Classical Criteria Research Articles

Electrocardiography versus Echocardiography in Severe Aortic Stenosis with the Consideration of Coexistent Coronary Artery Disease.

(1) Background: Coexistent coronary artery disease (CAD) might influence the ability of electrocardiogram (ECG) to identify echocardiographic left ventricular hypertrophy (ECHO-LVH) in patients with aortic stenosis (AS). We aimed to assess the relation between ECG-LVH (by the Sokolov-Lyon or Cornell criteria) and ECHO-LVH considering coexistent CAD. (2) Methods: We retrospectively analyzed the medical records of 74 patients (36 males) with severe AS who were hospitalized in the University Hospital in Cracow from 2021 to 2022. (3) Results: ECHO-LVH was present in 49 (66%) patients, whereas 35 (47.3%) patients had ECG-LVH. There was no difference between the rate of ECG-LVH in patients with vs. without ECHO-LVH. Single-vessel and multi-vessel CAD were diagnosed by invasive coronary angiography in 18% and 11% of patients, respectively. The sensitivity of the classical ECG-LVH criteria with regard to ECHO-LVH was low, reaching at best 41% for the Sokolov-Lyon and Cornell criteria. The results were similar and lacked a pattern when considering patients without significant stenosis, with single- and multi-vessel disease separately. Correlations between the left ventricular mass index and ECG-derived parameters were weak and present solely for the Lewis index (r = 0.31), R wave's amplitude >1.1 mV in aVL (r = 0.36), as well as the Cornell (r = 0.32) and Sokolov-Lyon (r = 0.31) voltage criteria (p < 0.01). The presence, location of stenoses, and CAD extent were not associated with the presence of either ECHO-LVH or ECG-LVH, irrespective of individual ECG-LVH criteria. (4) Conclusions: The sensitivity of classical ECG criteria for echocardiographic LVH in severe AS is low, regardless of coexistent CAD or its angiographic extent.

DETERMINAN KINERJA KARYAWAN PT. SMARTFREN TELECOM TBK

Abstract.&#x0D; Performance is the result of work in terms of quality and quantity achieved by an employee in carrying out their duties and responsibilities. The purpose of this research is to analyze the influence of compensation, leadership and career path on performance employee .Free variable in this research, namely compensation, leadership and career path, as well as the dependent variable, namely performance. Research population is an employee of PT. Smartfren Telecom Tbk Semarang Branch Office, with amount sample of 38 respondents. The data collection method is by distributing questionnaires to respondents. Data analysis uses multiple linear regression. Based on instrument test results data obtained results valid and reliable. Study this too has done it fulfil classical assumption test criteria. The result show that compensation, leadership and career path have a significant positive effect on employee performance.

Optimization procedure for conformance control

The article is devoted to the development of an optimization procedure for conformance control treatment. Currently, due to the significant share of reservoirs with high water cut, it is relevant to use methods that allow reducing the rate of production water cut increase. One of the most common methods to do this is to improve conformance by injecting suspension into the reservoir. The classical model of deep bed suspension migration has shown itself well for calculating the technological parameters of treatment, but it does not contain criteria for optimizing the process. The introduction of such criteria and their physical justification is the purpose of this work. The following objectives were set: modification of the classical model of deep bed suspension migration for layered strata, introduction of criteria of suspension treatment efficiency, and optimization of the process. Mathematical model consists of mass conservation laws and Darcy’s law. Initial data were selected for one of the fields in West Siberia, where suspension treatments were carried out to improve conformance. The field experience of these treatments is analyzed, the wells where the treatment was successful are determined. The new criterion for the effectiveness of suspension treatment is introduced. This criterion is the difference in the standard deviations of the flow rate along the layers before and after the treatment. It is established that this difference more clearly demonstrates the injectivity profile exchange than the classical Dykstra-Parsons criterion. The optimization procedure allows assessing the required slug volume that provides the maximum injectivity profile redistribution.

