Analysis of Challenges for Blockchain Adoption in Enterprise Distributed Applications

Decentralization, auditability, smart execution, and security are four ways that blockchain technology (BCT) differs from current cutting-edge technologies based on client-server architecture. Without the need of any middlemen, blockchain technology builds trust between untrustworthy parties. By employing its distinctive properties, blockchain technology is presently used to address the problems of enterprise distributed applications (EDAs) to some extent. As a result, businesses involved in a wide range of industries have shown interest in it. Despite being praised as tool for businesses to create secure applications, BCT is still not widely used. The objective of the current study is to use an extension of the technology acceptance model (TAM2), constituted by 15 hypotheses (H1–H15), to address the factors that influence professionals' desire to adopt the BCT in the EDAs. In order to achieve the research objective, the study consists of a quantitative non-experimental correlational method with the goal of creating an empirical model to evaluate the relationship between perceived usefulness, perceived ease of use, scalability, effort, performance, adaptability, maintainability, experience, and blockchain adoption in India with a focus on EDAs. Descriptive analysis, discriminant analysis, multiple linear regression, ANOVA, homoscedasticity, multicollinearity, reliability, linearity, survey question's normality, and independent errors are conducted to analyze survey data from a sample of 396 IT professionals from various firms in India. The findings show that IT professionals' desire to employ the BCT in EDAs are positively impacted by all the hypothesis except H3 and H8 that has no impact on IT professionals' desire to employ BCT

Persistent post-surgical pain following breast cancer surgery: An observational study in a tertiary care hospital

Objective: To determine the frequency of persistent pain in patients after breast cancer surgery, and to assess the distribution and characteristics of pain in such patients.Methods: The prospective observational single cohort study was conducted at the Department of Anaesthesiology and in the Breast Clinic of the Department of Surgery, Aga Khan University Hospital, Karachi, from August 2016 to January 2017, and comprised adult female patients with biopsy-proven carcinoma of breast who were scheduled for elective definitive breast cancer surgery. The patients were followed up for up to three months post-surgery and those with persistent pain were followed up for six months post-operation. Data was analysed using SPSS 19.Results: Of the 120 patients, 26(21.7%) developed persistent post-surgical pain for up to three months, while in 17(14.2%) patients, the pain continued for up to six months after the operation. Among those with persistent post-surgical pain, 11(42.3%) had burning pain, 10(38.5%) had throbbing pain, 3(11.5%) had numbness and 2(7.7%)had mixed character of pain. Also, 11(42.3%)patients developed pain at more than one site including axilla, chest wall, upper arm and surgical scar area, and the site of pain in majority patients 15(57.7%) was axilla.Conclusion: The incidence of persistent pain following breast cancer surgery was found to be 21.7%

A projected finite element update method for inverse identification of material constitutive parameters in transversely isotropic laminates

In this paper, a novel application of Finite Element Update Method (FEUM) is proposed for the inverse identification of material constitutive parameters in transversely isotropic laminates. Two-dimensional Digital Image Correlation (2D–DIC) is used for full-field measurements which is required for the identification process. Instead of measuring the in-plane displacements, which is a well-known application of 2D–DIC, we seek to measure the pseudo-displacements resulting from out-of-plane (towards camera) deflection of plate under a point load. These pseudo-displacements are basically the perspective projection of the three dimensional displacement fields on the image-plane of the image acquisition system. The cost function in this method is defined in terms of these projections instead of the true displacements – and hence the name Projected Finite Element Update Method (PFEUM). In this article, identification of in-plane elastic moduli of Carbon Fiber Reinforced Plastic (CFRP) plate has been performed using plate bending experiments which show pre-dominantly out-of-plane deflection with little contribution from the in-plane displacements. Identification results are validated by direct experimental measurements of the unknown elastic constants as well as theoretical estimates based on volume ratio of constituents. The results show good conformance between estimated and target values for at least three material parameters namely E1, E2 and G12. Effects of experimental noise on parameter estimates has also been evaluated to explain the observed deviation in estimated parameters with current test configuration

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Application of fuzzy-MOORA method: Ranking of components for reliability estimation of component-based software systems

Component-based software system (CBSS) development technique is an emerging discipline that promises to take software development into a new era. As hardware systems are presently being constructed from kits of parts, software systems may also be assembled from components. It is more reliable to reuse software than to create. It is the glue code and individual components reliability that contribute to the reliability of the overall system. Every component contributes to overall system reliability according to the number of times it is being used, some components are of critical usage, known as usage frequency of component. The usage frequency decides the weight of each component. According to their weights, each component contributes to the overall reliability of the system. Therefore, ranking of components may be obtained by analyzing their reliability impacts on overall application. In this paper, we propose the application of fuzzy multi-objective optimization on the basis of ratio analysis, Fuzzy-MOORA. The method helps us find the best suitable alternative, software component, from a set of available feasible alternatives named software components. It is an accurate and easy to understand tool for solving multi-criteria decision making problems that have imprecise and vague evaluation data. By the use of ratio analysis, the proposed method determines the most suitable alternative among all possible alternatives, and dimensionless measurement will realize the job of ranking of components for estimating CBSS reliability in a non-subjective way. Finally, three case studies are shown to illustrate the use of the proposed technique

Analyzing Project Complexity, Its Dimensions and Their Impact on Project Success

Projects are undertaken in all science, engineering, and technology fields to achieve strategic and tactical goals. It is evident from the literature that projects are becoming more complex day by day, making project complexity a domain for current research. The objective of this study is to evaluate project complexity using a systematic, comprehensive, and widely accepted definition that can capture the multidimensional nature of project complexity and its impact on project success. Therefore, an integrative systemic framework has been selected to define project complexity considering seven key dimensions: context, size, diversity, autonomy, connectivity, emergence, and belonging. The study employed structural equation modeling to analyze project complexity, its dimensions and their relationship with project success for complex engineering projects. After an extensive literature review, a validated questionnaire was developed and used to obtain responses from different countries (Pakistan, China, UAE, UK, USA, and others) in the engineering fields of aerospace, design, manufacturing, oil and gas, IT, and construction. The work shows that project complexity has a negative impact on project success for complex engineering projects. Further, analyses examined the relationship between project success and the seven dimensions of project complexity. The significance of this study lies in its evaluation of project complexity using a systematic and comprehensive definition which is different from previous studies and brings more clarity and understanding of the underlying mechanisms and causal relationships between project complexity, project success and their related factors. The findings suggest that careful consideration of these dimensions and their factors can help project managers better understand and navigate project complexity and ultimately improve project success rates