Proven Failure Research Articles

Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management.

Cardioneuroablation (CNA) has emerged as a potential alternative to pacemaker therapy in well-selected cases with vasovagal syncope (VVS). In recent years, the number of CNA procedures performed by electrophysiologists has considerably risen. However, some important questions, including proper patient selection and long-term results, remain unanswered. The present article aims to critically review and interpret latest scientific evidence for clinical indications and how to approach long-term management. CNA is a new approach that has been supported mainly by retrospective or observational data for its use in syncope. Overall, in mixed population studies treated with CNA, 83.3 to 100% have been reported to be free of syncope over follow-up periods of 6 to 52.1 months. For studies including patients who underwent CNA with pure VVS, 73.2 to 100% have been reported to be syncope-free over follow-up periods of 4 to 45.1 months. One large meta-analysis showed 91.9% freedom from syncope after CAN. To date, only one randomized controlled trial with small case number has been performed of CNA compared to non-pharmacological treatment in VVS. In this study of 48 patients with an average of 10 ± 9 spontaneous syncopal episodes prior to study enrollment and 3 ± 2 episodes in the year prior to CNA. After CNA, 92% were free of syncope compared with 46% treated with optimal non-pharmacological treatment to prevent new syncope episodes (P = 0.0004). To date, most studies have included younger patients (< 60 years of age). There are only limited data in patients older than 60, and some studies suggest less of an effect in relatively older patients. Cardioneuroablation can be performed to decrease syncope recurrence in adult patients aged < 60 years, with severe or recurrent cardioinhibitory syncope without prodromal symptoms, after proven failure of conventional therapies. Due to a paucity of data supporting efficacy in older individuals or for vasodepressor components, CNA in adult patients aged > 60 years or in the presence of a dominant vasodepressor should be considered investigational in severely symptomatic patients after proven failure of pharmacological and non-pharmacological therapies.

Concept of Equivalent Stress Criterion For Predicting Failure of Brittle Materials

Purpose: A paucity of proven failure criteria for brittle engineering materials exists, and this paper intends to present and validate a novel concept of equivalent stress criterion for predicting the failure of brittle isotropic homogeneous materials based on the concept of effective causative failure stress.&#x0D; Design/Methodology/Approach: Mathematical modelling is first performed based on strain-state equivalence, followed by conversion to the equivalent causative stress. The model is then validated with experimental and other data and with comparisons to traditional models. The material studied is BS 1452 Grade 250 continuous-cast grey cast iron with a Young’s Modulus of 39 000 MPa and ultimate tensile strength of 290 MPa. The test samples were prepared square in shape 12 mm x 12 mm to enable stresses in two perpendicular directions. Data is generated from uniaxial and bi-axial tests, performed using a standard universal testing machine, INSTRON 880, improvised to enable bi-axial recordings.&#x0D; Findings: Results point consistently to higher fidelity and transparency of the new model in representing the state of stress, especially in the second and fourth quadrants of the principal stress diagram, where Rankine’s criterion completely ignores stress differences and Mohr handles shear stresses in a suboptimal fashion. Both the maximum principal stresses and maximum shear stresses predicted by the proposed model are found to be somewhat greater than those from the traditional models, indicating higher accuracy and greater aggressiveness in prediction. The findings have further revealed that shearing effects play a greater role in the failure of engineering brittle materials than traditional failure theories have considered.&#x0D; Research Limitation: The study involved improvisation to enable biaxial stress recordings. This process was not perfect, resulting in smaller-than-ideal values of the lateral stresses.&#x0D; Practical implication: The study recommended process and equipment development toward perfecting multiaxial tests.&#x0D; Social implication: The survey will enrich the literature with pertinent design methodology to help in product design, including social-interest products. &#x0D; Originality / Value: Since truly homogeneous materials are known to withstand very high hydrostatic pressures, direct stresses alone do not constitute valid failure criteria for all loading conditions.

Analysis and Prediction of COVID-19 Pandemic in Bangladesh by Using ANFIS and LSTM Network.