Lorenz Kaotik Devre Tabanlı Entropi Kaynağı ile Özgün Gerçek Rasgele Sayı Üretimi ve Ses Şifreleme Uygulaması

This paper introduces a methodology for generating secure cryptographic key bits from analog values obtained from the Lorenz chaotic circuit. The analog values are transferred from the chaotic circuit to the computer via an Analog Discovery-2 device and then post-processed by using a fixed-point number representation format and Von-Neumann corrector for the sampled values on the MATLAB program. By employing this method, the analog values are digitized and randomized as the main idea is to obtain secure and efficient statistically random bits. Furthermore, the generated random bits are utilized for secure audio transmission by demonstrating a practical application of the proposed methodology. In addition to the classical randomness test criteria, and NIST 800.22 statistical test suite, the throughput bit stream is also subjected to Chi-square and FIPS 140-1 tests to further evaluate its effectiveness. The results of these comprehensive tests confirm the successful performance of the proposed system in generating statistically random bits and its secure audio encryption system. The utilization of the Lorenz chaotic circuit as an entropy source in generating true random bits for secure audio transmission applications showcases the potential of the proposed system.

Total neoadjuvant therapy using short course radiation with or without SIB to lateral pelvic lymph nodes in locally advanced ugly rectal cancer.

30 Background: Optimal management for lateral pelvic lymph nodes (LPLN) in Ugly locally advanced rectal cancer (LARC) is unknown &amp; is associated with worse outcomes. We hypothesise that total neo-adjuvant (TNT) using Short-course radiotherapy (SCRT) with SIB to lateral pelvic lymph nodes would improve outcomes. Methods: All consecutive patients of LARC with LPLN treated with SCRT-based TNT from Jan 2021 – Dec 2022 were reviewed (IEC No: 4116). The LPLN (external, internal, common iliac or obturator) was considered radiologically significant based on joint clinic review with classical criteria. They were divided into two groups (SIB-IMRT: up to 30Gy/5#; or not). The chemotherapy schedule was similar to RAPIDO study, followed by TME +/- LPLN dissection based on radiological response assessed in joint clinic. Two groups were compared for baseline features using Fisher’s exact/Chi-Square tests as appropriate. Outcomes were reviewed for overall response in LPLN (radiological or pathological), disease outcomes &amp; toxicity (acute radiotherapy CTCAE v5, 30-day Clavien Dindo post-surgical, &amp; HRQL EOTRC QLQ-C30). Results: From 398 patients, 83 (20.8%) were identified with LPLN receiving SCRT with TNT, of which 44 (53.01%) received a SIB boost. Overall, 40% were aged ≤ 45 years, 50% had poor histology (signet, PDAC, Mucinous), 35% had EMVI, and 83% were N2+. The two groups had a similar distribution of baseline features (p&gt;0.05) &amp; were matched for poor prognostic factors. The patients who received a boost were 20% more likely to complete TNT and undergo TME than patients who did not (81.8% vs 61.5%; p=0.0099), mainly due to a significantly lesser event of disease progression before surgery, rendering them inoperable (25% vs 33.3%; p=0.024). Boost was associated with an increased overall response at LPLN by 20% (84.1% vs 64.1%; p=0.011) &amp; decreased need for PLND by 15% in patients considered for surgery (15.9% vs 30.56%; p=0.072). At a median follow-up of 18 months, 26 patients (31.33%) identified with disease progression were similarly distributed in two groups with similar patterns (all but one had distant metastasis, of which 6 had loco-regional failures). A total of 17 deaths with a non-significant trend of higher 18-month OS observed (boost: 83.4+6.3 vs 75.6+7.8%; HR:2.29(CI:0.85 - 6.19; p=0.09). None of the patients had acute &gt; grade 3 CTCAE v5 toxicity within 4 weeks of radiotherapy completion. Four (4.8%) deaths were chemotherapy-related, &amp; one post-surgery toxicity with similar &gt; grade 3 Clavien Dindo complications in two arms. EORTC QLQ C-30 PROM scores were similar in two groups. Conclusions: In ugly, poor biology LARC, TNT with SCRT-SIB to LPLN seem safe &amp; feasible with improved response, treatment completion &amp; operability without significantly increase in toxicity rates. Long-term prospective studies are warranted to identify significant survival impact.

Novel electrocardiographic criteria may render possible the more accurate recognition of cardiac amyloidosis.

