Failed Attempt Research Articles

Trust: The Key to Building Stronger Physician Relationships

The transition from volume to value in healthcare has highlighted the importance of strong and genuine alliances between healthcare organizations and physicians. However, the absence of established guidelines for building such relationships has resulted in failed attempts, miscommunication, and missed expectations. This article discusses the varying degrees and levels of trust, and the importance of distinguishing between personal and impersonal perspectives. Trust-building behaviors are provided, including empowering physician colleagues, communicating often using multiple modalities, promoting transparency and sharing information, and developing clinical leadership among colleagues. The article concludes that healthcare organization leaders must be courageous enough to extend trust, which is much more than a magnanimous gesture, but an invitation to a collaborative future. The potential rewards of building trust can be enormous and well worth the effort, and trust as a foundation for high performance means trust comes first.

Feasibility of Amulet occluder implantation after failed left atrial appendage occlusion attempt: Insights from the EMERGE LAA postapproval study

BackgroundAlthough expertise in left atrial appendage occlusion (LAAO) has grown, certain intricate anatomies may pose challenges, rendering them unsuitable for LAAO with the selected device. ObjectiveThis analysis aimed to characterize outcomes of patients with prior failed percutaneous LAAO procedures who underwent a subsequent attempt with an Amulet occluder in the EMERGE LAA postapproval study. MethodsPatients enrolled in the National Cardiovascular Data Registry LAAO Registry who had an Amulet occluder implantation attempt between Food and Drug Administration approval (August 14, 2021) and June 30, 2023, were evaluated. A safety end point through 7 days or hospital discharge (whichever was later) and major adverse events through 45 days were reported. ResultsA total of 8591 patients underwent attempted Amulet occluder implantation, of whom 244 patients had prior failed LAAO. Implantation success was 88.9% and 96.2% in patients with prior failed LAAO and index LAAO, respectively (P < .001). The safety composite end point was low, occurring in 1.6% and 0.8% of patients with prior failed LAAO and index LAAO, respectively (P = .148). Any major adverse event through 45 days occurred in 7.4% and 6.3% of prior failed LAAO and index LAAO patient cohorts, respectively (P = .497); most adverse events were similar between the groups (P > .05). At 45 days, peridevice leak ≤3 mm was achieved in >90% of patients in either group. ConclusionA high degree of implantation success with a low rate of adverse events can be achieved with the Amulet occluder. The findings imply that the dual occlusive mechanism Amulet occluder facilitates successful closure, even in challenging anatomic scenarios.

In Default of Providence: Tragedy and Tess of the d'Urbervilles

Abstract Reconsidering Thomas Hardy's Tess of the d'Urbervilles: A Pure Woman in view of newly discovered textual discrepancies between editions and critical scholarship, this essay makes a necessary intervention in the reading tradition of the rape-fall-punishment triad by shifting the central event of the novel to the murder as it relates to aspects of the novel's religious framework. It argues that Tess's actions are contingent on a critical phrase, “a shining light,” that has been suppressed through the novel's complicated publication history and reconnects sections of the plot to restore the significance of tragedy in the novel without explaining that tragedy through her violation. By recovering the religious significance of conversion in the text as crucial to a structure of extralegal justice on which the events of the novel hinge, the essay argues that Tess's crime, rather than serving as mere irony, is motivated by faith and an understanding of justice that illuminates the problem of the uncanny God of the nineteenth century, present through absence. As the salvation plot is brought back into relevance with the marriage plot, the concept of Tess's love as a powerful force that should be able to overcome all is reduced to a failed attempt at epistemic reform. Through her failure, the novel raises questions about the possibilities of radical world-making that have historically been overlooked by Hardy's critics.

