The severe acute respiratory syndrome corona virus (SARSCoV-2), the etiologic agent of the most detrimental disease of the century, has tragically influenced the world dynamics. One of the major challenges faced by health sector globally, was to establish a treatment regimen and guidelines to combat this lethal condition

An incautious use of the well-known Galërkin’s technique to find approximate solutions of a differential problem may lead to apparently wrong results. Examples are based on an inverse approach to investigate buckling of compressed axisymmetric circular plates, a subject that is common in courses on mechanics of structures and stability of structural elements. We discuss how the mistake may originate and show how it is possible to recover the expected results, thus providing a means for the students to cross-check their outputs.

It is the quantitative paradigm that prevails in science today, but this is not a purely positive phenomenon, since what seems to be the exact expression of research results is only in fact a guise of absolute objectivity. Effect is given to the laws of nature in space whose structure is not fully known, but certainly heterogeneous, and hence different from the assumptions contained in most mathematical formulae. Indeed, most procedures contain an implicit assumption regarding the homogeneity of space, while the real-life problems relating to the impact of spatial heterogeneity can be seen especially where all kinds of spatial interpolations are applied. Due to heterogeneity of space, seasonality and polygeneticism, natural phenomena are usually characterized by multimodal (multi-peak) distributions of observed variables. Estimation of the mean states from such distributions expressed in terms of the arithmetic mean are inappropriate and in opposition to the basic property of the landscape that is regional differentiation (given that states accepted as representative may in fact be those occurring only rarely or actually precluded in nature). The aim of the work detailed here has therefore been to point out the dangers of undue trust being put in quantitative methods. The essence of progress in science is an increased scope of understanding of phenomena, not the level of detail at which they are described. Without an awareness of the properties of a structure under examination, statistical expressions do not lead to understanding of the principles by which that structure functions. Natural phenomena most often have a log-normal distribution and are polygenetic. A further key problem noted in the initial stages of research therefore relates to proper sampling. Attention is also drawn here to the variability of conditions and states represented by environmental samples, which makes it necessary to use weighted means (especially important where the cycling of matter is being investigated). The article exemplifies problems related to the use of quantitative methods in physical geography, especially in the context of the use of the commonest statistical measures. Apart from the criticism regarding the incautious use of statistical tools, an indication is also given of certain possibilities for statistical measures to be reinterpreted following division of data into subgroups representing specific fragments of space or categories of phenomena. Genetic explanations in a collection of chaotic data are provided for in this way.

Background: Oxytocin is a commonly used drug in the labor and delivery unit. Previous studies have shown the association between incautious use of oxytocin and adverse maternal and neonatal outcomes. The aim of this study was to assess whether the implementation of an oxytocin checklist in labor would affect expert opinion of oxytocin use in labor and delivery unit. Methods: This study was conducted in a single, university-affiliated medical center in two phases; before and after the implementation of an oxytocin checklist in the labor and delivery unit (2016-2017). Six experts reviewed cardiotocographs of deliveries performed in an urgent cesarean delivery due to non-reassuring fetal heart rate, after completing at least 4 hours of oxytocin infusion for induction or augmentation of labor. The experts included 3 obstetricians, a midwife, and 2 obstetrical expert nurses, who were tasked to conclude whether oxytocin was managed properly or not. Each case was reviewed by two reviewers separately. A total of 100 cases were reviewed; 50 before the oxytocin checklist implementation, and 50 after that implementation. Findings: We did not find a difference in the reviewers' assessment of oxytocin management before and after the institutional implementation of the checklist. Additionally, there were significant inconsistencies and inter-observer variations in their assessment before and after the checklist implementation. Interpretation: The implementation of an institutional oxytocin checklist did not affect expert assessment of the use of oxytocin in labor. Funding Statement: There was no funding of any kind. Declaration of Interests: All authors declare no conflict of interests or funding of any kind. Ethical Approval Statement: The study was approved by the Local Research Ethics Board at Sunnybrook Health Sciences Centre, Toronto, Canada.

