Perfect Storm Research Articles

Antibiotic Shortage During a Public Health Crisis—The Perfect Storm

This Viewpoint discusses the shortage of penicillin G benzathine during a surge in congenital syphilis cases in the US.

Obesity and lack of breastfeeding: a perfect storm to augment risk of breast cancer?

Triple-negative breast cancer (TNBC) is one of the most aggressive subtypes of breast cancer with higher rates of recurrence and distant metastasis, as well as decreased 5-year survival rates. Racial disparities are evident in the incidence and mortality rates of triple negative breast cancer particularly increased in young African American women. Concurrently, young African American women have multiple risk factors for TNBC including higher rates of premenopausal abdominal obesity (higher waist-hip ratio) and lower rates of breastfeeding with higher parity, implicating these factors as potentially contributors to poor outcomes. By understanding the mechanisms of how premenopausal obesity and lack of breastfeeding may be associated with increased risk of triple negative breast cancer, we can determine the best strategies for intervention and awareness to improve outcomes in TNBC.

SARS-CoV-2 and Environmental Changes: The Perfect Storm

The COVID-19 pandemic has had a significant impact on the global economy. It also provided insights into how the looming global climate crisis might be addressed, as there are several similarities between the challenges proposed by COVID-19 and those expected from the coming climate emergency. COVID-19 is an immediate health threat, but climate change represents a more gradual and insidious risk that will lead to long-term consequences for human health. Research shows that climate change, air pollution and the pandemics have a negative impact on health. Recent studies show that COVID-19 mortality increases with climate extremes. The goal of our review is to analyze the clinical findings of COVID-19 and how they are affected by the climate change, while also providing insight into the emergence of new variants and their ability to evade the immune system. We selected and synthesized data from primary studies, reviews, meta-analyses, and systematic reviews. Selection was based on rigorous methodological and relevance criteria. Indeed, a new variant of SARS-CoV-2, named JN.1, has emerged as the dominant, first in the United States and then worldwide; the variant has specific mutations in its spike proteins that increase its transmissibility. According to the World Health Organization (WHO), JN.1 is currently the most reported variant of interest (VOI), having been identified in 132 countries. We highlight the link between climate change and pandemics, emphasizing the need for global action, targeted medical approaches and scientific innovation.

Colorado providers call an array of funding woes a ‘perfect storm’

Colorado's community mental health providers say they are experiencing many of the downsides that can come with a period of dizzying change. Facing declining Medicaid rolls, a shifting payment model and no prospects for new state funding to support restructuring, the state's provider community is calling the current environment a “perfect storm” of crisis that could engulf patient care.

"Hot phase" clinical presentation of biventricular arrhythmogenic cardiomyopathy: when the perfect electrical storm spontaneously stops.

An 18-year-old male presented with syncope during a training break. Post-syncope, he developed effort dyspnea, which he associated with the Pfizer-BioNTech COVID-19 vaccine received a week earlier. Electrocardiogram showed T inversion in V1-V3, III, and aVF, while 24-hour Holter monitoring revealed frequent ventricular premature beats. A transthoracic echocardiogram showed severe biventricular dilation and mild left ventricular (LV) dysfunction. Cardiac magnetic resonance (CMR) imaging confirmed these findings, showing moderate right ventricular (RV) systolic dysfunction with akinesia of the inferior and inferolateral walls. T2 hypersignal in the middle segment of the inferior inferior interventricular septum suggested myocardial edema. Extensive transmural late gadolinium enhancement was noted in the RV and LV walls. An implantable loop recorder was implanted. Three months later, the patient was admitted with palpitations, fever, and a positive SARS-CoV-2 test. Sustained ventricular tachycardia (VT) episodes were documented and managed with amiodarone and β-blockers. Follow-up CMR showed a slight improvement in LV ejection fraction and resolution of edema. A single-chamber implantable cardioverter-defibrillator (ICD) was implanted. Genetic testing for arrhythmogenic RV cardiomyopathy (ARVC) was negative, and family screening was normal. Two years later, pre-syncope episodes occurred, and ICD interrogation revealed nonsustained VT. The patient is awaiting VT ablation. This case highlights the diagnostic and therapeutic challenges of ARVC, particularly in differentiating it from myocarditis. The "hot-phase" presentation, vaccine association, and subsequent SARS-CoV-2 infection added complexity. CMR was crucial for diagnosis, and VT management required a combination of medical therapy and invasive procedures.

