Emergency Circumstances Research Articles

COVID-19 and Female Fertility: An Observational Prospective Multicenter Cohort Study: Upholding Reproductive Rights in Emergency Circumstances.

Currently available research data points to COVID-19-related multi-organ system damage. This study aims to evaluate the impact of SARS-CoV-2 on the reproductive health, that is, plasma levels of FSH, LH, estradiol, AMH, and antral follicular count, of women undergoing level II ART techniques. This is a multicenter, prospective, and observational study by the reproductive medicine centers of Palermo's Ospedali Riuniti Villa Sofia-Cervello Hospital and Vanvitelli University. From September 2022 to March 2024, 203 patients aged 24-43 were enrolled, all with diagnosed infertility and a history of SARS-CoV-2 infection. Symptomatic women, patients testing positive for HIV or other liver viruses, and patients with a history of ovarian cancer or who had taken gonadotoxic drugs were excluded. Plasma measurements of FSH, LH, estradiol, AMH, and antral follicular count were performed before and after infection. The analysis accounting for the concentration of anti-Müllerian hormone (AMH) before and after COVID-19 infection shows an average concentration decrease from 1.33 ng/mL before SARS-CoV-2 infection to 0.97 ng/mL after infection. Average decrease after infection was -27.4%; average reduction of 1 follicle (95% CI: from -0.74 to -1.33) was reported following SARS-CoV-2 infection. Levels of E2 before and after SARS-CoV-2 infection did not vary significantly. Average FSH and LH levels before and after SARS-CoV-2 infection pointed to an increase. SARS-CoV-2 infection damages female reproductive health, causing significant reductions in AMH (-27.4%) and AFC (-1 antral follicle) values and an increase in FSH (+13.6%) and LH (+13.4%) values. No effect on E2 levels was reported. The pandemic has also affected the ability of infertile patients to access ART procedures, and that calls for a novel, updated blueprint designed to enhance our preparedness in the event that similar circumstances should occur again.

Odysseus inside the Cyclop’s cave: Turnaround strategy and leadership insights from the struggle against Polyphemu

The present study aspires to perform a thorough examination of the notion of turnaround strategy process within the context of Homer’s Odyssey. More specifically, focusing on Odysseus’ struggle against the one-eyed Cyclop, Polyphemus, we seek to draw some interesting insights into the way a turnaround process unfolds, as well as its key attributes and components. Although the topic of turnaround strategy has attracted significant research attention over the last 50 years, the vast majority of extant studies has focused on the practices of formerly declining companies which mainly originate from developed countries. Furthermore, most of the existing studies are based on quantitative research methodologies, such as large sample surveys. The novelty of the present study is associated with the adoption of a multidisciplinary perspective, whereby modern strategic management and leadership theories are applied in order to analyze and interpret one of the greatest masterpieces of global literature, Homer’ Odyssey. This objective is attained through the employment of a qualitative, case study research methodology. More specifically, the symbolic analysis of Odyssey’s Book 9, indeed yielded some very interesting insights regarding the way a representative turnaround process unfolds, as well as the importance of effective leadership as part of such processes. Based on Odysseus’ actions and behaviors toward his companions during this crisis situation, we conclude that transformational leadership may be the most appropriate leadership style under extraordinary and emergency circumstances.

Sensitivity and Specificity of Jolt Accentuation Maneuver in Diagnosis of Acute Meningitis