The increasing number of mass events involving large crowds calls for a better understanding of the dynamics of dense crowds. Inquiring into the possibility of a mechanical description of these dynamics, we experimentally study the crossing of dense static crowds by a cylindrical intruder, a mechanical test which is classical for granular matter. The analysis of our experiments reveals robust features in the crowds’ response, comprising both similarities and discrepancies with the response of granular media. Common features include the presence of a depleted region behind the intruder and the short-range character of the perturbation. On the other hand, unlike grains, pedestrians anticipate the intruder’s passage by moving much before contact and their displacements are mostly lateral, hence not aligned with the forces exerted by the intruder. Similar conclusions are reached when the intruder is not a cylinder, but a single crossing pedestrian. Thus, our work shows that pedestrian interactions even at high densities (3 to 6 ped/m2) do not reduce to mechanical ones. More generally, the avoidance strategies evidenced by our findings question the incautious use of force models for dense crowds.

Burns due to electric heating pad burst are frequently reported in newspapers and media, although the medical literature on the topic is scarce (1). Burns are more frequent during the cold months in children, old people, women, and less healthy population; they are favored by an incautious use of the bag – failure to detach the bag from the electric socket – and by a bad manufacture of the same – in the current case the rupture of the bag released a blackish malodorous liquid, the composition of which we were not able to know –. The actual case is peculiar for the presence of brownish papules linked on histological examination to non-specific inflammation and melanocytic hyperplasia. A brownish pigmentation of reticulated appearance due to incontinence of the melanin pigment has also been described in erythema ab igni, due to repeated exposure to infrared radiation, that is not hot enough to cause an acute burn.

Nowadays, almost all of us transfer data (especially personal data) to someone or something (usually through web pages), and we do not precisely know how those data are managed. All of those data, considered altogether, represent what is generally called “Big Data”. Big data offer a big opportunity of growth for probably all human activities, since they make available important data collected in distant places (both in space and time) virtually to everybody who has access to the Internet. On the other hand, big data may also present problems that, if not properly addressed, may yield legal consequences to those who have been implied in data collection, validation, publication and utilization. This paper has covered the most important and, up to now, the most widely considered consequence: privacy. It has also warned that the lack of validation of the posted data and their incautious use may expose liable subjects to legal consequences. To make things even more complex, it has also shown that the potentially liable subjects have not yet been fully identified. Therefore, caution is mandatory when dealing with big data.

Objective: The aim of this research is to identify risk factors for incautious use of oral non-prescription drugs (ONPD) and inform recommendations that promote cautious ONPD use among HEI students in the UAE.Methods: A cross-sectional survey-based study was conducted with 2875 students in three randomly selected UAE universities between January and April 2014.Results: More than half (1348; 57%) of participants reported using of ONPD in the past 90 days before study commencement. Of 1348 participants reported using ONPD, one-quarter (1348; 22.2%) of ONPD was classified as incautious ONPD usage. Analgesic/antipyretic (84.9%), non-steroidal anti-inflammatory drugs (NSAIDs) (1028; 76.3%), and cough and cold drugs (562; 41.7%) were reported by the majority of participants as the most commonly used ONPD. 10 risk factors were identified for incautious ONPD use. Participants with age group of 21 years and older (OR=0.554, 95%; CI=0.373-0.823; p<0.001), female (OR=0.339, 95%; CI=0.236-0.486; p<0.001), and students from medical schools (OR=0.619, 95%; CI=0.435-0.882; p=0.008) had lower odds of being incautious users compared to lower age group, males, and students from non-medical schools. Furthermore, participants with a polypharmacy behavior had higher odds of being irresponsible ONPD user than monopharmacy users (OR=1.400, 95%; CI=1.030- 1.02; p<0.001).Conclusion: One of five students is an incautious ONPD user. There is a need for an educational and behavioral intervention to motivate students to be cautious users.