Exploring Harith Iskander's Stand-Up Comedy Acts: An Analysis of Code-Switching Types through the Framework of Poplack's Theory

Code-switching can take different forms, such as intra-sentential (within the same sentence), inter-sentential (between different sentences) or extra-sentential (across sentences) switches. Delivering the intended meaning requires adherence to grammatical and linguistic standards. In this instance, the issue or outcome of misinterpreting a joke will lead to a failed attempt at humour. Therefore, this study is conducted to categorise the many forms of code-switching that are employed in sentences using Poplack's theory (1980). This study employed a basic interpretive qualitative methodology in three performances by Harith Iskander. The findings demonstrate that Harith Iskander regularly used both intra- and inter-sentential code-switching when telling his jokes. However, extra-sentential code-switching or tag switching was rarely used in his performances. To conclude, three categories of code-switching proposed by Poplack were found in Harith Iskander’s performances. For the recommendation, future researchers may employ primary data for in-depth analysis opportunities and to authentically determine the accurate frequency of code switching used in stand-up comedy performances.

Unveiling Ambergris: of the Failed Attempts to turn a Mystery into a Commodity

Unveiling Ambergris: of the Failed Attempts to turn a Mystery into a Commodity

Discovery of Methylenetetrahydrofolate Reductase (MTHFR) Deficiency in Individuals With Common Psychiatric Comorbidities: A Retrospective Case Review.

A retrospective analysis was conducted of a data set collected in an outpatient behavioral health clinic to assess medication metabolism and methylenetetrahydrofolate reductase (MTHFR) and to see if there was a correlation with certain diagnoses and/or gender. The outpatient routine completed genetic testing on their patients and the test results were later collected through a third-party company, which completed the pharmacogenomic test analyzing genetic variations in DNA, medication metabolism, and an MTHFR deficiency. This study reviewed 186 patients seen in an outpatient setting who were tested for an MTHFR deficiency and compared their psychiatric diagnoses and the number of failed medication attempts. Of those 186 patients, 77 had normal MTHFR enzyme function, 85 were found to have a moderate MTHFR deficiency, and 24 had a severe MTHFR deficiency. Those with a severe MTHFR deficiency had a higher number of medication trials as compared to those without the deficiency and there were overall more patients with a moderate MTHFR deficiency in this data set. Currently, MTHFR deficiency is not commonly tested due to lack of insurance coverage and provider knowledge, and due to the cost of the test itself. Thus, the diagnosis can often be missed.

In search of a growth model for Italy: the failed attempt of an export-led recovery strategy?

We analyse Italy’s growth pattern from 2001 to 2019 using the demand and growth regime categories proposed in the post-Keynesian tradition and recently adopted in the comparative political economy (CPE) literature. We argue that after the Global Financial and Economic Crisis (GFEC), Italy followed an export-led recovery strategy. In this respect, Germany’s growth model emerged as the successful model to follow. In the dominant view, Germany’s economic success since the mid-2000s was attributed to a series of painful but necessary economic reforms. The success of Germany’s export-led mercantilist regime became particularly attractive to Italy given the similar export-oriented manufacturing industry. However, Italy has followed the ‘wrong’ German model based on wage compression and restrictive budget policies while the ‘true’ German model is based on non-price competitiveness factors.

Crime, the city and the Congo: Family, race and the urban in recent Belgian cinema

Pieter Van Hees’s Waste Land (2014) situates Belgian national anxiety in the country’s White supremacist past and present, both of which milieux are shared by its language communities. The film suggests, perhaps in spite of itself, that the claim by Brussels to be a centre of power is ethnically, as well as ethically, problematic. It breaks a taboo in confronting Belgium’s colonial past, on the eve of the 150th anniversary of Leopold II’s accession (1865). Yet, it ultimately reproduces the economy of the racialized system it tries to critique, becoming particularly problematic from the point of view of Black women. The ineffability of spatial spectacle would betray the way in which its protagonist’s narrative is ‘mapped’ onto the space of Brussels, with the character’s breakdown – hence, a failed attempt at constructing his own narrative, at mapping his life in Brussels – bearing further unintentional testimony to the city’s abject history beneath it.

Lesbian and bisexual couples experiencing dual motherhood: (dis)encounters in the provision of healthcare.

