Critical Events Research Articles

Mountains and Waves: Fontan Circulation in Different Environmental Conditions.

As surgical options and medical care for patients with univentricular heart physiology continue to improve, leading to increased life expectancy and quality of life, a new population of Fontan patients is growing up with the desire to participate in leisure activities, including aquatic activities, high-altitude stays, and air travel. Due to significant data gaps and insufficient experience, current guidelines do not provide clear recommendations, leading to uncertainty and sometimes restrictive patient management. This review summarizes new insights and the current state of research on this subject and provides an overview of the long overdue change in policies toward less restrictive counseling for Fontan patients regarding swimming, diving, high-altitude stays, and air travel. The current review summarizes the physiologic impact of aquatic and high-altitude activities on the cardiovascular system and presents currently available data on this topic in Fontan patients. Patients with Fontan circulation in good clinical shape can tolerate activities in the water and in the mountains as well as air traveling without critical events. In order to be able to make general recommendations, further studies with larger numbers of cases must be carried out.

Simplifying traffic simulation - from Euclidean distances to agent-based models

AbstractUrban settings require a thorough understanding of traffic patterns to best manage traffic, be prepared for emergency scenarios and to guide future infrastructure investments. In addition to analyzing collected traffic data, traffic modeling is an important tool that often requires detailed simulations that can be computationally intensive and time-consuming. A well-known comprehensive simulation framework is MATSim. On the other hand, simpler shortest-path routing systems that compute trips on an individual basis promise faster computations. The primary focus of this study is to assess the viability of a fast shortest path routing system as a method of traffic simulation. This study compares the MATSim with the Graphhopper routing system. Key metrics include travel time accuracy, congestion levels, route similarity, vehicle miles traveled, and average travel time. By analyzing these metrics, this study shows that a shortest-path routing system can serve as an effective and expedient approximation of more resource intensive simulation frameworks. This has significant implications for authorities and planners, as it offers a quick and efficient tool for traffic management and decision-making during critical events, enhancing their ability to respond quickly and effectively to dynamic traffic conditions.

Beyond Automation: A Rigorous Testing Framework for Reliable AI Chatbots in Life Insurance

AI-driven chatbots are transforming customer service in Life Insurance, offering policyholders instant support, streamlined inquiries, and personalized recommendations. However, deploying these chatbots effectively requires addressing unique challenges, including interpreting complex insurance terminology, ensuring regulatory compliance, and maintaining data security and user privacy. This research introduces a detailed testing framework specifically tailored to Life Insurance chatbots, covering functional, non-functional, AI-specific, and compliance testing to guarantee accuracy, reliability, and adherence to legal standards. The framework emphasizes essential practices for verifying natural language understanding, sensitive data handling, and empathetic responses for users navigating critical life events. This research highlights the critical role of targeted testing to deliver robust, user-centered chatbot solutions in the Life Insurance sector.

Mycophenolate Mofetil, an Inhibitor of Inosine Monophosphate Dehydrogenase, and Tofacitinib, a Janus Kinase Inhibitor, Attenuate Airway Inflammation and Hyperresponsiveness in a Mouse Model of Allergic Asthma

Treatment-resistant asthma remains an unresolved clinical problem and a challenge for current medical science. Consequently, there is a growing and urgent need to develop novel or alternative therapeutic options for the treatment of asthma. The research problem raised in this study was to assess and compare mycophenolate mofetil (MMF), an inhibitor of inosine monophosphate dehydrogenase, and tofacitinib (TFB), a Janus kinase inhibitor, for anti-asthmatic properties, and consequently to determine whether these agents may have potential as alternative options for treatment of allergic asthma. For this purpose, we assessed the effect of administration of MMF and TFB on the development of a mouse model of allergic airway inflammation (AAI) and accompanying CD4+ (cluster of differentiation 4) T-cell immune response in the lung-draining mediastinal lymph nodes (MLNs) and lungs, i.e., in the inductive and effector sites, respectively, of the immune response underlying the development of allergic asthma. The results from a histopathological scoring system demonstrated that the administration of MMF and TFB did not prevent or abolish ovalbumin-induced AAI, but strongly attenuated its severity. The pulmonary function tests revealed that the treatment with MMF and TFB significantly reduced methacholine-induced bronchoconstriction. These results indicate that the treatment with TFB and MMF attenuated the development of ovalbumin-induced AAI. The magnitude of the anti-asthmatic effect was comparable between both agents. The study revealed that the impairment of the clonal expansion of effector CD4+ T cells in the MLNs is a critical event in the mechanism underlying the anti-asthmatic effect of MMF and TFB. Apart from this, the findings of the study strongly suggest that the suppression of the interleukin-33/suppression of tumorigenicity-2 signaling pathway may constitute an additional mechanism responsible for producing this effect. In turn, the results indicate that the anti-asthmatic action induced by the studied agents is not mediated by the generation of forkhead box protein 3-expressing CD4+ regulatory T cells. Clinical implication of the results: the results suggest that MMF and TFB may exert anti-asthmatic action, and thus they may be considered therapeutic options for the treatment of allergic asthma cases resistant to conventional/existing treatment.