Trp53 Deletion Promotes Exacerbated Colitis, Facilitates Lgr5+ Cancer Stem Cell Expansion, and Fuels Tumorigenesis in AOM/DSS-Induced Colorectal Cancer.

Colorectal cancer CRC remains one of the leading causes of cancer-related deaths worldwide, with chronic intestinal inflammation identified as a major risk factor. Notably, the tumor suppressor TP53 undergoes mutation at higher rates and earlier stages during human inflammation-driven colon tumorigenesis than in sporadic cases. We investigated whether deleting Trp53 affects inflammation-induced tumor growth and the expression of Lgr5+ cancer stem cells in mice. We examined azoxymethane (AOM)/dextran sodium sulfate (DSS)-induced colon tumorigenesis in wild-type Trp53 (+/+), heterozygous (+/-), and knockout (-/-) mice. Trp53-/- mice showed increased sensitivity to DSS colitis and earlier accelerated tumorigenesis with 100% incidence. All groups could develop invasive tumors, but knockouts displayed the most aggressive features. Unlike wild-type CRC, knockouts selectively showed increased populations of Lgr5+ colon cancer stem-like cells. Trp53 loss also boosted laminin, possibly facilitating the disruption of the tumor border. This study highlights how Trp53 deletion promotes the perfect storm of inflammation and stemness, driving colon cancer progression. Trp53 deletion dramatically shortened AOM/DSS latency and improved tumor induction efficiency, offering an excellent inflammation-driven CRC model.

The evolutionary and ecological convergence of the raccoon and raccoon dog: A perfect storm of invasive species in Europe

AbstractThis paper initially describes the evolution of body shape in the raccoon (Procyon lotor) and the raccoon dog (Nyctereutes procyonoides). I explain how their similarities are the result of convergent evolution, the process by which unrelated organisms come to resemble one another in form, function, or both. This is the first examination of this phenomenon in these two species. In addition, I consider how their convergent traits and habits as omnivores have contributed to their astounding success as invasive species in Europe. Problems have arisen from these introductions, including impacts on prey species. Considering their broad adaptability as “stout” shaped mesocarnivores should aid in understanding their behavior and ecology, and could assist in addressing their management in Europe. Last, I offer suggestions for the control of raccoons given their compensatory versus additive mortality patterns, a practice that may also have implications for the regulation of raccoon dog populations.

A combination of protein phosphatase 2A inhibition and checkpoint immunotherapy: a perfect storm.

Immune checkpoint blockade has emerged as a potent new tool in the war on cancer. However, only a subset of cancer patients benefit from this therapeutic modality, sparking a search for combination therapies to increase the fraction of responding patients. We argue here that inhibition of protein phosphatase 2A (PP2A) is a promising approach to increase responses to immune checkpoint blockade and other therapies that rely on the presence of tumor-reactive Tcells. Inhibition of PP2A increases neoantigen expression on tumor cells, activates the cGAS/STING pathway, suppresses regulatory Tcells, and increases cytotoxic Tcell activation. In preclinical models, inhibition of PP2A synergizes with immune checkpoint blockade and emerging evidence indicates that patients who have tumors with mutations in PP2A respond better to immune checkpoint blockade. Therefore, inhibition of PP2A activity may be an effective way to sensitize cancer cells to immune checkpoint blockade and cell-based therapies using tumor-reactive Tcells.

8009 The Unravelling of a Perfect Storm: A Case of COVID-19 Induced Thyroid Storm Presenting as Heart Failure and Atrial Fibrillation

8009 The Unravelling of a Perfect Storm: A Case of COVID-19 Induced Thyroid Storm Presenting as Heart Failure and Atrial Fibrillation

Corporations and positive duties to fulfil socio-economic rights: developing international human rights law

ABSTRACT There is much contestation about the nature and scope of corporate human rights obligations under international law. Some maintain that corporations have a basic responsibility to avoid human rights violations in their operations; others argue for a wider scope of accountability, including a more active duty to protect human rights. I argue that corporations should have positive duties under international law to fulfil all human rights, especially socio-economic rights. I ground my argument in the staggering inequality that exists between the wealthiest corporations, on the one hand, and the poorest parts of the global population, on the other. This is entrenched by a perfect storm of global economic inequality, international trade, and transnational corporate power. This creates structural poverty, which enables conglomerates to generate profits that, promises notwithstanding, do not reach people living in indigency. This results in the anomaly whereby indigent communities actually subsidise corporate profits. It is this inequity and concomitant benefit, that justifies the imposition of positive duties on corporations to fulfil socio-economic rights. However, this duty is limited. I identify a series of interlocking factors, the coalescence of which creates a reasonable and justifiable imposition of human rights duties onto corporations.