The early diagnosis of cardiac amyloidosis (CA) is paramount, since there are effective therapies that improve patient survival. The diagnostic accuracy of classical electrocardiographic (ECG) signs, such as low voltage, pseudoinfarct pattern, and conduction disturbances in the diagnosis of CA, is inferior to that of the echocardiographic myocardial deformation criteria; therefore, our aim was to find more accurate novel ECG criteria for this purpose. We tested the diagnostic value of five novel ECG criteria, two of them devised by us, in 34 patients with confirmed CA (20 transthyretin amyloidosis and 14 AL amyloidosis) and 45 control patients with left ventricular hypertrophy on echocardiography due to hypertension, valvular aortic stenosis and hypertrophic cardiomyopathy. The following novel ECG criteria, that suggested CA, were tested: QRS amplitude in lead I<0.55mV (I<0.55); QRS amplitude in lead aVR<0.5mV (aVR<0.5); average QRS amplitude of leads I+aVR<0.575mV [(I+aVR)<0.575]; average QRS amplitude of leads I+aVR/average QRS amplitude of leads V1-4<0.375 [(I+aVR)/(V1-4)<0.375]; average QRS amplitude of leads I+aVR/longest intrinsicoid deflection in leads I,aVL,V1-6<0.0115 [(I+aVR)/I,aVL,V1-6ID<0.0115]. The I<0.55, aVR<0.5, (I+aVR)<0.575, (I+aVR)/(V1-4)<0.375, (I+aVR)/I,aVL,V1-6ID<0.0115 test accuracy (TA) were 81%, 84.8%, 82.3%, 84.8%, and 83.3%, respectively; the sensitivity (SE): 76.5%, 82.4%, 85.3%, 82.4%, and 76.9%; specificity (SP): 84.4%, 86.7%, 80%, 86.7%, and 87.5%; positive predictive values (PPV): 78.8%, 82.4%, 76.3%, 82.4%, and 80%; negative predictive values (NPV): 82.6%, 86.7%, 87.8%, 86.7%, and 85.4%; area under curve (AUC) values: 0.8922, 0.8794, 09016, 0.8824, and 0.8462 were respectively. These parameters of the novel ECG criteria were at least as good as those reported by other authors in the literature of the qualitative (TA: 67%, SE: 80%, SP: 34%, PPV: 75%, NPV: 42%, AUC: 0.57) and quantitative apical sparing (TA: 64-80%, SE: 66-81.3%, SP: 55-78.3%, PPV: 33-83.9%, NPV: 41-75%, AUC: 0.62-0.68) and left ventricular ejection fraction/global longitudinal strain >4.1 (TA: 77%, SE: 93%, SP: 38%, PPV: 79%, NPV: 69%, AUC: 0.65) echocardiographic criteria. Among the classical criteria, the low voltage in limb leads criterion was present most frequently (in 73.5%) in patients with CA, with slightly worse diagnostic value than the novel ECG criteria (TA: 78.5%, SE: 73.5%, SP: 82.2%, PPV: 75.8%, NPV: 80.4%). The novel ECG criteria [mostly the aVR<0.5, (I+aVR)/(V1-4)<0.375] seem at least as reliable in the diagnosis of CA as the best echocardiographic myocardial deformation criteria and might be used either together with the echocardiographic criteria or as stand-alone criteria to diagnose CA in the future.

Rockburst hazard assessment and prevention and control strategies in the Ruihai gold mine

Ruihai gold mine is a super large underwater gold mine with an initial mining depth of more than 1,400 m. Deep mining may face rockburst disaster. In order to scientifically control the potential rockburst risk, ensure the safety of underground personnel and equipment, and realize the safe and efficient mining of the mine, it is necessary to evaluate the rockburst risk of the mine and formulate appropriate rockburst risk warning and mitigation strategies. XRD mineral composition analysis and conventional rock mechanical tests were carried out on the parent rock granite samples. The results show that there are differences in the lithologic composition and rock mechanics parameters of the three colors of granite, which are preliminarily determined as three kinds of granite; The rockburst tendency of three kinds of granites is evaluated by using three classical rockburst criteria, and the discrimination results of the three rockburst criteria are not completely consistent or even contradictory. The application limitations rockburst risk assessment based on index criteria are discussed and analyzed in detail. It is proposed to apply microseismic monitoring technology to warn and manage the rockburst risk of Ruihai gold mine in development and mining stages, and put forward microseismic monitoring layout schemes and targeted rockburst prevention and control measures in different stages. The research results can provide reference for similar projects.