Protocol development and feasibility of the PEACH in Asia study: A pilot study on PEri-anesthetic morbidity in CHildren in Asia.

Comprehensive data on pediatric anesthesia outcomes, particularly severe critical events (SCEs), are scarce in Asia. This highlights the need for standardized research to assess anesthesia safety and quality in the diverse settings. The PEACH in Asia pilot study aimed to test the feasibility of a standardized protocol for investigating SCEs in anesthesia practices across Asia, evaluate the data acquisition processes, and determine the sample size for a main study. This multicenter pilot study involved ten institutions across nine Asian countries, including children from birth to 15 years undergoing diagnostic or surgical procedures. Data on SCEs were collected using standardized definitions. The study assessed the feasibility and estimated the sample size needed for the main study. The pilot study enrolled 330 patients, with a SCE incidence of 12.4% (95% CI: 9.2-16.4%). Respiratory events were observed in 7.0% of cases, cardiovascular instability in 4.9%, and drug errors in 0.6%. Based on the SCE incidence observed in the pilot study, the estimated sample size required for the main study is at least 10 958 patients. The pilot study demonstrated the feasibility of the study protocol but identified several challenges, particularly in resource-limited settings. These challenges included a significant burden associated with data collection, technical issues with electronic case report forms (e-CRFs), variability in patient enrollment across institutions (ranging from 4 to 86 patients per site), and incomplete data acquisition (24.8% of height data and 9.7% of disposition data were missing). The PEACH in Asia pilot study successfully validated a protocol for investigating SCEs in pediatric anesthesia across Asia. Addressing the challenges identified in the pilot study will be crucial for generating robust data to improve pediatric anesthesia safety in the region. Key issues to address include improving data collection methods, resolving e-CRF technical difficulties, and ensuring consistent institutional support.

Does cognitive aid app design influence the speed of actions during a critical event?: A simulation study.

Does cognitive aid app design influence the speed of actions during a critical event?: A simulation study.

Empowering microgrids for sustainable transportation electrification: A comprehensive methodology for resource adequacy and grid resilience

Transportation electrification has emerged as a pivotal solution to mitigate carbon emissions from the transportation sector. However, this shift towards electric vehicles (EVs) presents significant challenges for municipalities and utilities, particularly in ensuring the electrical grid's capacity to meet the increased demand. In this sense, this work introduces a novel methodology to address these challenges by 1) quantifying the impact of EVs on the hosting capacity (HC) of residential microgrids (MGs), and 2) proposing a novel control strategy to meet grid resource adequacy requirements under high levels of transportation electrification. For this, first, a simplified approach to quantify the overall demand in residential MGs, accounting for the influence of EVs and typical demand profiles based on real-world data from municipalities and utility systems is developed. Second, a new frequency controller is introduced, utilizing Distributed Phasor Measurement Units (D-PMU) and mobile energy sources (MES) to ensure compliance with resource adequacy requirements under high levels of EVs penetration. The proposed controller takes advantage of the low latency and high-resolution capabilities of D-PMU technology to enable the harnessing of MES, preventing critical frequency nadir events, and improving the overall system resource adequacy performance under both transient and steady-state analysis. Real-world data from Seattle, WA, USA, is used in the developed case studies, and comparative analysis between traditional SCADA, state-of-the-art D-PMU-based controller, and the proposed controller is presented. The obtained results indicate that significant improvements are achieved by the proposed controller, empowering utilities to ensure reliable operations amidst transportation electrification challenges imposed on resource adequacy.