The bond with healthcare services is a crucial dimension in facilitating the maternal journey of lesbian and bisexual women couples. This study aimed to analyze the culturally constructed meanings regarding the bond with healthcare services and professionals by lesbian and bisexual women who experienced dual motherhood. It is a qualitative investigation grounded in interpretative anthropology. The research corpus was built based on in-depth interviews with 10 lesbian and bisexual women, aged 30 to 39 years. The results indicate that access to parenthood, until its realization, involved a journey permeated by satisfactions and sufferings triggered by failed attempts and gestational losses. Challenges experienced in healthcare provision were also reported due to prejudices, lack of empathy, and unpreparedness of professionals in dealing with prenatal care for lesbian and bisexual women couples. Manifestations of discrimination were more pronounced concerning non-gestational mothers. The findings offer insights into implementing policies that prioritize humanization and planning programs and healthcare services based on culturally sensitive care for lesbian and bisexual women couples as they transition into dual motherhood.

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

BackgroundTo our knowledge, there is no previous report in the literature of non-traumatic neglected complete cervical spine dislocation characterized by anterior spondyloptosis of C4, extreme head drop, and irreducible cervicothoracic kyphosis.Case presentationWe report the case of a 33-year-old Caucasian man with a 17-year history of severe immune polymyositis and regular physiotherapy who presented with severe non-reducible kyphosis of the cervicothoracic junction and progressive tetraparesia for several weeks after a physiotherapy session. Radiographs, computed tomography, and magnetic resonance imaging revealed a complete dislocation at the C4–C5 level, with C4 spondyloptosis, kyphotic angulation, spinal cord compression, and severe myelopathy. Due to recent worsening of neurological symptoms, an invasive treatment strategy was indicated. The patient’s neurological status and spinal deformity greatly complicated the anesthetic and surgical management, which was planned after extensive multidisciplinary discussion and relied on close collaboration between the orthopedic surgeon and the anesthetist. Regarding anesthesia, difficult airway access was expected due to severe cervical angulation, limited mouth opening, and thyromental distance, with high risk of difficult ventilation and intubation. Patient management was further complicated by a theoretical risk of neurogenic shock, motor and sensory deterioration, instability due to position changes during surgery, and postoperative respiratory failure. Regarding surgery, a multistage approach was carefully planned. After a failed attempt at closed reduction, a three-stage surgical procedure was performed to reduce displacement and stabilize the spine, resulting in correct spinal realignment and fixation. Progressive complete neurological recovery was observed.ConclusionThis case illustrates the successful management of a critical situation based on a multidisciplinary collaboration involving radiologists, anesthesiologists, and spine surgeons.

Proof of the Existence of Hell: An Extension of the Stone Paradox

Abstract As shown in (Łukowski, Gensler, 2013), the paradox of the stone is a failed attempt to show that “omnipotence” is a contradictory concept. An element of the argument presented there is that God, while unable to lift the stone, can nevertheless annihilate it. This work considers the amplification of the paradox of the stone to the form generated by the question: can God create a stone which He will not be able to lift, nor, once created, will He be able to destroy.

Assessment of the implantation window and embryonic factor impact to the treatment of recurrent implantation failure (RIF). A prospective study

