Laparoscopic totally extraperitoneal inguinal hernia repair in the elderly: A prospective control study

Inguinal hernia (IH) repair can be obtained with both open and laparoscopic techniques, which are usually performed using a transabdominal preperitoneal (TAPP) or a totally extraperitoneal (TEP) approach. The aim of the study was to evaluate whether the results of laparoscopic TEP IH repair in the elderly ( 6565 years old) are different with respect to results obtained in younger patients. One hundred and four consecutive patients (four women and 100 men, median age of 57 years, range=21-85 years) with unilateral (N=21, 20.2%) or bilateral (N=83, 79.8%) IH were prospectively enrolled in the study. Patients were divided into two groups according to their age: group A (N=68, 65.4%) aged <65 years and group B (N=36, 34.6%) aged 6565 years. The mean operative time was not significantly different between groups (48\ub120 vs. 52\ub120 min, p=0.33). One case of increased PaCO2 was observed in each group (p=0.72) and two and one case of pneumoperitoneum (p=0.57) in groups A and B, respectively. Two (1.9%) patients (one in each group; p=0.55) required TEP conversion. Mild postoperative complications developed in four patients of each group (p=0.44). After one-year follow-up, three (2.9%) recurrences occurred (group 1=1, group 2=2, p=0.55), both in patients who had undergone direct IH repair. The overall postoperative relative risk of complications related to age was 1.08 (95% confidence interval=0.91-1.27, p=0.53). In conclusion, our results suggest that in patients with IH scheduled for TEP repair, age does not represent a contraindication to surgery in terms of complication rate and postoperative results

Gamification design:toward developing image perception scales for generation Z consumers

Purpose – Drawing from the Personal Construct Theory, this research study analyzes the impact of employing gamified apps on user behavior by investigating the service-related images and individual preferences of Generation Z (GenZ) consumers, as these emerge from gamified applications in a tourism context. Design/methodology/approach – The Repertory Grid Analysis (RGA) elicited the top elements that reflect GenZer perceptions in tourism from empirical studies in the United Kingdom and Greece. Generalized Procrustes Analysis (GPA) was used to investigate the structure of the data for the creation of representative Consensus Biplots of the most important conceptual constructs to advance consumer decision-making modelling via gamification. Findings – As per different gamified app best-practices considered, we extract common perceptual elements (e.g. place informative aspects, exploration, lodgings, food/catering), but also different image components (e.g. virtual/interactive, business vs. commercial traveling, entertainment, heritage/cultural informative aspects) from comparing UK with Greek GenZers’ responses. These extracted attributes are then presented in two dimensional charts, respectively, towards creating tourist perception scales. Research limitations/implications – Notwithstanding the wide availability of gamified apps, research on gamification design in tourism and hospitality is still in the early phase. This study demonstrates the need to identify and optimize the formation of different images among GenZers. It also highlights the advantageous nature of the proposed combination of Procrustes analysis with the RGA.Originality/value – This research is among the first empirical ones towards creating scales for measuring tourist perceptions of GenZers coming from different consumer markets. It responds to scholars’ recent calls for better informing gamification design and improving contemporary consumer experience.<br/

Exploring the constraint profile of winter sports resort tourist segments

Many studies have confirmed the importance of market segmentation both theoretically and empirically. Surprisingly though, no study has so far addressed the issue from the perspective of leisure constraints. Since different consumers face different barriers, we look at participation in leisure activities as an outcome of the negotiation process that winter sports resort tourists go through, to balance between related motives and constraints. This empirical study reports the findings on the applicability of constraining factors in segmenting the tourists who visit winter sports resorts. Utilizing data from 1,391 tourists of winter sports resorts in Greece, five segments were formed based on their constraint, demographic and behavioral profile. Our findings indicate that such segmentation sheds light on factors that could potentially limit the full utilization of the market. To maximize utilization, we suggest customizing marketing to the profile of each distinct winter sports resort tourist segment that emerge

Exploring the negotiation thesis application among ski resort tourists: a segmentation approach

The negotiation thesis offers a framework for understanding the participation decision making of tourists. Unlike previous studies that investigate the causal relationship between constraints and tourists’ revisit intention, this study identified distinct segments of ski tourist based on the relative strength of constraints experienced and then investigated their decision-making process across a sample of 1,348 tourists of ski resorts. Chi-Squared Automated Interaction Detection (CHAID) analysis revealed that the decision making process regarding intention to revisit a ski destination varies between highly versus less constrained ski tourists, indicating different relative strengths of interpersonal, intrapersonal and structural constraints and different interactions among them when predicting revisit intention. On a practical basis, albeit the vast majority of participants were willing to repeat its visit, we offer customized per segment recommendations on increasing frequency of visitation and spending levels

The effect of sport tourists' travel style, destination and event choices, and motivation on their involvement in small-scale sports events

This exploratory study investigates whether and in which way motivation and destination, travel and event selection criteria influence sport tourists ’ involvement in small-scale events. Thus, a model was developed and tested at a small scale sport event in Sfendami, Greece. To test the six hypotheses of the proposed model a primary research study was conducted, which received responses from 181 participants. Implementation of the partial least square technique showed that changes in sport tourists’ travel style exert a direct and positive effect on involvement, as well as an indirect effect with motivation acting as a mediator; however, perception of destination and events characteristics does not exert a significant influence on participants’ involvement. Additionally, the model's ability to predict the motivational aspects of sport tourists’ participation was demonstrated. Multidimensional scaling was employed to assist with event service design and improve organizers’ capabilities to develop effective promotional strategies

Endometriosis and Infertility: A Multi-cytokine Imbalance Versus Ovulation, Fertilization and Early Embryo Development

Endometriosis is tightly linked to infertility which is manifested at very early or more advanced stages of the gestational cycle. Alteration on the production of a great number of cytokines/growth factors can be accused for problems on ovum maturation, fertilization or implantation. Yet, macroscopically these stages are characterized by the inability of conception. A closer look of the cytokinic profile during the conceptional and early gestational cycle could, however, localize the problem and allow a therapeutic approach. In this commentary, going through the cytokine requirement during ovulation, fertilization and the early stages of pregnancy, it became possible to specifically define the harmful endometriosis-induced cytokines for each of the conceptional and early gestational stages. Thus, regulating the levels of interferon-γ and tumor necrosis-α will facilitate ovulation and fertilization, whereas adjusting the levels of interleukin-1β and colony stimulating gactor-1 will facilitate implantation

Robust thermal stability for batch process intensification with model predictive control

Thermal runaways in exothermic batch reactors present major safety and economic issues for industry. Control systems currently used are not capable of detecting thermal runaway behaviour and achieve nominally safe operation by carrying out the reaction at a low temperature. Recently, improvements in safety and process intensity have been achieved by using Model Predictive Control (MPC) with embedded stability criteria. The reliance of this approach on accurate model predictions makes plantmodel mismatch a crucial issue. The most common source of plant-model mismatch is uncertainty of model parameters. Scenario-based MPC and worst case MPC are used with stability criterion K and Lyapunov exponents in this work. The effect of all uncertain parameters on thermal runaway potential can be identified easily for simulations in this work. Hence, worst case MPC results in a computationally more efficient control scheme than scenario-based MPC, whilst ensuring the same extent of safety and process intensification