Autobiographical Reasoning and Severity of Personality Dysfunction

Narrative identity is defined as a personal life story that integrates an understanding of the past and an envisioned future to provide life with a sense of meaning, unity and purpose. The key process through the construction of narrative identity is autobiographical reasoning, which can be understood from the perspective of three indicators: exploratory narrative processing, meaning-making, and self-event connections. The relationship between narrative identity and personality disorders has been examined extensively over the last decade. According to the latest literature, autobiographical reasoning could be a crucial narrative indicator of the severity of personality dysfunction. However, there was no research to verify this hypothesis. The main goal of the presented research was to examine relationships between autobiographical reasoning and the severity of personality dysfunction. The analysis includes data collected from 11 volunteers using a questionnaire (Self and Interpersonal Functioning Scale [SIFS]) and Life Story Interview (Critical Events). Each statement was treated separately (N = 88) in order to enable statistical analysis. The preliminary results show that the indicators of autobiographical reasoning are negatively correlated with some of the aspects of the severity of personality dysfunction. The results support the reasonability of the approach followed in this research, and contribute to academic discussion about relationships between narrative identity and personality disorders.

Long‐Term Foehn Reconstruction Combining Unsupervised and Supervised Learning

ABSTRACTFoehn winds, characterised by abrupt temperature increases and wind speed changes, significantly impact regions on the leeward side of mountain ranges, e.g., by spreading wildfires. Understanding how foehn occurrences change under climate change is crucial. As foehn is a meteorological phenomenon, its prevalence has to be inferred from meteorological measurements employing suitable classification schemes. Hence, this approach is typically limited to specific periods for which the necessary data are available. We present a novel approach for reconstructing historical foehn occurrences using a combination of unsupervised and supervised probabilistic statistical learning methods. We utilise in situ measurements (available for recent decades) to train an unsupervised learner (finite mixture model) for automatic foehn classification. These labelled data are then linked to reanalysis data (covering longer periods) using a supervised learner (lasso or boosting). This allows us to reconstruct past foehn probabilities based solely on reanalysis data. Applying this method to ERA5 reanalysis data for six stations across Switzerland and Austria achieves accurate hourly reconstructions of north and south foehn occurrence, respectively, dating back to 1940. This paves the way for investigating how seasonal foehn patterns have evolved over the past 83 years, providing valuable insights into climate change impacts on these critical wind events.

The Bhisho March and Massacre of September 1992: The ‘Leipzig Option’ and the Meanings of Mass Action in the South African Transition

ABSTRACT Amid repressive state violence and an escalating civil war in the Eastern Cape’s Border region, on 7 September 1992 more than 80,000 people marched to Bhisho, capital of the Ciskei Bantustan, to bring an end to the rule of its military ruler, Brigadier Gqozo. Widespread fears of a fatal showdown were realised when the Ciskei Defence Force opened fire, killing 29 and injuring more than 200. This critical event, understood as a most pivotal moment in South Africa’s transition to democracy, has rarely been subjected to historical scrutiny. This article casts new light on the events and politics surrounding the march, the contested meanings of mass action, the consequences of the massacre, and its subsequent narration by politicians in the wake of the tragedy. As the tragic culmination of the mass action campaign by the African National Congress (ANC), the Bhisho march became a theatre of the contested politics of mass action within the Tripartite Alliance. An initiative of local and regional alliance structures in the Border region, the march was exploited by national politicians to serve strategic agendas in the national negotiations, while the ANC’s narrative was carefully curated to legitimate its leaders and their national project.

