 × 103/мл до значения 2,4±0,3 × 102/мл после облучения. Сопоставляя данные контроля (исходное число выросших колоний) и опыта (число колоний, выросших после проведения фотоактивированной дезинфекции), мы установили, что антимикробное действие фотоактивированной дезинфекции находится в прямой зависимости от длительности облучения. Так, эффективность комбинированного использования фотосенсибилизатора с НИЛИ в 1,2 раза превышает активность этакридина лактата (время экспозиции – 60 с) и в 2,0 раза превышает противомикробный эффект лазерного излучения синего спектра (время экспозиции – 120 с).У проведеному дослідженні вивчали вплив НІЛВ на тлі фотосенсибілізатора (етакридину лактату) на селективну елімінацію патогенних і умовно-патогенних мікроорганізмів. Враховуючи те, що етакридину лактату притаманні властивості антисептика, слід було встановити максимально можливий час дії етакридину лактату як фотосенсибілізатора. Встановлено, що після дії риванолу (етакридину лактату) протягом 1,5-3-х хвилин відзначалася бактерицидна дія на мікроорганізми. Дія ж антисептика в проміжку від 30 до 60 с не супроводжувалася вираженою кількісною зміною мікробної популяції. Другим етапом дослідження стало визначення чутливості мікроорганізмів до різних концентрацій фотосенсибілізатора. Використали водний розчин етакридину лактат у концентраціях 0,1; 0,05; 0,01%. Отримані результати дозволяють зробити висновок, що розчин етакридину лактату в концентрації 0,1% підвищує чутливість мікроорганізмів до дії низькоінтенсивного лазерного випромінювання. В ході проведеного експерименту було встановлено антимікробну дію комбінованого впливу 0,1%-вого розчину етакридину лактату і лазерного випромінювання синього спектра, що проявляється зниженням числа КУО/мл сукупної мікрофлори зубного нальоту. Кількість КУО знижується зі значення 14,3±0,12 × 103/мл до значення 2,4±0,3 × 102/мл після опромінення. Зіставляючи дані контролю (початкове число колоній, що виросли) і досліду (число колоній, що виросли після проведення фотоактивованої дезінфекції), ми встановили, що антимікробна дія фотоактивованої дезінфекції знаходиться в прямій залежності від тривалості опромінення. Так, ефективність комбінованого використання фотосенсибілізатора з НІЛВ в 1,2 рази перевищує активність етакридину лактату (час експозиції – 60 с) і в 2,0 рази перевищує антимікробний ефект лазерного випромінювання синього спектра (час експозиції – 120 с)

Excess of health care use in general practice and of comorbid chronic conditions in cancer patients compared to controls

<p>Abstract</p> <p>Background</p> <p>The number of cancer patients and the number of patients surviving initial treatments is expected to rise. Traditionally, follow-up monitoring takes place in secondary care. The contribution of general practice is less visible and not clearly defined.</p> <p>This study aimed to compare healthcare use in general practice of patients with cancer during the follow-up phase compared with patients without cancer. We also examined the influence of comorbid conditions on healthcare utilisation by these patients in general practice.</p> <p>Methods</p> <p>We compared health care use of N=8,703 cancer patients with an age and gender-matched control group of patients without cancer from the same practice. Data originate from the Netherlands Information Network of General Practice (LINH), a representative network consisting of 92 general practices with 350,000 enlisted patients. Health care utilisation was assessed using data on contacts with general practice, prescription and referral rates recorded between 1/1/2001 and 31/12/2007. The existence of additional comorbid chronic conditions (ICPC coded) was taken into account.</p> <p>Results</p> <p>Compared to matched controls, cancer patients had more contacts with their GP-practice (19.5 vs. 11.9, p<.01), more consultations with the GP (3.5 vs. 2.7, p<.01), more home visits (1.6 vs. 0.4, p<.01) and they got more medicines prescribed (18.7 vs. 11.6, p<.01) during the follow-up phase. Cancer patients more often had a chronic condition than their matched controls (52% vs. 44%, p<.01). Having a chronic condition increased health care use for both patients with and without cancer. Cancer patients with a comorbid condition had the highest health care use.</p> <p>Conclusion</p> <p>We found that cancer patients in the follow-up phase consulted general practice more often and suffered more often from comorbid chronic conditions, compared to patients without cancer. It is expected that the number of cancer patients will rise in the years to come and that primary health care professionals will be more involved in follow-up care. Care for comorbid chronic conditions, communication between specialists and GPs, and coordination of tasks then need special attention.</p

Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report

<p>Abstract</p> <p>Introduction</p> <p>Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge.</p> <p>Case presentation</p> <p>We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4), which was treated conservatively.</p> <p>Conclusion</p> <p>Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.</p

Тактика ведения больного с плечевым периартритом на этапе оказания первичной медицинской помощи