The dangerously contagious virus named “COVID-19” has struck the world strong and has locked down billions of people in their homes to stop the further spread. All the researchers and scientists in various fields are continually developing a vaccine and prevention methods to aid the world from this challenging situation. However, a reliable prediction of the epidemic may help control this contiguous disease until the cure is available. The machine learning techniques are one of the frontiers in predicting this outbreak’s future trend and behavior. Our research is focused on finding a suitable machine learning algorithm that can predict the COVID-19 daily new cases with higher accuracy. This research has used the adaptive neuro-fuzzy inference system (ANFIS) and the long short-term memory (LSTM) to foresee the newly infected cases in Bangladesh. We have compared both the experiments’ results, and it can be forenamed that LSTM has shown more satisfactory results. Upon study and testing on several models, we have shown that LSTM works better on a scenario-based model for Bangladesh with mean absolute percentage error (MAPE)—4.51, root-mean-square error (RMSE)—6.55, and correlation coefficient—0.75. This study is expected to shed light on COVID-19 prediction models for researchers working with machine learning techniques and avoid proven failures, especially for small imprecise datasets.

The Case for an IGAD Development Bank

A multilateral development finance institution for the Inter-Governmental Authority on Development (IGAD) region represents the chance to create a strong pro-developmental actor—and energise the IGAD itself. Yet, senior IGAD officials will need to look beyond the traditional development banking model if they hope to make an impact of the scale needed to drag these poorest of countries out of poverty. In this article, the author argues for the design of a development bank modelled after successful role models—like the China Development Bank—instead of proven failures. A mix of government and private sector participation, a widely disbursed capital base and a temporary base in London will help ensure the proposed IGAD Communities Development Bank acts as bridge and vector of pro-developmental capitalism in the IGAD region.

Risk analysis for the design of a safe artificial pancreas control system

Closed-loop glucose control has the potential to improve the glycemic control in patients with diabetes mellitus type 1. Such an artificial pancreas (AP) should keep the user safe despite all disturbances and faults. The objective of this paper is to analyze those perturbations according to their effects on the glycemic status, and thereby supporting an informed design process of the control system. As suggested by the international standard ISO 14971 for risk management of medical devices, the well proven failure modes and effects analysis (FMEA) was chosen as instrument. An FMEA scheme was modified for this purpose and applied to a single-hormone system with subcutaneous and intraperitoneal routes for glucose sensing and insulin administration. Faults that imply urgent danger and thus require fast detection and diagnosis were identified and distinguished from disturbances that can be sufficiently addressed by basic control functions, e.g. by adaptive control algorithms. Requirements and testing criteria for basic control functions as well as fault detection and diagnosis functions can be derived from the provided overview.

GNE myopathy: proven failure of sialic acid supplementation… what's next?

Malgre un essai de phase II prometteur, l’acide sialique a liberation prolongee n’a pas confirme son efficacite sur une plus large population de patients. Une deception certaine, mais d’autres pistes therapeutiques restent ouvertes comme evoque lors des 23e Journees Neuromusculaires a Marseille les 6 et 7 septembre derniers.

The Prospects and Problems of an IGAD Regional Development Bank

A multilateral development finance institution for the Inter-Governmental Authority on Development (IGAD) region represents the chance to create a strong pro-developmental actor – and energize the IGAD itself. Yet, the IGAD senior officials will need to look beyond the traditional development banking model if they hope to make an impact of the scale needed to drag these poorest of countries out of their poverty. In this paper, we argue for the design of a development bank modelled after successful role models – like the China Development Bank – instead of proven failures. A mix of government and private sector participation, a widely disbursed capital base, and a temporary base in London, will help ensure the proposed IGAD Communities Development Bank acts as bridge and vector of pro-developmental capitalism in the IGAD region.

Mysteries of success for small and medium enterprises in Ga-Rankuwa Township of Pretoria in Gauteng Province, South Africa

The small and medium enterprises (SMEs) are important to the South African economy and social development. This paper discusses the case of Ga-Rankuwa Township SMEs, causes of their proven failure and the methods used by the SMEs owned by people who came from foreign countries and operating in this township. These foreign SMEs did not have access to loans for business. On the other hand the local ones could apply for the loans but many did not know how and where. The locals then forfeited the opportunity, but still refused to partner with foreign ones who could assist them. The foreign ones were more successful in using business skills and knowledge to nurture their SMEs. They also contributed to the township’s economy by employing local people. Recommendations include that local SMEs should partner with foreign ones to develop synergies, and that the SME agency, Small Enterprise Development Agency (SEDA) should design policies for foreign SME access to business loan funds by ensuring and enforcing local empowerment as part of their loan access package

Applicability and precautions of use of liver injury biomarker FibroTest. A reappraisal at 7 years of age.