Iterative Hille‐type oscillation criteria of half‐linear advanced dynamic equations of second order

In this paper, we establish iterative Hille‐type criteria for advanced functional half‐linear dynamic equations of the second order. These results extend and improve recent criteria established by multiple authors for the same equation and encompass classical criteria. We provide an example to demonstrate the significance of the results obtained.

Population Pharmacokinetic and Pharmacodynamic Modeling of Romiplostim Biosimilar GP40141 and Reference Product in Healthy Volunteers to Evaluate Biosimilarity.

GP40141 is a romiplostim biosimilar. A Phase 1 clinical trial was previously conducted in healthy volunteers to evaluate the pharmacodynamics (PD), pharmacokinetics (PK), and safety of GP40141 compared to the reference romiplostim (NCT05652595). Using noncompartmental analysis, the biosimilarity of PD end points was determined according to the classical criterion (0.8-1.25). PK end points were also in good agreement between GP40141 and the reference romiplostim; however, the confidence interval for the area under concentration-time curve from time 0 to the time of last measurement was slightly out of the bioequivalence range (0.91-1.29). Population PK/PD was used in the present study to characterize the individual PK and PD data of 56 healthy subjects in 2 cross-over periods of the Phase 1 clinical trial. Body weight and neutralizing antibodies to romiplostim were found to be important predictors of apparent volume of distribution and linear elimination constant, respectively. Within the framework of the conducted modeling, population estimates of PK/PD parameters were obtained, which were in agreement with literature data for the reference romiplostim. Additionally, values of intersubject variability, previously unreported for romiplostim in a healthy subject population, were derived. Covariate analysis, conducted during model development, as well as visual diagnostics and model-based simulations, demonstrated the absence of significant differences in PK and PD between GP40141 and romiplostim-ref.

Изменение имиджа профессии педагогического работника в условиях трансформации современного образовательного пространства

The article analyses the situation concerning the transformation of the teacher’s status under modern conditions. Changes associated with reconsidering the value of education as a whole place the status of the teacher in a contradictory position. On the one hand, the long-term conditions of the pandemic have demonstrated the need to create a new methodological system for all forms of education, thereby providing new requirements to the personality and professional level of the teacher. On the other hand, the personnel shortage of teaching staff limits the process of adopting the system of a new personality meeting modern educational challenges and demands. At the same time, scientific discussions remain valid about what exactly a modern teacher should be like so that his image, students and parents’ trust begin growing. Today, image is becoming the main attribute of social and professional relations. In pedagogical activity, the processes of creating a professional image, which consists of individual’s assimilation and reproduction of social experience, are becoming increasingly relevant. Connected with the rethinking of the processes of professional self-determination and formation, there is a need to analyze professional competencies in the context of training a future teacher. In many ways, the professional activity of a teacher involves constructive interaction with the subjects of the educational process: with colleagues, students and their parents. The way interactions are built and contacts are established let us make conclusions about the professional qualities of a teacher. Ushinsky: «The teacher is a key figure in the reform of education, in the matter of teaching and upbringing, nothing can be improved in the entire school business without bypassing the head of the teacher» [Egorychev, 1993. P.79]. At the same time, along with classical criteria, the image of a modern teacher is also determined by compliance with new requirements, namely, the presence of emotional intelligence and its correct projection onto students, taking into account their requests and social needs. It is advisable to lay the vector at the stage of mastering higher pedagogical education, systematically changing educational programs of training future teachers. The paper reveals issues related to the image characteristics of the status of a modern teacher, based on empirical assessments of the main subjects of the educational process. The promise of scientific understanding of the issue is noted, along with growing interest in the search for optimal mechanisms aimed at increasing the role and significance of the teaching profession under modern conditions.