The aim: to study of the prognostic value of endometrial receptivity and preimplantation genetic diagnosis of embryos, and their influence on the effectiveness of in vitro fertilization (IVF) programs. We also evaluate the importance of this factor in comparison with other potential causes of infertility. Materials and methods: This prospective cohort study included 123 infertile women who underwent in vitro fertilization (IVF) treatment. 93 patients had repeated unsuccessful implantation attempts and were divided into three groups: group 1 - patients who were treated using genetically untested embryos according to a standard fixed stimulation protocol, group 2 - patients who were treated using euploid embryos after preimplantation genetic screening according to standard fixed protocol; group 3 - patients who underwent treatment using euploid embryos after pre-implantation genetic screening and determination of the implantation window with subsequent modification of the stimulation protocol, according to the endometrial examination result. 30 patients had a first attempt at IVF, which was carried out using genetically untested embryos, according to a standard fixed protocol, and made up the control group (CG). Determination of the window of implantation was carried out by triple aspiration biopsy of the endometrium during the luteal phase of the menstrual cycle since the endometrium is most susceptible to implantation during this period. Samples were analyzed using scanning electron microscopy. Based on the results obtained, the endometrial preparation protocol was individualized for the next attempt. preimplantation genetic testing (PGT) of embryos was carried out by the next generation (NGS) method. Statistical analysis was performed using IBM SPSS V25.0 for Windows software. Results: According to the obtained results, patient characteristics, screening rates, IVF cycle characteristics, and the number, quality, and stage of transferred embryos were compared between groups. The rate of clinical pregnancy was 46.7 % among patients of group 1.70 % among patients of group 2, 82.8 % among patients of group 3 and 50.0 % of the control group and statistically significantly different between groups (χ2=10.955, p= 0.012). The rate of live birth was 43.3 % among patients of group 1, 53.3 % among patients of group 2, 72.4 % among patients of group 3 and 43.3 % - of the control group, however, it did not differ statistically significantly between groups (χ2=6,639, р=0,084) Conclusions: The unique window of implantation and the embryonic factor are among the main reasons for multiple failed implantation attempts. Personalization of the endometrial preparation protocol and preimplantation embryo diagnosis are effective methods to improve IVF outcomes

Preparation of the endometrium in the programs of auxiliary reproductive technologies for sterility in women

Background. The most important stage in the treatment of infertility is the introduction into clinical practice of the methods of in vitro fertilization (IVF), which made it possible to implement the function of childbirth in almost all forms of female infertility. The introduction of endoscopic technologies made it possible to significantly expand diagnostic possibilities and clarify the nature of intrauterine pathology when using assisted reproductive technologies. Purpose – of the research should be to increase the effectiveness of the treatment of female infertility when using assisted reproductive technologies and hysteroscopy by creating conditions in the endometrium for embryo implantation. Materials and Methods. A study was conducted in 42 patients with infertility aged 32 to 38 years. In all women, the morphological state of the endometrium was determined after diagnostic hysteroscopy. The patients were divided into 2 clinical groups. Group 1 included 28 women who were in a state of preparation for IVF after hysteroscopy with changes characteristic of endometrial pathology, which were found during ultrasound. The second group included 14 patients in whom, according to ultrasound, no structural changes of the endometrium were noted. These patients had a failed IVF attempt. In the next cycle, the women underwent a diagnostic hysteroscopy due to the lack of pregnancy after the first IVF attempt. Results. Group 1 patients (n = 28) with endometrial changes before IVF showed that the causes of pathology were: endometrial hyperplasia (53.6%); chronic endometritis (21.4%), endometriosis (25%). Therefore, before stimulation of superovulation, a hysteroscopy was performed to confirm the morphological diagnosis. In patients of the 2nd group (n = 14) after hysteroscopy and histological examination, pathological changes of the endometrium were found in all patients. Chronic endometritis occurred in 5 cases (35.7%), micropolyposis of the endometrium – in 6 (42.9%), endometriosis – 3 (21.4%). Clinical pregnancy occurred in 17 patients (60.7%) in the first group, in 9 (64.2%) in the second group. Conclusions. Hysteroscopy with morphological examination of the endometrium remains the main method of diagnosing intrauterine pathology. Diagnosis of infertility by hysteroscopy plays a very important role in the normalization of reproductive function during in vitro fertilization (IVF). After an unsuccessful IVF attempt, in the absence of pathological changes in the endometrium, a diagnostic hysteroscopy should be performed to rule out endometrial pathology.