This paper discusses the Colorado Rules of Professional Conduct as applicable to business, transactional, real estate, and title lawyers in Colorado. This paper also discusses comparable rules of professional conduct and interpretations from a number of other states and the ABA's Model Rules of Professional Conduct, including newly adopted Model Rule 8.4(g) and its potential negative impact on practicing lawyers, notwithstanding the good intentions of the rule. This paper addresses many of the 2018 and earlier interpretations, including regarding waiver of attorney-client privilege and work-product through incautious use of modern communications technologies and electronic file storage. It also discusses practical and ethical aspects of an attorney accepting cryptocurrency for legal fees or as a retainer, new developments relating to multi-party representation, and the application of recent interpretations of a prosecutor's duties under Rule 3.8 to subpoenas issued by grand juries to lawyers.

It is frequently noted that police crime statistics can reflect reality badly because of under-reporting and under-recording. Less frequently noted is the fact that other sources of data can be just as problematic. This article reflects on two sources of statistics on murder – the National Injury Mortality Surveillance System and the MRC’s Burden of Disease estimates – and argues that the incautious use of these data can lead to erroneous conclusions.

Introduction/aims Oxytocin, an effective drug to increase the rate and strength of uterine contractions, is used in more than half of all labors. Intravenous infusions are adjusted frequently at the bedside because the uterine response can vary greatly. Clinical protocols recommend discontinuing oxytocin in the presence of overly frequent contractions because they can decrease oxygen delivery to the fetus and result in brain injury. Despite well-established guidelines, incautious use of oxytocin is reported in 45-71% of births with severe asphyxia and subsequent litigation. In 2011 Medstar Franklin Square Medical Center introduced specialized obstetrical software (PeriCALM Patterns V2.01 PeriGen, Cranbury, NJ) with electronic fetal monitor (EFM) pattern recognition and display features specifically designed to assist in the prompt recognition of uterine tachysystole. Uterine tachysystole (UT) is defined as the presence of more than 5 contractions per 10 minutes, averaged over a 30-minute period. The objective of this study was to compare the rates of UT in the periods “Before” and “After” the introduction of this software in women with induction or augmentation of labor. Methods/process/procedures Inclusion criteria were labors with live singleton cephalic-presenting babies at term with EFM recordings. The “Before” group comprised 6728 births (3869 with induction or augmentation) from February 2006 to February 2010. The “After” group included 3790 births (1988 with induction or augmentation) from January 2012 to December 2013. Induction or augmentation status was ascertained by automated review of the electronic medical record database searching for evidence of interventions or oxytocin use to induce or enhance labor. Each EFM record was analyzed by PeriCALM Patterns software to determine contraction counts in 30 minute segments. Results As a result of early detection and prompt remediation, very substantial reductions were observed in a variety of UT-related measures. In women with induction or augmentation the rate of tachysystole fell from 22.7% to 17.3% (p<0.0001). When UT did occur, the average duration fell from 64 minutes to 54 minutes (p=0.0039). In those who experienced UT, the total percentage of time spent in UT decreased by 36.5% over the course of this study (p<0.0001). There were also decreases in the percentages of babies with severe neonatal depression, but the small numbers precluded statistical significance. Discussion/outcomes This is the first report of a large and systematic review on the effect of efforts to reduce uterine tachysystole. We observed a very substantial and sustained reduction in both the incidence and duration of UT in patients with augmentation or induction of labor. The 36.5% reduction in the total percentage of time spent in UT reflects a marked changed in clinical behavior. We attribute this marked improvement to the coexistence of several essential factors present in IT initiatives that actually change behavior: 1. Objective computations at the point of care that are personalized to the individual patient; 2. Continuous trend analysis and feedback showing the patient’s situation related to expected norms; 3. Clearly established clinical policies regarding expected therapeutic actions; 4. Active quality improvement follow up.

ABSTRACT Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.

The conservation status of amphibians is often assessed using public databases because of a lack of up-to-date field data. However, it is crucial that this kind of data is used carefully, evaluating the reliability and the consistency of the information. In Italy, the conservation status of the painted frog, Discoglossus pictus , was recently assessed using public databases, and the outcome highlighted a worrying situation for the species. We analyzed the reliability of these conclusions and reassessed the status of the painted frog, taking into account its insular distribution and new data of species occurrence. Our results contrast with the previous analysis and show how an incautious use of public databases can lead to inaccurate assessment of the amphibian conservation status.