Background: Acute meningitis is a potentially fatal illness that necessitates immediate identification and medical intervention. The Jolt Accentuation Maneuver (JAM) is a straightforward and non-invasive diagnostic test that can help in diagnosis of acute meningitis. Objectives: This study assessed the accuracy of JAM in detecting acute meningitis by evaluating its sensitivity and specificity. Methods: The study was done at Pak Emirate Military Hospital, Rawalpindi, from January 2024 to June 2024, using prospective observational method. 280 patients with symptoms indicative of meningitis were included in the study. Every patient received JAM procedure, followed by an examination of CSF, which was used as the definitive method for diagnosis. Results: The study group had average age of 35.2 years and was almost equally divided between males (50.7%) and females (49.3%). The prevalent symptoms consisted of headache (97.1%), fever (92.9%) and neck stiffness (82.1%). The JAM test demonstrated sensitivity of 88.9% (p<0.001) and specificity of 60.0% (p<0.05). The positive predictive value (PPV) was 80.0% (p<0.05) and negative predictive value (NPV) was 75.0% (p<0.05). The overall accuracy of the data was 82.1% (p<0.001) indicating statistical significance. The study of ROC curve revealed an area under the curve of 0.90, indicating a high level of diagnostic accuracy. Conclusions: JAM is a diagnostic test for acute meningitis that is quite sensitive and has a decent level of specificity. Due to its high sensitivity, it is highly effective tool for initial screening, particularly in emergency circumstances. Nevertheless, because of its moderate specificity, it is necessary to confirm positive JAM results with other diagnostic testing. Incorporating JAM into clinical practice can expedite diagnosis and prompt treatment, potentially enhancing patient outcomes. Keywords: Acute meningitis, Diagnosis, Jolt Accentuation Maneuver, Sensitivity, Specificity.

Government policies on port resilience amid strike events—A two-stage Van Damme based tripartite evolutionary game

In contrast to natural phenomena, such as extreme weather, accidents, disasters, and public health emergencies, labor strikes are human-induced emergent circumstances arising from low real wages in most cases. During disputes with ports, the labor typically exerts control over the duration and scale of strikes to negotiate improved benefits, while port authorities may seek collaboration with neighboring ports to enhance resilience and mitigate transportation disruption risks. Should the government participate as a third party in the game as an indirect stakeholder? The government must assess the necessity of engagement in the first stage and select an appropriate strategy in the second. Within the framework of tripartite equilibrium, this study examines the evolutionary paths of stability points, dual-stable states, and unstable states under different government engagement policies, as well as the influence of each factor on the tripartite strategy choice. The results reveal that (1) the right timing and policies for government engagement can mitigate more than half of the damage from the strike to the overall system; (2) port alliances can speed up 50 % of the evolution time of the labor to terminate the strike; (3) the government will play the dominant role when the risk of the strike to labor is increased; and (4) the expected duration of strikes can have an inverted “U”-shaped effect on port strategies but a “U”-shaped effect on government policies. The application of the two-stage evolutionary game model in this study develops an analytical framework that provides better reference for the government’s actual decision-making.

How to avoid heavy life losses in Liulin-like flash flood events

Abstract. From 11 to 12 August 2021, an extreme rainstorm attacked the Liulin Town, a very common town in Hubei Province, China. The rainstorm triggered flash flood and caused heavy live losses. This study first conducted an analysis on the causes of the flash flood disaster, then, performed a simulation to review the flash flood process, and finally discussed the technical strategies and approaches to avoid life losses in similar cases. The main understandings include: (1) accumulative rainfall of shorter interval and time-sliding is significantly helpful to improve warning accuracy; (2) flash flood risk needs to be evaluated at catchment scale and making room for floods is necessary; (3) residential buildings threatened by flash floods need to rebuild some structures for live-saving in emergency circumstances; and (4) early warning system needs to have capabilities to collect real basin-wide rainfall and flood information, especially in case of rainstorm, and to be smart to judge hazard level.

Defining the Value of Vascular Surgery Service at a Tertiary Academic Medical Center