BackgroundFibroTest (FT) is a validated biomarker of fibrosis. To assess the applicability rate and to reduce the risk of false positives/negatives (RFPN), security algorithms were developed. The aims were to estimate the prevalence of RFPN and of proven failures, and to identify factors associated with their occurrences.MethodsFour populations were studied: 954 blood donors (P1), 7,494 healthy volunteers (P2), 345,695 consecutive worldwide sera (P3), including 24,872 sera analyzed in a tertiary care centre (GHPS) (P4). Analytical procedures of laboratories with RFPN > 5% and charts of P4 patients in with RFPN were reviewed.ResultsThe prevalence of RFPN was 0.52% (5/954; 95%CI 0.17-1.22) in P1, 0.51% (38/7494; 0.36-0.70) in P2, and 0.97% (3349/345695; 0.94-1.00) in P3. Three a priori high-risk populations were confirmed: 1.97% in P4, 1.77% in HIV centre and 2.61% in Sub-Saharan origin subjects. RFPN was mostly associated with low haptoglobin (0.46%), and high apolipoproteinA1 (0.21%). A traceability study of a P3 laboratory with RFPFN > 5% permitted to correct analytical procedures.ConclusionThe mean applicability rate of Fibrotest was 99.03%. Independent factors associated with the high risk of false positives/negatives were HIV center, subSaharan origin, and a tertiary care reference centre, although the applicability rate remained above 97%.

The Virtue of Simplicity

In this paper we explore material simplicity, defined as the virtue disposing us to act appropriately within the sphere of our consumer decisions. Simplicity is a conscientious and restrained attitude toward material goods that typically includes (1) decreased consumption and (2) a more conscious consumption; hence (3) greater deliberation regarding our consumer decisions; (4) a more focused life in general; and (5) a greater and more nuanced appreciation for other things besides material goods, and also for (6) material goods themselves. It is to be distinguished from simple-mindedness, a return to nature, or poverty. Simplicity overlaps with traditional virtues such as temperance, frugality, and wisdom, and sustains and enables traditional virtues such as justice and generosity. Simplicity is a virtue because it furthers human flourishing, both individual and social, and sustains nature’s ecological flourishing. For analytic purposes, we consider six areas in which simplicity can make important contributions: (1) basic individual flourishing, (2) basic societal flourishing, (3) individual freedom or autonomy, (4) the acquisition of knowledge, (5) living meaningfully, and (6) preserving and protecting nonhuman beings. The proven failure of materialism to secure subjective happiness or objective flourishing argues for the practice of voluntary simplicity and for the radical reform of modern consumer societies.

Taiwan's Future National Identity: Attitudes and Geopolitical Constraints

ROBERT M. MARSH [*] ABSTRACT People in Taiwan who favor the establishment of an independent Republic of Taiwan face the reality constraint that mainland (the PRC) threatens to use force to prevent this. Those who hold the opposite view and favor the reunification of Taiwan with mainland face a different reality constraint: the non-democratic, economically underdeveloped and, therefore, unappealing character of the PRC. These reality constraints were included in the way questions were phrased in several Taiwan surveys during the 1990s. Respondents were asked: (1) after Taiwan announces its independence it could maintain peaceful relations with Communist China, should Taiwan become an independent country? (2) mainland and Taiwan were to become similar in economic, political, and social conditions, should the two sides of the Strait be unified into one country? Depending on how a person answered both of these questions, s/he was categorized as having one of the following four types of national identification: Taiwan nationalist, nationalist, Pragmatist, and Conservative. This paper first analyzes the distribution of these four types of respondents in surveys conducted before and after the 1996 PRC firing of missiles into the waters near Taiwan's two largest seaports. Next, I show the effect of objective ethnicity (pen-sheng jen vs. wai-sheng jen) and subjective ethnicity (self-identification as Taiwanese or or both) on national identification preferences. These survey findings are then examined within a geopolitical context. From Beijing's point of view, the Taiwan independence movement is a secessionist movement. A comparative analysis of the outcomes of secessionist movements around the world shows that attempts at secession are almost always unsuccessful, for the basic reason that states do not willingly give up what they consider their sovereign territory. And since even modem democratic states are unwilling to accept a loss of territory, even a future democratic PRC would be unlikely to accept Taiwan's independence. AMONG THE POPULATION of Taiwan, those who favor the establishment of an independent Republic of Taiwan face the reality constraint that mainland (the PRC) has not renounced the use of military force if Taiwan declares its independence. Supporters of the opposite type of national identity -- reunification of Taiwan with mainland -- also face a reality constraint: the non-democratic, economically less developed character of the PRC. Surveys of attitudes in Taiwan toward future national identity made a significant advance in 1992 when they began annually to use Wu Naiteh's new formulation (Wu 1993) and to ask respondents: (1) If after Taiwan announced its independence it could maintain peacful relations with the Chinese communist government, then Taiwan should become an independent country. Do you agree? (2) If mainland and Taiwan were to become similar in economic, social and political conditions, then the two sides of the Strait should be united into one country. Do you agree? The second view is basically the position of President Lee Teng-hui, who stated in an address to the National Unification Council on July 22, 1998, China must be reunified. However, this reunification must be under a system of democracy, freedom and equitable prosperity... The nation should by no means be unified under the proven failure of comunism or the so-called 'one country, two systems' formula (Taiwan Research Institute 1998b:5). Even the PRC regime is aware that China's present political institutions and economy are more alienating than appealing to Taiwan residents. From answers to these two questions, Wu (1993, 1997) and Shen and Wu (1998) classified respondents into four types of national identification preferences: Taiwan nationalists, nationalists, Pragmatists, and Conservatives (see Table 1). …