Prinuditel'naya migratsiya tsygan v Zapadnuyu Sibir' v 1933 g. kak element gosudarstvennoy politiki osvoeniya Severa

The history of the forced migration of Roma in 1933 from Moscow and the Moscow region to Western Siberia and their life in the conditions of a labor settlement was reconstructed. The study was carried out on the basis of correlating the published archival sources identified by the author with memories and testimonies of eyewitnesses and participants in the events recorded in the 1990s - early 2000s. It is shown that the deportation of the Roma to Western Siberia in 1933, despite its ethnic nature, does not fit into the typology of forced ethnic migrations, the “core and defining elements” of which are the total migrations of the “punished peoples.” It is also incorrect to consider that the reason for the deportation of the Roma to Siberia was the recognition of them as a socially harmful and intolerant ethnic group due to their nomadic lifestyle, closed nature, uncontrollability and criminality. It is concluded that the deportation of the Roma to Western Siberia in 1933 should be considered not as a targeted anti-Roma action, but as a failed attempt at forced settlement in the context of general state actions aimed at developing the northern and eastern regions of the country.

Fueling the future: Overcoming the barriers to market development of renewable fuels in Germany using a novel analytical approach

Germany has set ambitious targets for reducing greenhouse gas (GHG) emissions, namely by 65% until 2030 (compared to the 1990 level) and achieving climate neutrality by 2045. Although GHG emissions have decreased in most sectors, the transport sector has experienced failed reduction attempts. Renewable fuels are promising sustainable fuel alternatives that can replace current market-dominant fossil fuels to reduce GHG emissions. However, the market development of renewable fuels is hindered by various economic, environmental, technical, regulatory, and social barriers. Using a novel holistic approach, this study aims to analyze the market development barriers for renewable fuels in the German transport sector. First, a novel extension to the decision making trial and evaluation laboratory (DEMATEL) method is proposed using the Type-2 Neutrosophic Numbers (T2NN), which is improved by the K-means algorithm. Second, the maximum mean de-entropy algorithm is applied to convert the results of T2NN-DEMATEL into input for interpretive structural modeling (ISM). Next, a case study is conducted to analyze the impacts of barriers on different transport modes using the T2NN-based additive ratio assessment. Extensive sensitivity analyses are conducted to measure the impacts of different factors under different circumstances. The obtained results indicate that insufficient renewable energy policies and regulations, the lack of coordination in the supply chain, and high technology conversion challenges are the most significant barriers. Moreover, road and maritime transport are affected more than the aviation and rail sectors by the market development barriers.

Do Suicide Attempters Have a Right Not to Be Stabilized in an Emergency?

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients' level of decisional capacitation-among other relevant information-in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs-the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness.

Treatment seeking behaviours, antibiotic use and relationships to multi-drug resistance: A study of urinary tract infection patients in Kenya, Tanzania and Uganda.

Antibacterial resistance (ABR) is a major public health threat. An important accelerating factor is treatment-seeking behaviour, including inappropriate antibiotic (AB) use. In many low- and middle-income countries (LMICs) this includes taking ABs with and without prescription sourced from various providers, including health facilities and community drug sellers. However, investigations of complex treatment-seeking, AB use and drug resistance in LMICs are scarce. The Holistic Approach to Unravel Antibacterial Resistance in East Africa (HATUA) Consortium collected questionnaire and microbiological data from adult outpatients with urinary tract infection (UTI)-like symptoms presenting at healthcare facilities in Kenya, Tanzania and Uganda. Using data from 6,388 patients, we analysed patterns of self-reported treatment seeking behaviours ('patient pathways') using process mining and single-channel sequence analysis. Among those with microbiologically confirmed UTI (n = 1,946), we used logistic regression to assess the relationship between treatment seeking behaviour, AB use, and the likelihood of having a multi-drug resistant (MDR) UTI. The most common treatment pathway for UTI-like symptoms in this sample involved attending health facilities, rather than other providers like drug sellers. Patients from sites in Tanzania and Uganda, where over 50% of patients had an MDR UTI, were more likely to report treatment failures, and have repeat visits to providers than those from Kenyan sites, where MDR UTI proportions were lower (33%). There was no strong or consistent relationship between individual AB use and likelihood of MDR UTI, after accounting for country context. The results highlight the hurdles East African patients face in accessing effective UTI care. These challenges are exacerbated by high rates of MDR UTI, suggesting a vicious cycle of failed treatment attempts and sustained selection for drug resistance. Whilst individual AB use may contribute to the risk of MDR UTI, our data show that factors related to context are stronger drivers of variations in ABR.