BackgroundVascular surgeons play a critical role in the functioning of a healthcare system. As a service line, vascular surgery not only performs its own complex operations but also provides support to other surgical specialties by assisting in the management of vascular-related complications. Previous reports have acknowledged the value of consulting vascular surgeons; however, these studies have primarily been limited to single-center series. In this study, we aim to contribute to the existing literature by sharing our experience and highlighting the financial value of consulting vascular surgeons at a large tertiary academic medical center. MethodsInstitutional electronic medical records were retrospectively queried for all operations performed by vascular surgeons from 2020-2022. Two separate procedural groups were identified. The first group comprised all surgeries where vascular surgery was listed as a co-surgeon for other surgical specialties. The second group comprised all surgeries where vascular surgery was the primary surgeon for service-level cases. Service cases were defined as operations resulting directly from (1) iatrogenic complications from other services, (2) consultations for traumatic injury, or (3) primary surgeon for non-vascular cases. The Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule was used to calculate work relative value units (wRVU) per primary procedure code. ResultsA total of 7821 surgeries were performed with vascular involvement over the study period. Of these, 726 operations (9.3%) were co-surgeon cases requiring intraoperative vascular assistance, from 109 surgeons across all 16 surgical specialties. There was no missing data. The most common specialties requesting vascular assistance included cardiac surgery (n=247, 34.0%), orthopedic surgery (n=152, 20.9%), and neurosurgery (n=131, 18.0%). Total procedural wRVU for co-surgeon cases was 16,220, and total charges exceeded $77.5 million dollars. Vascular surgery served in a primary surgeon role in an additional 154 service-level cases (2.0%) resulting from ten non-surgical services. The most common service-level indication was iatrogenic vascular injury (n=87, 56.4%), and the majority of service-level cases required urgent or emergent surgery (n=123, 79.9%). These procedures generated an additional 2,150 wRVU and $1.1 million dollars in charges for the hospital system. Of all co-surgeon or service-level cases, 19.1% (n=168) occurred after-hours and 10.3% (n=91) occurred on a holiday or weekend. ConclusionVascular surgery is crucial to the operation of all surgical services and many non-surgical service lines within an academic medical center. Apart from providing essential services for primary vascular diseases, the vascular surgery service line offers substantial financial benefits to the healthcare system through its consulting role. A considerable portion of operative consultations are performed under urgent or emergent circumstances, often necessitating surgical intervention outside regular working hours or on holidays/weekends. These findings have significant implications for assessing the value and compensation of vascular surgeons in today's healthcare landscape.

Юридические ограничения в организации выборов и референдумов в условиях чрезвычайного положения: конституционно-правовой аспект

The article is dedicated to the study of the problem of restrictions to political rights of citizens in the state of emergency. Based on an analysis of laws on elections, referendum and the state of emergency, the author concludes that the constitutional legislator is forced to use methods of election (discretion), sufficiency of grounds (need to exclude spontaneous decisions), proportionality, detailed legal regulation (grounds for the introduction, cancellation and amendment of the state of emergency), reasonable flexibility of the legal policy and adequacy of the law enforcement practice. Extraordinary and emergency circumstances that objectively exclude any freedom of public events, debates, discussions, speeches and sharing opinions on politics and resolutions of government authorities are the only sufficient basis to introduce the state of emergency in a country or its certain territories.

Design of Radial Distribution System to Study Load-Flow and Short Circuit Analysis Using ETAP Software

This work's analysis provides information on fault analysis and load flow studies, which help to understand how radial distribution networks operate both in normal and emergency circumstances. The research explores optimization methods, describing capacitor placement, transformer size, and feeder reconfiguration in order to lower losses and increase system efficacy. Moreover, the work looks at reliability-focused maintenance techniques, stressing the need of predictive maintenance and condition monitoring in raising the dependability of radial distribution networks. Modern electrical power networks depend heavily on their radial distribution system, which effectively and dependable distributes electricity to customers. Many radial distribution system-related topics are covered in detail on this website, including analytical methods, optimization processes, and dependability enhancement strategies. Power flow, voltage control, and losses in radial networks are investigated in this paper under a range of operational situations. The last and crucial stage of a power system, the electrical distribution system makes sure that customers have a steady supply of electricity. Regretfully, because it is often neglected and exposed to environmental risks, our distribution network has a number of problems. Our distribution feeder is rigorously analyzed for load flow and short-circuits in order to overcome these challenges and find and fix problems. The main topics of this study are the load flow and short-circuit analysis of a radial distribution feeder, which is mostly constructed with (ETAP). The final and crucial part of a power system, the electrical distribution system ensures that consumers receive an uninterrupted and steady supply of electricity. Our distribution feeder undergoes a rigorous and cautious process to address these issues front on because of the uncontrollable nature and susceptibility of our network to environmental hazards. This paper delves deeply into the issues of short-circuiting and load flow in radial distribution feeders. Both symmetrical and asymmetrical faults are thoroughly investigated by mathematical computations and ETAP simulations; the results of the software simulations are contrasted with those of the mathematical analysis. These discoveries will definitely influence the development and management of our system and point us in the direction of workable and practical solutions.