Auctox A New Method to Evaluate the Safety of Anticancer Drugs

The evaluation of anticancer drugs safety is currently based on considering the worst Adverse Event (AE) in a particular patient. The aim of the study was to define a new method which would better describe the impact of treatment on Quality of Life (QoL), combining Patient Reported Outcomes (PROs) and the monitoring of all AEs. A comparative approach to the classic National Cancer Institute-Common Toxicity Criteria for Adverse Events (NCI-CTCAE) classification was performed to assess the interest of monitoring Area Under the Curve (AUC) of toxicities on quality of life. A negative impact on global health status, assessed by the VAS of EQ-5D-3L, was significantly identified for three AEs based on CTCAE grade alone versus seven when considering AUCtox assessment.

Распространение магнитогидродинамических волн и гравитационная неустойчивость в астрофизической анизотропной и теплопроводной плазме

The hydrodynamic instability of a magnetised, self-gravitating rotating anisotropic plasma is analysed in the collisionless approximation and taking into account the heat flux vector on the basis of the modified Chew-Goldberger-Low equations. The dispersion relation is derived and simplified cases of propagation of small-amplitude perturbation waves are discussed, with modified analytical criteria for hydrodynamic instability obtained. In accordance with the general dispersion relation, three cases when the propagation of the perturbation wave passes across, along, and obliquely to the magnetic field vector are specifically considered. It is shown that anisotropic pressure and heat flux not only modify the classical Jeans instability criterion but also induce new unstable regions. It is found that the presence of uniform plasma rotation reduces the critical wave number and has a stabilising effect on the gravitational instability criterion for transverse propagation of the perturbation wave and has no effect in the case of its longitudinal propagation. The inclusion of thermal flows leads to the appearance of two additional wave modes. The results obtained are important for the construction of evolutionary magnetohydrodynamic models of collisionless astrophysical plasma.

A validated real-time PCR test for simultaneous detection of Gallus gallus and Meleagris gallopavo in feed instead of an impossible poultry test

Description of the subject. Use of all processed animal proteins (PAPs) in animal feeds was banned in the EU due to the outbreak of bovine spongiform encephalopathy (BSE). This total feed ban was progressively lifted for non-ruminant PAPs from 2013 onwards. Use of ruminant PAPs in feed remains totally prohibited. In order to extend the reintroduction of poultry PAPs in pig feed, and of pig PAPs in poultry feed, as recently decided, poultry species and pig detection tests were required to check that there is no intra-specific recycling. Objectives. In this study, we describe the official EURL-AP real-time PCR method for the simultaneous detection of chicken (Gallus gallus L.) and turkey (Meleagris gallopavo L.), the two most widely used poultry species in PAPs. Method. Classic quality criteria for the validation of a PCR method are considered. A cut-off is required for the interpretation of results. Transferability was tested through an interlaboratory study. Results. The developed PCR assay amplifies an 84 bp fragment encompassing the mitochondrial DNA on 12S ribosomal RNA, tRNA-Val and 16S ribosomal RNA sequences. The qualitative method was successfully assessed for several performance criteria: specificity, sensitivity, efficiency and robustness. The applicability of the test was verified on poultry PAPs and on compound feed containing 0.1% in mass fraction of poultry PAPs. An interlaboratory validation study demonstrated that the proposed real-time PCR method is transferable. Conclusions. The combined chicken-turkey real-time PCR assay is fit for the purpose of detecting poultry PAPs.

Oscillation Criteria Enhanced for Advanced Half‐Linear Dynamic Equations

The purpose of this study is to develop new iterative oscillation criteria for second‐order half‐linear advanced dynamic equations. These findings improve and extend recently established criteria for the same equation by several authors as well as encompass the existing classical criteria for associated ordinary dynamic equations. Some examples are given to show that the outcomes are accurate, practical, and adaptable.