The ‘Perfect Storm’: Food Banks and Food Insecurity During the Covid-19 Pandemic

In the UK, food banks and other forms of food aid have become a normalised support mechanism for those living at the sharp end of poverty. Drawing from accounts of those who have used, worked, and volunteered in two of England’s food banks during the Covid-19 pandemic, this article explores some of the key challenges that emerged for food aid during this unique period. In documenting these experiences, the paper concurs with previous work that has identified the expanding role of food banks in providing core welfare support, suggesting an increasingly extended welfare function of food aid. This has implications for understanding the effectiveness of welfare – and the appropriateness of our reliance on voluntary aid – in the post-pandemic period.

Uncertainty in healthcare operations: How hospitals weather the perfect storm

AbstractWe focus on two of the many sources of uncertainty in healthcare operations, mix uncertainty – the variation in the complexity of care required by the patient mix, and volume uncertainty – the variation in the volume of care demanded by the patient population. Using an interdisciplinary perspective, we study the impact of mix and volume uncertainties on two important healthcare outcomes, length of stay and number of procedures, along with the mitigation impacts of the operational concepts of related focus and utilization levels. Based on large dataset of 830,853 patient discharges in 26 clinical departments across 731 hospitals in five U.S. Midwest states, our results indicate that mix and volume uncertainties each have a significant impact on patient care. We also find that related focus and department utilization levels have a mitigating effect on uncertainty in healthcare settings. Lastly, we find considerable heterogeneity in the effects of uncertainty across hospital types and departments. We discuss key research and managerial implications of our findings.

Centromeric transposable elements and epigenetic status drive karyotypic variation in the eastern hoolock gibbon.

Great apes have maintained a stable karyotype with few large-scale rearrangements; in contrast, gibbons have undergone a high rate of chromosomal rearrangements coincident with rapid centromere turnover. Here we characterize assembled centromeres in the Eastern hoolock gibbon, Hoolock leuconedys (HLE), finding a diverse group of transposable elements (TEs) that differ from the canonical alpha satellites found across centromeres of other apes. We find that HLE centromeres contain a CpG methylation centromere dip region, providing evidence this epigenetic feature is conserved in the absence of satellite arrays; nevertheless, we report a variety of atypical centromeric features, including protein-coding genes and mismatched replication timing. Further, large structural variations define HLE centromeres and distinguish them from other gibbons. Combined with differentially methylated TEs, topologically associated domain boundaries, and segmental duplications at chromosomal breakpoints, we propose that a "perfect storm" of multiple genomic attributes with propensities for chromosome instability shaped gibbon centromere evolution.

Oxacillin-resistant Staphylococcus spp.: Impacts on fatality in a NICU in Brazil - confronting the perfect storm

ObjectiveAnalyse the incidence, risk factors, antimicrobial susceptibility profile, and fatality in neonates infected with oxacillin-resistant Staphylococcus spp. (ORS). MethodsIn this retrospective observational descriptive cohort study, the medical records of neonates admitted to the Neonatal Intensive Care Unit (NICU) from January 2015 to June 2022 were analysed. Participants were monitored daily through the National Healthcare Safety Network. ResultsAmong the 1610 neonates, 193 (12 %) developed ORS infections, primarily in the bloodstream (96.8 %). The incidence of these infections/patient-days decreased by 51.8 % between 2016 (8.3) and 2022 (4). The median age of affected neonates was 17.5 days (IQR:12–28.7). Pre-emptive prescription of fourth-generation cephalosporins (OR=14.36; P<0.01) emerged as a risk factor in the multivariate analysis. Staphylococcus epidermidis was the most prevalent species (60.1 %), with one isolate showing a “susceptible, increased exposure” profile to vancomycin. Additionally, 2 % of pathogens were extensively drug-resistant (XDR). ORS infections were associated with prolonged hospital stays (from 10 to 46 days) and increased mortality (from 10.2 % to 19.2 %). The median time between infection and the fatal outcome was 15 days (IQR:8–40), and Staphylococcus capitis was the most lethal species (26.7 %). ConclusionsThe high incidence of ORS infections was linked to extended hospitalisation and increased mortality, highlighting the complexity of this situation - a "perfect storm." This underscores the urgency of implementing effective interventions for managing and preventing ORS infections in the NICU.