Intracytoplasmic sperm injection facilitates fertilization even in the most severe forms of male infertility: pregnancy outcome correlates with maternal age and number of eggs available

To evaluate, in a prospective study, the fertilization and pregnancy rates after intracytoplasmic sperm injection (ICSI) in infertile couples with severe male infertility. Intracytoplasmic sperm injection was performed in 229 consecutive IVF cycles on 190 couples with rigorously defined severe male infertility or proven failure of fertilization in prior IVF cycles. Neither male nor female partners were chosen from a waiting list or on any other selective basis, including age, prior or anticipated ovarian response, or oocyte number or quality. There were no upper age limits, in no instance was donor sperm used for ICSI, and cycle cancellation rate was minimal. Private genetics and fertility center in Fairfax, Virginia. Fertilization, transfer, and pregnancy rates were measured in ICSI-treated couples, and comparisons were made regarding both female age and strictly defined semen categories. Two hundred six cycles (90%) resulted in ETs, with initiation of 52 pregnancies (25% per transfer, 23% per cycle). Thirty-eight of 52 (18% per transfer) were clinical pregnancies with established gestational sacs or were ongoing or delivered. Pregnancies were achieved even in older women but were more readily established in younger women producing larger numbers of metaphase II oocytes. The severity of semen abnormalities had some small effect on fertilization rate, but only actual necrospermia was associated with markedly decreased frequency of embryo formation. Pregnancy per transfer was similar across groups. In some cases, pregnancy was initiated with fewer than 100 viable sperm in the ejaculate. Intracytoplasmic sperm injection is a very powerful new treatment for severe male infertility. Paradoxically, egg number and probably egg quality are now the main determinants of success in treating male infertility.

Failure of beta-lactam antibiotics and marked efficacy of fluoroquinolones in treatment of murine Yersinia pseudotuberculosis infection

The treatment of yersiniosis by beta-lactams is questionable considering the proven failure of newer beta-lactams for treating murine Yersinia enterocolitica infection. Another modality of experimental treatment was performed with a virulent strain of Y. pseudotuberculosis (nonproducer of beta-lactamase) highly susceptible (in terms of MICs) to amoxicillin, cefotaxime, ceftriaxone, imipenem, doxycycline, gentamicin, and ofloxacin. The in vivo comparative efficacy of these drugs was evaluated in a standardized and reproducible mouse model of systemic infection. Each single antibiotic was injected intravenously once, at 30 h after intravenous inoculation of the infective strain, and then repeatedly (at 30, 52, and 76 h postinfection). In vivo results were measured by counting the viable bacteria recovered from the whole spleens of mice sacrificed at selected times. Cefotaxime, even at high doses (250 mg/kg of body weight), was totally ineffective. Amoxicillin and imipenem at high doses (200 and 100 mg/kg, respectively) and ceftriaxone at usual doses (20 mg/kg) were active only in stopping bacterial proliferation to a more or less slight degree. Ceftriaxone was able to reduce viable counts in the spleen only at high doses (200 mg/kg), as were gentamicin (20 mg/kg) and doxycycline (125 mg/kg). Ofloxacin at the low dose of 5 mg/kg was demonstrated to be very effective by the very significant decrease observed in bacterial numbers from 10(6) to 10(3) CFU per spleen. The pharmacological parameters do not in themselves explain all the discrepancies between the in vitro and in vivo activities of beta-lactams on yersiniae. No emergence of beta-lactam-resistant organisms, which could explain the failure of beta-lactams, was detected. Thus, their use should be delayed in the therapy of human yersinosis until further investigations are carried out. The fluoroquinolone appeared more active and rapid than reference drugs in the treatment of murine yersinosis, which confirms initial clinical results.