Strengthened by struggle: Homeland attachment in the Karen diaspora after the 2021 Myanmar coup

This study delves into the heightened dynamics of homeland attachment within the Karen diaspora following the 2021 Myanmar military coup. It examines how this critical event has catalyzed a stronger sense of belonging and identity among the displaced Karen people across global diasporic communities. Drawing on qualitative data, this research highlights the intensified connection to their homeland that the Karen diaspora maintains, despite geographical separation and the transformative impact of resettlement. The concept of “homeland” for the Karen goes beyond physical borders, encompassing the shared experiences and narratives fostered within refugee camps and passed down through generations. This paper discusses how post-coup displacement has reshaped identity and how notions of home are re-envisioned within the diaspora’s collective memory and cultural practices. It demonstrates that homeland attachment is a complex mosaic of collective memories, cultural practices and a persistent sense of belonging that transcends boundaries. By exploring the transnational identities of the Karen diaspora post-coup, this work provides insights into the mechanisms by which displaced communities maintain their cultural uniqueness and affirm their belonging in a globalized world. The findings present a nuanced view of the dual challenges of assimilation and cultural retention, offering a deeper understanding of the strategies the Karen diaspora employs to preserve their identity in the face of these forces.

CRITICAL CAUSAL EVENTS IN SYSTEMS BASED ON CQRS WITH EVENT SOURCING ARCHITECTURE

Context. The article addresses the problem of causal events asynchrony which appears in the service-oriented information systems that does not guarantee that the events will be delivered in the order they were published. It may cause intermittent faults occurring at intervals, usually irregular, in a system that functions normally at other times. Objective. The goal of the work is the comparison and assessment of several existing approaches and providing a new approach for solving the causal events synchronization issue in application to the systems developed using Command Query Responsibility Segregation (CQRS) with Event Sourcing (ES) architecture approach. Methods. Firstly, the method of estimation of the likelihood of causal events occurring within the systems as the foundation for choosing the solution is suggested. Based on the results of the analysis of several projects based on CQRS with ES architecture it shows that the likelihood of critical causal events depends on the relationships among entities and the use-cases connected with the entities. Secondly, the Container of Events method, which represents a variation of event with full causality history, adapted to the needs of CQRS with ES architecture systems, was proposed in this work. The variants of its practical implementation have also been discussed. Also, the different solutions, such as Synchronous Event Queues and variation of Causal Barrier method were formalized and assessed. Thirdly, the methods described have been discussed and evaluated using performance and modification complexity criteria. To make the complexity-performance comparative assessment more descriptive the integrated assessment formula was also proposed. Results. The evaluation results show that the most effective solution of the issue is to use the Container of Events method. To implement the solution, it is proposed to make the modifications of the Event Delivery Subsystem and event handling infrastructure. Conclusions. The work is focused on the solution of the critical causal events issue for the systems based on CQRS with ES architecture. The method of estimation of the likelihood of critical causal events has been provided and different solutions of the problem have been formalized and evaluated. The most effective solution based on Container of Events method was suggested.

Inhibition of STAT3 signaling as critical molecular event in HUC-MSCs suppressed Glioblastoma Cells: Erratum

Inhibition of STAT3 signaling as critical molecular event in HUC-MSCs suppressed Glioblastoma Cells: Erratum

Sonoanatomy of the difficult airway. A case–control study

Introduction and objectivesThe occurrence of a difficult airway during intubation is a critical event in anaesthesia. Despite the usefulness of clinical predictors, difficult intubation frequently arises unexpectedly. The aim of this study was to determine the utility of airway ultrasound in detecting these patients. Materials and methodsThis was a case–control study. The patients in the case group were identified from the registry of patients with reports of difficult laryngoscopy (Cormack III and IV). The controls were selected from among patients classed as Cormack I who underwent surgery under general anaesthesia. Fifty patients (25 cases and 25 controls) participated in the study. All patients underwent ultrasound to obtain 3 measurements: distance from the skin to the hyoid bone, distance from the skin to the epiglottis, and distance from the skin to the vocal cords. ResultsA skin-to-hyoid bone distance greater than 9.8 mm (50% of the sample) generated an odds ratio of 5.46 (p = 0.005); a skin-to-epiglottis distance greater than 21.3 mm (50% of the sample) generated an odds ratio of 6.62 (p = 0.002). There was no significant difference in the skin-to-vocal cords distance. ConclusionsUltrasound has proven to be a useful tool for predicting difficult laryngoscopy. Despite the low sensitivity of clinical predictors, they appear to improve the detection of patients with difficult laryngoscopy when integrated into predictive models alongside ultrasound values.