The Influence Of Service Quality, Customer Relationship Management (CRM) And Brand Image On Customer Loyalty With Customer Satisfaction As An Intervening Variable

The aim of this research is to determine and analyze the influence of Service Quality, Customer Relationship Management (CRM) and Brand Image on Customer Loyalty with Customer Satisfaction as an intervening variable. This research uses purposive sampling with a sample of 100 respondents. This research testing uses quantitative methods. The validity test results of all question items are valid because the value of rcount &gt; rtable. The reliability test results of all question items are reliable because the Cronbach Alpha value is&gt; 0.60. The results of the classical assumption test all variables meet the classical assumption criteria. The results of multiple linear regression analysis in this research obtained b1 = 0.133 which shows the positive influence of the Service Quality variable (X1) on customer loyalty (Y). Meanwhile b2 = 0.182 shows the positive influence of CRM variables (X2) on Customer Loyalty (Y). Lastly, b3 = 0.252 shows the positive influence of the Brand Image variable (X3) on Customer Loyalty (Y).To test the hypothesis, there is a partially significant influence between Service Quality (X1) on customer loyalty (Y) with a value of tcount &gt; ttable (3.978 &gt; 1.983). CRM (X2) has a partially significant effect on Customer loyalty (Y) with a value of tcount &gt; ttable (2.164 &gt; 1.983). Brand Image (X3) has a partially significant effect on Customer Loyalty (Y) with a value of tcount &gt; ttable (2.335 &gt; 1.986). Customer Satisfaction (Z) mediates the influence of Service Quality (X1) on Customer Loyalty (Y) with a value of tcount &gt; ttable (14.734 &gt; 1.983). Customer Satisfaction (Z) mediates the influence between CRM (X2) on Customer loyalty (Y) with a value of tcount &gt; ttable (10.335&gt;1.983). Customer Satisfaction (Z) mediates the influence of Brand Image (X3) on Customer Loyalty (Y) with a value of tcount &gt; ttable (10.258 &gt; 1.983). Customer Satisfaction (Z) has a partially significant effect on Customer Loyalty (Y) with a value of tcount &gt; ttable (3.513 &gt; 1.983).

Resolution criteria to avoid artificial clumping in Lagrangian hydrodynamic simulations with a multiphase interstellar medium

ABSTRACT Large-scale cosmological galaxy formation simulations typically prevent gas in the interstellar medium (ISM) from cooling below $\approx 10^4\, \mathrm{K}$. This has been motivated by the inability to resolve the Jeans mass in molecular gas ($\ll 10^5\, \mathrm{M}_{\odot }$) which would result in undesired artificial clumping. We show that the classical Jeans criteria derived for Newtonian gravity are not applicable in the simulated ISM if the spacing of resolution elements representing the dense ISM is below the gravitational force softening length and gravity is therefore softened and not Newtonian. We re-derive the Jeans criteria for softened gravity in Lagrangian codes and use them to analyse gravitational instabilities at and below the hydrodynamical resolution limit for simulations with adaptive and constant gravitational softening lengths. In addition, we define criteria for which a numerical runaway collapse of dense gas clumps can occur caused by oversmoothing of the hydrodynamical properties relative to the gravitational force resolution. This effect is illustrated using simulations of isolated disc galaxies with the smoothed particle hydrodynamics code swift. We also demonstrate how to avoid the formation of artificial clumps in gas and stars by adjusting the gravitational and hydrodynamical force resolutions.

On the generalization capability of artificial neural networks used to estimate fretting fatigue life

This study assesses the generalization capacity of artificial neural networks (ANNs) for predicting fretting fatigue of mechanical contacts using different materials and geometries. These ANN utilize as inputs, material properties and stress quantities that have been physically related to the fatigue crack initiation mechanism under multiaxial loading. Initially trained and validated on aeronautical aluminum alloys data, one tests their generalization performance by applying them to fretting fatigue data for Ti‐6Al‐4V, ASTM A743 CA6NM steel, and Al 7050-T745, employing both cylindrical and spherical pads under various loading conditions, including out-of-phase loading. The ANNs adeptly predict fatigue lives across this extensive dataset, surpassing classical multiaxial fatigue criteria in accuracy. This underscores the effectiveness of ANN-based methodologies in diverse fretting fatigue scenarios.