Treatment of tic douloureux with a new anticonvulsant (clonazepam).

Twenty-five patients affected by 30 episodes of tic douloureux were treated with a new anticonvulsant, clonazepam. In 40% there was complete control of the neuralgia and an additional 23.3% were significantly helped by the drug. Sixteen patients had previously been resistant to carbamazepine, and eight of them were completely and one partially relieved by clonazepam. The side-effects, somnolence and unsteadiness of gait, were present to some extent in 80 and 88% of the cases respectively, being severe in about half of them. It is concluded that clonazepam can be considered as a second choice for the treatment of this condition, after proven failure with carbamazepine. Possible mechanisms of action are discussed.

MAJOR ISSUES IN MONETARY ECONOMICS

THE purpose of this paper is to survey the major issues in monetary economics, with a view to discerning the most fruitful lines of future theoretical and empirical research. This is a useful point in time at which to undertake such a survey, for both a negative and a positive reason. The negative reason is that the upsurge of the monetarist counter-revolution, which began some years ago in the United States on the basis of the proven failure of Keynesian fiscal policy to control inflation, and which promised to revitalize the whole field of monetary economics in this and other countries previously dominated by Keynesianism, has subsided into disarray due to the failure of monetarism, as understood by the public, to deliver policies effective in controlling inflation effectively and without prolonged and relatively large-scale unemployment. (It should be noted that the leading monetarists never promised such easy success, but the public nevertheless was led to expect it; meanwhile, 'monetarism' has learned from the experience a great deal about the importance of priceexpectations, lags, and micro-economic market functioning, while 'Keynesianism' has largely retreated into a desperate appeal for rescue to the sociologists and a reiteration of the need for an incomes policy-despite its historically amply proven futility-to control the key monetary variable that is left undetermined in the Keynesian model.) The positive reason is the arrival of a new generation of monetary economists, come too lately and from too diverse origins to be partisans of rather than learners from the Keynesian revolution and the monetarist counter-revolution, and equipped with requisite mathematical and statistical tools to forward the scientific evolution of monetary economics. There is therefore a challenge to be met, and a scientifically useful response possible. But there are dangers that the opportunity will be wasted by distraction of effort to activities of peripheral scientific value. Apart from the fact that the collapse of the established international monetary system over the past two years has tended to concentrate attention on the short-run policy problems of international crisis, there are three major reasons for concern about the present state of monetary economics. First, there is a noticeable tendency for the relics of the Keynesian revolution and their contemporary disciples to attempt to force anyone seriously interested in the influence of money and of monetary policy into the mould of the largely fictitious 'classical orthodoxy' against which the Keynesian

The Military on Capitol Hill: Prospects in the Quest for Funds

Public backing for defense expenditures is at its lowest ebb in recent history. Despite pervasive disenchantment, public knowledge about military programs remains limited and the translation of that disenchantment into effective political action even more restricted. Congressional lobbyists on both sides of military issues remain relatively ineffective. Congress, reacting to waste and poor weapons system performance, is doing an improved job of scrutinizing military programs and weeding out proven failures, but has remained impotent in canceling new programs its members consider ill advised. Overall, Congress has very little impact on military expenditure levels. Presidents regularly succeed in getting approved virtually the full range of military programs they request from Congress. During President Nixon's second term, that trend is expected to continue. While he might prefer to see his 1976 military budget rise above $100 billion, the President's greater wish to hold down taxes and total federal spending is likely to produce a 1976 military budget slightly in excess of $90 billion.