An Umbrella Literature Review on Aortopathy and Fluoroquinolone Use

Background: Aortic dissection and aortic rupture are critical vascular events often predisposed by aneurysmal dilation of the aorta. The use of fluoroquinolone has been associated with aortic dissection and aortic rupture, necessitating a careful clinical review before use. Despite black box warnings, fluoroquinolones continue to be one of the commonly prescribed antibiotics. Critical care providers, specifically those who work in close association with high-volume aortic centers, can play an active role in antibiotic stewardship in the use of fluoroquinolones in patients with a known or predisposition to aortopathy. Aim: This paper provides a brief review of the potential effects of fluoroquinolones on the development of aortic aneurysm, dissection, and or rupture and the cautions to be exercised when using fluoroquinolones, especially in people who are predisposed to developing aortopathies. Methods: A rapid umbrella review was conducted on the effects of fluoroquinolones on aortopathy and the potential for acute aortic events associated with their use. The PICO (Population, Intervention, Comparator, Outcome) strategy coined the research question. It is as follows: In patients with known aortopathy or a known risk of aortopathy, what are the risks of an acute aortic event from taking fluoroquinolones compared to other antibiotics? A meta-analysis was done with selected studies utilizing a random effects model (utilizing Statsdirect software), which showed a pooled effect that favored the association of fluoroquinolones with aortopathy. Findings: Meta-analysis results showed a pooled effect that favored the association of fluoroquinolones with aortopathy. Discussion: Fluoroquinolone use potentiates the risk of developing aortic aneurysm and aortic dissection. Despite published evidence and warnings from manufacturers and regulatory bodies, fluoroquinolone use continues to be a covert contributor to the development of aortopathy. Conclusion: The literature reports multiple instances of fluoroquinolone-induced aortopathy. As such, fluoroquinolones should be reserved for use in situations where their benefits clearly outweigh the risks.

Sudden Cardiac Death Risk Prediction Based on Noise Interfered Single-Lead ECG Signals

Sudden cardiac death (SCD) represents a critical acute cardiovascular event characterized by rapid onset of cardiac and respiratory arrest, posing a significant threat to patients due to its high fatality rate. Monitoring indices related to SCD using wearable devices holds profound implications for preemptive measures aimed at reducing the incidence of such life-threatening events. Hence, this study proposed a predictive algorithm for SCD leveraging single-lead electrocardiogram (ECG) signals featuring low signal-to-noise ratios. Initially, simulated electrode motion artifact noise was introduced to ideal ECG signals to emulate the signal conditions with low signal-to-noise ratios encountered in everyday scenarios. To meet the criteria of simplicity and cost-effectiveness required for wearable devices, the analysis focused exclusively on single-lead signals. The proposed algorithm in this study employed a lightweight machine learning approach to extract 12-dimensional features encompassing ventricular late potentials, T-wave electrical alternation, and corrected QT intervals from the signal. The algorithm achieved an average prediction accuracy of 93.22% within 30 min prior to SCD onset, and 95.43% when utilizing a normal sinus rhythm database as a control, demonstrating robust performance. Additionally, a comprehensive Sudden Cardiac Death Index (SCDI) was devised to quantify the risk of SCD, formulated by integrating pivotal two-dimensional features contributing significantly to the algorithm. This index effectively distinguishes high-risk signals indicative of SCD from normal signals, thereby offering valuable supplementary insights in clinical settings.

Концепция периоперационного риска: обзор литературы

INTRODUCTION: Perioperative risk refers to the likelihood of adverse events occurring during and after surgery. For the purpose of defining and classifying adverse events and predicting them, a comprehensive search of Pubmed and Lens.org was made according to the author expert opinion. OBSERVATIONS: Traditionally, two main types of postoperative adverse events have been investigated: complications and mortality. However, over the past decade, there has been a growing trend to expand the range of adverse events analyzed, from intraoperative critical events and the quality of recovery from anesthesia to the development of intensive care syndrome, assessing quality of life, disability, and survival over time. An important aspect associated with adverse events and outcomes is the provision of additional resources for a long-term stay for patients with acute respiratory viral infections and inpatient care after discharge, among other things. The review formulates its own concept of perioperative risk, based on a critical analysis of literature, with an emphasis on the need to create an ideal tool, such as a calculator, that must undergo external validation. This tool should include available, modifiable variables, and accurately determine the full range of adverse events and outcomes during the intra- and early postoperative periods, as well as delayed events. The concept shall also focus on identifying and characterizing patients with a high risk of perioperative complications.