“Tin Cans and String”: Democrats’ Failed Attempts to Challenge Conservative Talk Radio from 1994 to 1996

ABSTRACT In the mid-1990s, Democratic Party leaders attempted to counter the popularity of Rush Limbaugh and other conservative talk radio hosts following the Republican sweep of the 1994 midterm elections. President Bill Clinton appeared on shows around the country, his White House began a national radio outreach initiative, party strategists proposed creating their own radio program, and some congressional Democrats visited popular shows such as Imus in the Morning. Meanwhile, former Senator Gary Hart of Colorado and former governors Mario Cuomo of New York and L. Douglas Wilder of Virginia launched their own talk radio shows, while former New York City Mayor Ed Koch continued his program. This study examines the impetus for these Democratic broadcast efforts between 1994 and 1996, the content and style of the different shows, and the reasons they failed to overcome the Republican advantage in talk radio.

Security in cloud computing: Methods for ensuring privacy and integration in modern applications

Cloud computing has become a necessary component for data storage and processing and is becoming more widespread. However, there are threats to the security and privacy of user data, which is why it is important to find out the most effective methods for ensuring data security in the cloud. The purpose of the study was to develop methods aimed at ensuring privacy and security in cloud environments and in modern applications. The method of analysis was used to review other publications on the topic, and the method of experiment was used for practical implementation. The main results of the study include the development of a security monitoring programme. It analyses event logs and determines the number of failed login attempts, which indicates the detection or absence of suspicious activity. Access to resources is checked, and the necessary information is displayed on the console. A comparison table of cloud platforms has been created, considering their advantages and disadvantages in the context of data security and privacy. It specifies the criteria for delivering services to the selected services. A block diagram of ways to provide security in cloud computing is developed, illustrating the relationship between various aspects of providing security in cloud systems. It contains parameters and strategies for encrypting data, protecting sensitive data, and countering attacks. Various aspects of security and methods of ensuring privacy in cloud computing are considered, namely authorisation, intrusion detection, regulatory requirements, integration with modern applications, monitoring and logging, user identification and authentication. The practical significance of the study lies in the creation of innovative ways to help improve security and privacy in cloud computing. They will allow cloud developers and administrators to effectively protect user data and ensure their privacy in modern applications

The Keystone Perforator Island Flap: Review of Utility and Versatile Clinical Applications.

The keystone perforator island flap (KPIF) was described almost a decade ago. However, this flap has only recently been recognized for its advantages in various clinical applications in plastic surgery. A better understanding of the versatility of KPIFs can help promote the widespread adoption of this technique for complex wounds in various anatomical regions. A retrospective chart review was conducted of patients undergoing KPIFs from December 2018 to March 2022 at the authors' home institution. The indications, surgical approaches, patient characteristics, and outcomes were extracted for review and analysis. A total of 12 patients (ages 13-86 years) underwent reconstruction with KPIFs for oncologic and nononcologic defects. By anatomic region, three cases involved the upper back, six involved the lumbosacral region, one involved the perineum, and two involved the midfoot. Half of the patients (n = 6) had failed previous attempts at wound closure. The mean defect size was 13.8 × 10.0 cm for the upper back lesions, 13.7 × 4.8 for the lumbosacral defects, and 3.5 × 2.0 for the metatarsal wounds. Median follow-up time for all patients was 7.5 months (IQR: 4-10.5). On follow-up, there was 100% flap survival. KPIFs are a simple, safe, and suitable option for reconstructive closure of defects in many anatomical areas, including wounds complicated by previous failed closure attempts, with low complication risk profile.