The Impact of Emergency Circumstances on the Disbursement of Zakat

The Impact of Emergency Circumstances on the Disbursement of Zakat

Improving emergency evacuation capacity for subway stations based on agent-based modelling

Purpose Modern subway transportation systems need to satisfy increasing safety demands to rapidly evacuate passengers under hazardous emergency circumstances, such as fires, accidents or terrorist attacks, to reduce passenger injuries or life losses. The emergency evacuation capacity (EEC) of a subway station needs to be revised timely, in case passenger demand increases or the evacuation route changes in the future. However, traditional ways of estimating EEC, e.g. fire drills are time- and resource-consuming and are difficult to revise from time to time. The purpose of this study is to establish an intuitive modelling approach to increase the EEC of subway stations in a stepwised manner. Design/methodology/approach This study develops an approach to combine agent-based evacuation modelling and building information modelling (BIM) technology to estimate the total evacuation time of a subway station. Findings Evacuation time can be saved (33% in the studied case) from iterative improvements including stopping escalators running against the evacuation flow and modifying the geometry around escalator exits. Such iterative improvements rely on integrating agent-based modelling and BIM. Originality/value The agent-based model can provide a more realistic simulation of intelligent individual movements under emergency circumstances and provides precise feedback on locations of evacuation bottlenecks. This study also examined the effectiveness of two rounds of stepwise improvements in terms of operation or design to increase the EEC of the station.

Право на дерогацию*

The article systematically outlines possible conventional and other normative cases and conditions for the application of derogatory measures provided for by the main international human rights treaties and the Constitution of the Russian Federation. The author notes that international human rights treaties allow States parties to introduce, under certain conditions, legal norms restricting the application of certain rights, as well as in the event of emergency circumstances on their territory, to deviate from fulfilling their international obligations to protect human rights and fundamental freedoms and suspend their national legislation in this area. Derogatory measures are taken only to the extent necessary for the State in the interests of its security, but they should not contradict obligations arising from general international law. The article states that for the modern development of Russia, the interpretation of the norms of international law on derogation, the grounds used in it and the limits of limitation of rights are of great legal and practical importance. In the event of a state of emergency in a country or in some of its regions, the protection of human rights, albeit with some exceptions dictated by special circumstances, is still among the international obligations of the State.

Development of a three-stage hierarchical model for quick calculating stair evacuation time of high-rise building coupled with simulation analysis

Calculating the evacuation time during staircase evacuation is essential to evaluate the security conditions of high-rise buildings under emergency scenarios. A three-stage hierarchical model for calculating emergency evacuation time is constructed by combining discrete state update rules and continuous forms in computation to investigate the evacuation process of pedestrians in multi-floor buildings in emergency circumstances. Combined with simulation analysis, the model considers the capacity constraint of stairwell and congestion effects and calculates the evacuation time hierarchically. The model's validity is verified by the existing evacuation simulator for a hypothetical building case study, coupled with a comprehensive computational comparison. Calculations on entire and separate evacuation times are explored considering different stairway capacity restrictions and geometric features. Computational results demonstrated that this model is effective and may be regarded as a valid tool for staircase evacuation time calculation in the context of high-rise buildings.

Professional and applied physical training as the main type of military professional activity of cadets