To propose suggestions for improvements in care based on conclusions from studies on low Apgar scores and substandard care during labor. Studies on infants with low Apgar scores in a general obstetric population 2004-2006 and claims for financial compensation on the behalf of infants, based on the suspicion that substandard care in conjunction with childbirth has caused severe asphyxia or neonatal death in Sweden 1990-2005. The most common flaws were related to insufficient fetal surveillance, defective interpretation of cardiotocography (CTG) tracings, not acting in a timely fashion on abnormal CTG, and the incautious use of oxytocin. Besides, in half of the infants a suboptimal mode of delivery added further trauma to the already asphyxiated infant. Additionally, resuscitation was unsatisfactory in many of these infants. The most critical flaw was defective compliance with the guidelines concerning ventilation and the early paging of skilled personnel in cases of imminent asphyxia or known complications during labor. In many case reports, the documentation of the neonatal resuscitation was insufficient to enable accurate and reliable evaluation. Examples of proposed improvements in care during labor are the introduction of a permanent educational atmosphere with aside time for daily educational rounds and discussion, cooperation around the use of standardized terminology in CTG interpretation, the cautious use of oxytocin, and the routine paging of a pediatrician before birth in cases of complicated delivery or imminent asphyxia. The proposed interventions need to be evaluated in clinical trials in the future.

Abstract Cognitive psychological research on the fallibility of human memory is reviewed, focusing on evidence of memory distortions and illusions, with the aim of sharing research on memory with clinical psychologists and practitioners who use memory recovery techniques to help clients recover memories of suspected childhood sexual abuse. The authors' review of the memory literature suggested that incautious use of memory recovery techniques may lead some adult clients who were not abused to come to believe that they were. They consider current methods of assessing whether or not clients have repressed memories of childhood sexual abuse and techniques to minimise the risk of creating illusory memories or beliefs.

We demonstrate that morphological observables (e.g. steepness of the radial light profile, ellipticity, asymmetry) are intertwined and cannot be measured independently of each other. We present strong arguments in favour of model-based parametrisation schemes, namely reliability assessment, disentanglement of morphological observables, and PSF modelling. Furthermore, we demonstrate that estimates of the concentration and Sersic index obtained from the Zurich Structure & Morphology catalogue are in excellent agreement with theoretical predictions. We also demonstrate that the incautious use of the concentration index for classification purposes can cause a severe loss of the discriminative information contained in a given data sample. Moreover, we show that, for poorly resolved galaxies, concentration index and M_20 suffer from strong discontinuities, i.e. similar morphologies are not necessarily mapped to neighbouring points in the parameter space. This limits the reliability of these parameters for classification purposes. Two-dimensional Sersic profiles accounting for centroid and ellipticity are identified as the currently most reliable parametrisation scheme in the regime of intermediate signal-to-noise ratios and resolutions, where asymmetries and substructures do not play an important role. We argue that basis functions provide good parametrisation schemes in the regimes of high signal-to-noise ratios and resolutions. Concerning Sersic profiles, we show that scale radii cannot be compared directly for profiles of different Sersic indices. Furthermore, we show that parameter spaces are typically highly nonlinear. This implies that significant caution is required when distance-based classificaton methods are used.