Perfect Storm for Legal Education: Privatization, Polarization, and Pedagogy

Perfect Storm for Legal Education: Privatization, Polarization, and Pedagogy

Twenty-First Century Competencies; about Competencies for Industry 5.0 and the Opportunities for Emerging Economies

The philosophy of Industry 5.0 recognises the transformative power of the industrial sector to add value to society and employees. Industry 5.0 is distinct from its predecessors because it relies on a tripod of sustainability, human centricity, and resilience. These three thematic principles aim to improve work safety, research, and innovation and strengthen industrial resilience and competitiveness. However, a perfect storm is brewing for the future of work, brought about by the concerning trends of displacement and low skill levels of workers’ competencies in handling the new technologies of Industry 5.0 in emerging economies. This conceptual paper will describe Industry 5.0 and provide historical insights on the importance of acquiring the desired twenty-first-century competencies needed in the workforce for Industry 5.0 and how these competencies can be cultivated. Two research questions guided the study in identifying these twenty-first-century competencies, how these competencies can be cultivated and taught in the education curriculum and policies of emerging economies, and the crucial importance of adapting Industry 5.0 to these emerging economies. The study concluded that emerging economies must play an active role in shaping the future by creating policies that will advance social stability, resource preservation, and climate objectives, which will enable more productive production processes with lower waste and energy usage.

The perfect technological storm: artificial intelligence and moral complacency

Artificially intelligent machines are different in kind from all previous machines and tools. While many are used for relatively benign purposes, the types of artificially intelligent machines that we should care about, the ones that are worth focusing on, are the machines that purport to replace humans entirely and thereby engage in what Brian Cantwell Smith calls “judgment.” As impressive as artificially intelligent machines are, their abilities are still derived from humans and as such lack the sort of normative commitments that humans have. So while artificially intelligent machines possess a great capacity for “reckoning,” to use Smith’s terminology, i.e., a calculative prowess of extraordinary utility and importance, they still lack the kind of considered human judgment that accompanies the ethical commitment and responsible action we humans must ultimately aspire toward. But there is a perfect technological storm brewing. Artificially intelligent machines are analogous to a perfect storm in that such machines involve the convergence of a number of factors that threaten our ability to behave ethically and maintain meaningful human control over the outcomes of processes involving artificial intelligence. I argue that the storm in the context of artificially intelligent machines makes us vulnerable to moral complacency. That is, this perfect technological storm is capable of lulling people into a state in which they abdicate responsibility for decision-making and behaviour precipitated by the use of artificially intelligent machines, a state that I am calling “moral complacency.” I focus on three salient problems that converge to make us especially vulnerable to becoming morally complacent and losing meaningful human control. The first problem is that of transparency/opacity. The second problem is that of overtrust in machines, often referred to as the automation bias. The third problem is that of ascribing responsibility. I examine each of these problems and how together they threaten to render us morally complacent.

Koru Mindfulness Training for Nursing Students: Weathering the Perfect Storm.

Koru Mindfulness Training for Nursing Students: Weathering the Perfect Storm.

Hashtag capitalism: An introduction

This article aims to introduce the phenomenon of ‘hashtag capitalism’ – that is, the ability of shareholders, employees, customers and even members of society to leverage social media in a way that influences corporate behaviour. While it is a positive development that, via social media, members of society are engaging with and influencing corporate decision-making, there are also concerns that some individuals are able to influence the financial decisions and opinions of others, and that such individuals might need to be held accountable. The article describes the different developments that have created the perfect storm to give rise to hashtag capitalism and argues that there is an urgent need for corporate law and regulation to reckon with this phenomenon, to ensure that we are able to retain the benefits while effectively addressing the risks involved.

The Perfect Storm: Applying the Multiple Streams Framework to Understand the Adoption of a WHO Framework Convention on Tobacco Control-Based Policy in Mexico.

The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.