Abstract. The readiness of the Armed Forces to repel the armed aggression of the Russian Federation is determined by many factors, one of which is the training of personnel. The activities of all military specialists, including physical training specialists, are aimed at ensuring a high level of personnel training. This is due to the fact that the development of physical qualities, formation and improvement of military-applied skills and abilities of servicemen is the key to successful combat operations.
 Physical readiness is the physical condition of a serviceman characterized by appropriate bodily development, certain functional resources of the body and the required level of motor fitness, which ensures the successful performance of combat missions for the purpose.
 Automation, computerization of military equipment and changes in the methods of warfare have led to a decrease in the share of physical effort in its control and muscle work in the structure of professional combat activity of servicemen in general, and at the same time increased the level of neuropsychological stress and tension, expanded the range of adverse factors of military combat activity. The connection between physical fitness and combat activity of servicemen of some military specialties has become hidden and indirect.
 Reforming educational institutions in the Armed Forces of Ukraine requires addressing global issues of improvement and finding new ways to solve the problems of vocational training of military personnel. The effective performance of cadets in educational institutions largely depends on their professional and applied training.
 One of the main tasks of teaching cadets the techniques and methods of ensuring professional and personal safety in emergency circumstances and in extreme conditions is to improve their firearms skills, as well as to increase the level of resistance to physical activity in training and service activities.
 The most important components of the professional skills of cadets of educational institutions are physical, professional and applied physical, psychological and firearms training.
 They belong to the cycle of professional disciplines and are designed to promote readiness for armed defense of the law, to maintain the constant readiness of future defenders to resolutely and skillfully stop illegal acts using physical force, special means and firearms.

Comparative analysis of models of special legal regimes

The author deepens the knowledge about the models of special legal regimes and their historical and philosophical basis. The author highlights the genesis and characteristics of the models of special legal regimes: classical, «state of siege» and «marital law», which are the basis of national legal systems of modern states. The author identifies the common and distinctive features of the «state of siege» of the Romano-Germanic legal family and the «marital law» of the Anglo-Saxon legal family. The author establishes that the models of all special legal regimes are aimed at protecting the public interest and legitimate restriction of human rights and freedoms in emergency circumstances. The author points out that respect for the rule of law and legal procedures is an important characteristic of the «state of siege» which provides for specific constitutional regulation of extraordinary powers of the authorities, while «marital law» is included in the general legal order with enhanced control of the judicial branch. It is proved that a common unifying feature of these regimes is that they all recognize the fiduciary obligations of the State to protect such values as the constitutional order, sovereignty, territorial integrity, life and health of the population, and environmental safety. Both models are characterized by attention to the need to justify and proportionality of human rights restrictions. The author further develops the position that the fiduciary basis of relations between a person and the State when enacting special legal regimes is directly determined by the range of legal guarantees which the State undertakes to introduce and observe both at the international and national levels. At the same time, it is proved that none of the proposed models offers effective and universal measures to ensure human rights in the event of an emergency. The author establishes that the key difference between the «state of siege» and «marital law» models lies in different approaches to the consolidation and implementation of legal guarantees of human rights in the course of special legal order.

A phenomenological study on psychological resilience of aircraft rescue and fire fighting professionals

The primary objective of this study is to investigate the specific aspects of psychological resilience among ARFF professionals. Utilizing a qualitative approach and collecting data from 11 ARFF professionals using semi-structured interviews, this study delves into an exploration of factors that contribute to psychological resilience among Aircraft Rescue and Firefighting (ARFF) personnel stationed at State Airports, a group operating under emergency circumstances within the aviation industry. The investigation reveals three overarching themes: micro-level personal factors, meso-level organizational factors, and macro-level environmental/societal factors. Key findings reveal that micro-level personal factors, including personality traits and individual coping mechanisms, significantly influence ARFF professionals’ psychological resilience. Encompassing leadership quality and team dynamics, meso-level organizational factors have emerged as crucial contributors to resilience. Finally, macro-level environmental/societal factors, such as social support networks and the broader emergency preparedness context, have been identified as integral elements shaping psychological resilience. This qualitative approach, designed to capture the nuanced experiences and perceptions of ARFF professionals through a multi-level exploration of psychological resilience, extends its implications to the realms of aviation and emergency response. Micro-level considerations illuminate the significance of human resources-related decisions, such as recruitment and training, in fortifying ARFF professionals’ resilience. Meso-level considerations provide evidence for the impactful role of leadership and effective safety measures in promoting resilience. Macro-level considerations underscore the importance of environmental design and spillover effects, such as family support, in shaping resilience. An understanding of the factors that contribute to psychological resilience may be directly transferable to the creation of support mechanisms and targeted interventions and may also be directly transferable to assist emergency response teams in the aviation sector.