Modeling Emergency Traffic Using a Continuous-Time Markov Chain

This paper aims to propose a novel call for help traffic (SOS) and study its impact over Machine-to-Machine (M2M) and Human-to-Human (H2H) traffic in Internet of Things environments, specifically during disaster events. During such events (e.g., the spread COVID-19), SOS traffic, with its predicted exponential increase, will significantly influence all mobile networks. SOS traffic tends to cause many congestion overload problems that significantly affect the performance of M2M and H2H traffic. In our project, we developed a new Continuous-Time Markov Chain (CTMC) model to analyze and measure radio access performance in terms of massive SOS traffic that influences M2M and H2H traffic. Afterwards, we validate the proposed CTMC model through extensive Monte Carlo simulations. By analyzing the traffic during an emergency case, we can spot a huge impact over the three traffic types of M2M, H2H and SOS traffic. To solve the congestion problems while keeping the SOS traffic without any influence, we propose to grant the SOS traffic the highest priority over the M2M and H2H traffic. However, by implementing this solution in different proposed scenarios, the system becomes able to serve all SOS requests, while only 20% of M2M and H2H traffic could be served in the worst-case scenario. Consequently, we can alleviate the expected shortage of SOS requests during critical events, which might save many humans and rescue them from being isolated.

Two ubiquitous aldo-keto reductases in the genus Papaver support a patchwork model for morphine pathway evolution

The evolution of morphinan alkaloid biosynthesis in plants of the genus Papaver includes permutation of several processes including gene duplication, fusion, neofunctionalization, and deletion resulting in the present chemotaxonomy. A critical gene fusion event resulting in the key bifunctional enzyme reticuline epimerase (REPI), which catalyzes the stereochemical inversion of (S)-reticuline, was suggested to precede neofunctionalization of downstream enzymes leading to morphine biosynthesis in opium poppy (Papaver somniferum). The ancestrally related aldo-keto reductases 1,2-dehydroreticuline reductase (DRR), which occurs in some species as a component of REPI, and codeinone reductase (COR) catalyze the second and penultimate steps, respectively, in the pathway converting (S)-reticuline to morphine. Orthologs for each enzyme isolated from the transcriptomes of 12 Papaver species were shown to catalyze their respective reactions in species that capture states of the metabolic pathway prior to key evolutionary events, including the gene fusion event leading to REPI, thus suggesting a patchwork model for pathway evolution. Analysis of the structure and substrate preferences of DRR orthologs in comparison with COR orthologs revealed structure-function relationships underpinning the functional latency of DRR and COR orthologs in the genus Papaver, thus providing insights into the molecular events leading to the evolution of the pathway.

Spine deformity surgery in patients with Beals syndrome can be effectively performed but does risk revision surgery.

Beals syndrome or congenital contractual arachnodactyly is a rare disorder characterized by multiple joint contractures, Marfanoid body habitus and crumpled ears and has been associated with scoliosis. This study reports a clinical series of patients with Beals syndrome who have had surgical treatment for their spinal deformity. A retrospective review of all patients at a single institution who had a genetically-confirmed diagnosis of Beals syndrome and had surgical treatment for their scoliosis were reviewed for surgical outcome and complications. There were eight patients who had surgery at an average age of 11.5years, four were female and four had cardiovascular abnormalities requiring treatment. The preoperative coronal Cobb was 82.3° which improved to 42.1°(46.8% correction), and 46.5° (43.5% correction) at final follow-up. Preoperative halo-gravity-traction was used in three patients. Three patients had a posterior instrumentation and fusion (PSFI), 2 a combined anterior/PSFI, 1 had tethering, 1 with PSFI with posteriorly-approached discectomy, and 1 with a PSFI and vertebral column resection. One of the eight patients had a critical intraoperative neuromonitoring event but was normal following appropriate responses and no patient awoke with neurologic deficits. Two had an unplanned return to the operating room for implant dislodgement and each had a successful revision. Scoliosis associated with Beals syndrome can have large curves at the time of surgery and require a variety of surgical approaches to achieve a good result. Revision surgery with return to the operating room is necessary in 25% of patients.