The Cauchy Problem for the General Telegraph Equation with Variable Coefficients under the Cauchy Conditions on a Curved Line in the Plane

The Riemann method is used to prove the global correctness theorem to Cauchy problem for a general telegraph equation with variable coefficients under Cauchy conditions on a curved line in the plane. The global correctness theorem consists of an explicit Riemann formula for a unique and stable classical solution and a Hadamard correctness criterion for this Cauchy problem. From the formulation of the Cauchy problem, the definition of its classical solutions and the established smoothness criterion of the right-hand side of the equation, its correctness criterion is derived. These results are obtained by Lomovtsev’s new implicit characteristics method which uses only two differential characteristics equations and twelve inversion identities of six implicit mappings. If the righthand side of general telegraph equation depends only on one of two independent variables, then it is necessary and sufficient that it be continuous with respect to this variable. If the right-hand side of this equation depends on two variables and is continuous, then in its integral smoothness requirements it is necessary and sufficient the continuity in one and continuous differentiability in the other variable. The correctness criterion represents the necessary and sufficient smoothness requirements of the right-hand side of the equation and the Cauchy data. From the established global correctness theorem, the well-known Riemann formulas for classical solutions and correctness criteria to Cauchy problems for the general and model telegraph equations in the upper half-plane are derived. In the works of other authors, there is no necessary (minimally sufficient) smoothness on the right-hand sides of the hyperbolic equations of real Cauchy problems for the set of classical (twice continuously differentiable) solutions.

A new fuzzy approach of vehicle routing problem for disaster-stricken zones

Abstract Route planning problems are among the activities that have the highest impact in emergency logistical planning, goods transportation and facility location-distribution because of their effects on efficiency in resource management, service levels and client satisfaction. In the extreme conditions, such as disaster-stricken zones, the difficulty of vehicle movement between nearest different affected areas (demand points) on planning routes cause the imprecision of time of movement and the uncertainty of feasibility of movement. In this paper, the imprecision is presented by triangular fuzzy numbers and the uncertainty is presented by a possibility measure. A new two-stage, fuzzy bi-criterion optimization approach for the vehicle routing problem (VRP) is considered. On the first stage, the sample of so-called “promising” closed routes are selected based on a “constructive” approach. On the second stage, triangular fuzzy valued Choquet aggregation (TFCA) operator is constructed for the selected closed routes. The evaluation of constructed routes, levels of failure and possibility of vehicle movement on the roads are aggregated by the TFCA operator by the new criterion – minimization of infeasibility of movement. The new criterion together with the classic criterion – minimization of the total distance traveled – creates a bi-criteria fuzzy VRP. The constructed VRP is reduced to the bi-criteria fuzzy partitioning problem, and an 𝜀-constraint approach is developed for solving it. For numerical experiments, a parallel algorithm is created on the basis of D. Knuth’s algorithm of Dancing Links (DLX). An example is presented with the results of our approach for the VRP, where all Pareto-optimal solutions are found from the set of promising routes. The optimal solutions tend to avoid roads that are problematic because of extreme situations.

Peripartum Cardiac Arrest with Terminal QRS Distortion: A Case Report.

Peripartum cardiac arrest is increasing in incidence. While pulmonary embolism (PE) remains an important cause of peripartum morbidity and mortality, other cardiovascular emergencies such as myocardial infarction (MI) are now the leading cause of pregnancy-related death. Emergency physicians (EP) need to be well versed in subtle electrocardiographic (ECG) signs of coronary ischemia to better care for peripartum patients in cardiac arrest. A 38-year-old gravida 2 parity1 female three days post-partum presented in cardiac arrest. After approximately 12minutes of Advanced Cardiac Life Support including electric defibrillation, the patient experienced sustained return of spontaneous circulation. The physician team was primarily concerned for PE based on an initial ECG demonstrating terminal QRS distortion in V2 but no ST-segment elevation myocardial infarction (STEMI). Computed tomography angiography (CTA) of the chest did not reveal PE. Repeat ECG after CTA demonstrated STEMI criteria, and the patient was emergently taken to the cardiac catheterization laboratory where she was found to have 99% occlusion of the left anterior descending artery. Emergency physicians should have a high index of suspicion for MI when managing peripartum patients in cardiac arrest. The ECG findings specific for coronary-occlusive acute MI but not included in the classic STEMI criteria increase accuracy and prevent delays in diagnosis; however, the clinical uptake of this paradigm has been slow. Early recognition of terminal QRS distortion can help EPs more rapidly diagnose the etiology of cardiac arrest.