Плечовий суглоб є найбільш анатомічно складним і рухливим з усіх в організмі людини. При адекватному навантаженні він може прослужити достатньо довго, в іншому разі – легко піддається ураженню. У 16 % усіх випадків патології опорно-рухового апарату причиною звернення до лікаря загальної практики є біль у плечовому суглобі, причому щорічна захворюваність становить 15 нових випадків на 1000 пацієнтів у центрах первинної медичної допомоги. Серед усіх захворювань плечового суглоба найчастіше (приблизно у 80 % випадків) трапляється плечовий періартрит (ПП). Зазвичай ця патологія вражає людей працездатного віку (40–70 років) та призводить до їхньої тимчасової непрацездатності. Захворюваність на ПП у загальній популяції сягає 3–5 %. Щодо розповсюдженості даної патології на території України сьогодні немає чітких даних через те, що існують певні проблеми з її виявленням. Несвоєчасні звернення пацієнтів і виявлення захворювання, неадекватні лікування та профілактика ускладнень можуть призводити до стану «замороженого плеча», у результаті якого виникає стійке обмеження рухів в ураженій кінцівці, а отже, й життєдіяльності загалом, та який може завершитися інвалідизацією.In 16% of all cases of the musculosceletal system pathology the reason for applying to a general practitioner is pain in the shoulder joint, with an annual incidence of 15 new cases per 1,000 patients in primary care centers. Among all shoulder joint diseases, the most frequent (in approximately 80 % of cases) is periarthritis of the shoulder (PS). This pathology usually affects people of working age (40–70 years) and leads to their temporary disability. The incidence of PS in the general population reaches 3–5%. As there are many pathological conditions characterized by severe pain and a limitation of active and passive movements in the shoulder joint, the diagnosis of PS is often misleading, that can lead to choosing the wrong treatment. That is why it is necessary to consider the question of the correct diagnostic program for the PS in the practice of a family doctor. It should be noted that the diagnosis of PS is mainly clinical and is usually based on patients complaints and their examination. Among all medical imaging techniques the most simple and economically affordable method for visualizing the periarticular tissues at the primary health care is ultrasound. The main goals of the therapy of PS are to get rid of pain and return the full volume of movements in the affected limb. A relatively new and promising method in the treatment of joints diseases, including PS, is the use of autologous platelet-rich plasma (APRP). At the present time, our research is being carried out to improve the prognosis of PS at early stages. Patients in the main group, taking NSAIDs and physical rehabilitation (from the sub-acute period), were offered to receive periarticular injections of APRP. Such therapy gives a positive result in a short term and prolongs the period of remission.Среди всех заболеваний плечевого сустава чаще всего (примерно в 80 % случаев) встречается плечевой периартрит (ПП). Заболеваемость ПП в общей популяции составляет 3–5 %. Обычно эта патология поражает людей трудоспособного возраста и может приводить к их инвалидизации в случае выбора неверной тактики. Относительно новым и перспективным методом в лечении заболеваний суставов, в частности ПП, является использование аутологичной богатой тромбоцитами плазмы (АБоТП). На данный момент нами проводятся исследования с целью улучшения прогноза ПП у пациентов на ранних стадиях. Больным основной группы наряду с приемом нестероидных противовоспалительных средств и проведением физической реабилитации (с подострого периода) было предложено инъекционное периартикулярное введение АБоТП. Такая терапия дает положительный результат в короткие сроки и значительно удлиняет период ремиссии

Shoc2 Is Targeted to Late Endosomes and Required for Erk1/2 Activation in EGF-Stimulated Cells

Shoc2 is the putative scaffold protein that interacts with RAS and RAF, and positively regulates signaling to extracellular signal-regulated protein kinases 1 and 2 (ERK1/2). To elucidate the mechanism by which Shoc2 regulates ERK1/2 activation by the epidermal growth factor (EGF) receptor (EGFR), we studied subcellular localization of Shoc2. Upon EGFR activation, endogenous Shoc2 and red fluorescent protein tagged Shoc2 were translocated from the cytosol to a subset of late endosomes containing Rab7. The endosomal recruitment of Shoc2 was blocked by overexpression of a GDP-bound H-RAS (N17S) mutant and RNAi knockdown of clathrin, suggesting the requirement of RAS activity and clathrin-dependent endocytosis. RNAi depletion of Shoc2 strongly inhibited activation of ERK1/2 by low, physiological EGF concentrations, which was rescued by expression of wild-type recombinant Shoc2. In contrast, the Shoc2 (S2G) mutant, that is myristoylated and found in patients with the Noonan-like syndrome, did not rescue ERK1/2 activation in Shoc2-depleted cells. Shoc2 (S2G) was not located in late endosomes but was present on the plasma membrane and early endosomes. These data suggest that targeting of Shoc2 to late endosomes may facilitate EGFR-induced ERK activation under physiological conditions of cell stimulation by EGF, and therefore, may be involved in the spatiotemporal regulation of signaling through the RAS-RAF module