Adapting the Gamified Educational Networking Online Learning Management System to Test a Decentralized Simulation-Based Education Model to Instruct Paramedics-in-Training on the Emergency Intraosseous Access and Infusion Skill.

Intraosseous (IO) access and infusion is a safe and rapid alternative to intravenous access in obtaining vascular access for administering fluids and drugs. Healthcare professionals, such as primary and advanced care paramedics, use IO access and infusion in emergency circumstances where peripheral intravenous routes are inaccessible. IO access skills require hands-on training, which can be done remotely if the participants have access to simulation, instructions, guidance, and feedback. For the purpose of moving the training outside of the simulation laboratories, we have developed (1) an inexpensive and scalable three-dimensional (3D) printed and silicone-based advanced adult proximal tibial IO access and infusion simulator and (2) a unique learning management system (LMS) for remote simulation-based training. The LMS was built using the Django platform and supports experiential learning by providing access to educational and instructional content (including virtual simulation and serious games), allowing peers to communicate among themselves and with subject-matter experts, provide and receive feedback asynchronously, and engage in learning using gamification elements. The aim of this technical report is to describe the process of development and the final product of the LMS as a research and educational tool to scaffold remote learning of emergency IO skills by paramedics-in-training.

Alert System to Prevent Drowning using IoT- A Survey

Swimming is a popular sport as it is a pleasant recreational hobby. Aside from its physical benefits, it also relieves stress and gives a sense of peace. So, it is highly preferred by children’s, adults, and sometimes even elderly people. Many countries have made swimming and other life skills compulsory activities in school to avoid fatalities in the event of disaster. While swimming has many advantages, safety precautions are paramount to avoid unintentional deaths. While various drowning prevention systems and technologies have been developed, many of them lack accuracy in detecting drowning incidents and fail to provide an effective rescue mechanism for swimmers in distress. To develop a smart anti-drowning and alert system, this study presents a comprehensive survey of existing drowning systems and suggests a proposed model in response to the identified gaps and challenges in current systems. The suggested framework includes Arduino microcontrollers, voice recognition technology, ultrasonic sensors, and alert generators. The proposed approach not only addresses the constraints of existing systems, but it also provides a cost-effective and scalable solution that can be used in a variety of water environments, including pools and natural bodies of water. The suggested system has the potential to reduce reaction times in emergency circumstances, adding to the overall enhancement of water safety. Future research could focus on practical implementation, testing, and improvement of the proposed model to improve its usefulness in reducing drowning accidents.

Perioperative Challenges in Airway and Ventilatory Management of a Neurosurgical Patient with Klippel–Feil Syndrome

AbstractKlippel–Feil syndrome, a rare congenital anomaly, has a classical triad of low posterior hairline, short neck, and restriction of neck movements. Complex airway anatomy increases the risk of neurological damage while handling the airway during positioning and laryngoscopy. We address the possible anesthetic challenges that one might face in these patients, such as difficult airway, difficult weaning from the ventilator with increased chances of reintubation, prolonged intensive care and mechanical ventilation, and difficult tracheostomy. Every anesthesiologist must be aware of the available options in the management of a difficult airway in emergent circumstances. Despite the numerous encounters, we were able to effectively manage a case of Klippel–Feil syndrome perioperatively.

Peculiarities of Labor Relations Regulation amid Imposition of Martial Law and Special Economic Measures: Problems and Prospects for Harmonization

The need to counter external threats to Russia’s national security predetermined the development of new and improvement of existing regulations in 2022. An assessment and comparative analysis of the legal means and innovations available in the field of labor confirmed that there is an objective need for comprehensive legal regulation of labor relations during emergency events. Considering the features of the organization of labor activity amid imposition of martial law and the operation of special economic measures, the author exposes conceptual uncertainty, discrepancies in the order, content and limits of impact on the sphere of labor, difficulties in applying and controversial issues of innovations were revealed, the lack of a general concept and uniformity of labor regulation in the conditions of emergency circumstances. It is proposed to streamline the regulations by focusing on the fact that countering threats to national security is the system-forming basis for the differentiation of the legal regulation of relations in the sphere of labor.

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity

What COVID-19 Vaccine Distribution Disparity Reveals About Solidarity