ObjectiveTo increase our knowledge of the occurrence of substandard care during labour.DesignA population-based case–control study.SettingStockholm County.PopulationInfants born in the period 2004–2006 in Stockholm County.MethodsCases and controls were identified from the Swedish Medical Birth Register, had a gestational age of ≥33 complete weeks, had planned for a vaginal delivery, and had a normal cardiotocographic (CTG) recording on admission. We compared 313 infants with an Apgar score of <7 at 5 minutes of age with 313 randomly selected controls with a full Apgar score, matched for year of birth.Main outcome measureSubstandard care during labour.ResultsWe found that 62% of cases and 36% of controls were subject to some form of substandard care during labour. In half of the cases and in 12% of the controls, CTG was abnormal for ≥45 minutes before birth. Fetal blood sampling was not performed in 79% of both cases and controls, when indicated. Oxytocin was provided without signs of uterine inertia in 20% of both cases and controls. Uterine contractions were hyperstimulated by oxytocin in 29% of cases and in 9% of controls, and the dose of oxytocin was increased despite abnormal CTG in 19% and 6% of cases and controls, respectively. Assuming that substandard care is a risk factor for low Apgar score, we estimate that up to 42% of the cases could be prevented by avoiding substandard care.ConclusionsThere was substandard care during labour of two-thirds of infants with a low Apgar score. The main reasons for substandard care were related to misinterpretation of CTG, not acting on an abnormal CTG in a timely fashion and incautious use of oxytocin.

Two effects arise for the modelling of block maxima from dependent time series: a reduced rate of convergence for the block maxima probability distribution towards the generalised extreme value distribution, and an increase in uncertainty of the parameter estimates compared to independent or short range dependent records. These effects are exemplified with a simulation study using a white noise, a short-range and a long-range dependent process. The two issues raised turned out to be relatively unproblematic for short-range dependent processes. For long-range dependent processes, especially the increased parameter uncertainty poses a problem. Incautious use of standard procedures would lead to a severe underestimation of the parameter uncertainty which implies a misconception of accuracy for derived quantities, such as return levels which are frequently used for risk assessment and dimensioning of hydraulic structures.

Credit derivatives play important role in financial markets, but they are considered quite controversial and their effects on the stability of financial markets aren’t complexity examined yet. So the aim of this paper is to explore the risks of credit derivatives in the context of global financial crisis. Object of the research– credit derivatives and their risks. Methods of the research: systematic analysis of scientific literature, logical comparative analysis and generalization methods. The main conclusions are presented: Global financial crisis of 2007 – 2008 years has disclosed problems and risks of credit derivatives and what broad impact would be on the financial system stability in the case of incautious use of them. Credit derivatives became one of the crisis causes, while they had to hedge of credit risk and to diversify it. Due to globalization and integration of financial markets financial crisis originated in the USA has grown into global financial crisis. Consisting problems in credit derivatives markets should be solved by implementing special package of tools. They should cover these areas: regulation of credit derivatives markets, standardization of financial instruments, reconsideration of credit ratings mechanism and methodology, and also development of market infrastructure.

ObjectiveTo describe possible causes of delivery-related severe asphyxia due to malpractice.Design and settingA nationwide descriptive study in Sweden.PopulationAll women asking for financial compensation because of suspected medical malpractice in connection with childbirth during 1990–2005.MethodWe included infants with a gestational age of ≥33 completed gestational weeks, a planned vaginal onset of delivery, reactive cardiotocography at admission for labour and severe asphyxia-related outcomes presumably due to malpractice. As asphyxia-related outcomes, we included cases of neonatal death and infants with diagnosed encephalopathy before the age of 28 days.Main outcome measureSevere asphyxia due to malpractice during labour.ResultsA total of 472 case records were scrutinised. One hundred and seventy-seven infants were considered to suffer from severe asphyxia due to malpractice around labour. The most common events of malpractice in connection with delivery were neglecting to supervise fetal wellbeing in 173 cases (98%), neglecting signs of fetal asphyxia in 126 cases (71%), including incautious use of oxytocin in 126 cases (71%) and choosing a nonoptimal mode of delivery in 92 cases (52%).ConclusionThere is a great need and a challenge to improve cooperation and to create security barriers within our labour units. The most common cause of malpractice is that stated guidelines for fetal surveillance are not followed. Midwives and obstetricians need to improve their shared understanding of how to act in cases of imminent fetal asphyxia and how to choose a timely and optimal mode of delivery.Please cite this paper as:Berglund S, Grunewald C, Pettersson H, Cnattingius S. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005. BJOG 2008;115:316–323.