Unanticipated Occurrence Research Articles

Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on Treatment Delays and Final Margin Status.

Mohs micrographic surgery may be discontinued with positive margins as an anticipated strategy for multidisciplinary care or as an unanticipated occurrence. Management of primary tumors has not been compared after anticipated versus unanticipated incomplete Mohs micrographic surgery (iMMS). To compare rates and timing of adjuvant surgery after iMMS and final margin status when iMMS is anticipated versus unanticipated. Secondary outcomes were preoperative and intraoperative clinicopathologic factors associated with iMMS. Cases of iMMS of keratinocyte carcinomas at a tertiary academic center between 2005 and 2022 were classified as anticipated (preoperative assembly of multidisciplinary teams) or unanticipated (ad hoc management of positive margins). Rate, timing, and final margin status of adjuvant surgery was compared between anticipated and unanticipated iMMS cohorts using χ2/Fisher exact test for categorical variables and t-test for continuous variables. Of 127 iMMS cases, 51.2% (65/127) were anticipated. Anticipated iMMS cases were more likely to undergo additional resection (98.5% vs 72.6%, p < .001), with fewer delays (3.9 vs 13.2 days, p < .001) and higher rates of final margin clearance (84.6% vs 59.7%, p < .001). When iMMS is anticipated as part of multidisciplinary care, patients are more likely to undergo additional resection, with fewer delays to next surgery and higher final margin clearance rates.

“Just another thing for me to stress off of”: Responses to unintentional fentanyl use in a community-based study of people who use opioids

The unintentional consumption of fentanyl is a serious health risk for people who use illicit drugs. In an ongoing community-based study regarding polysubstance use among people who use opioids, we found that 17 of 58 (29%) of participants who did not endorse fentanyl use in the past thirty days tested positive for fentanyl during point-of-care urinalysis (UA). This paper describes the reactions and experiences of participants who were informed they had consumed fentanyl unintentionally, as well as how the research team handled the unanticipated occurrence of discordant results. Consistent with other recent studies, we found that people learning of unintentional fentanyl use expressed strong concerns about accidental overdose. It was common for participants to reflect on recent substance use experiences that were atypical and might have involved fentanyl, as well as to examine sources of recent drug purchases. While not all participants were surprised that they had unintentionally consumed fentanyl, all felt that learning their positive results was important due to risk of overdose. Research and medical staff have an opportunity to promote awareness of possible contamination by sharing and discussing UA test results with people who use drugs in non-judgmental manner. In addition to the widely promoted harm reduction strategy of testing drugs with fentanyl test strips, self-administered point-of-care UA, particularly after an unexpected reaction to using a drug, could provide useful information for people buying and using illicit drugs.

Has COVID-19 intensified the oil price–exchange rate nexus?

This paper extends the existing empirical literature by investigating whether the COVID-19 crisis has strengthened the dynamic relationships between oil price and exchange rate. We find significant breaks in the relationships wherein a common break is detected around the COVID-19 outbreak period. Of note, the interactions between the two markets intensified since the outbreak of the COVID-19 pandemic. Overall, our findings imply that the investors and policymakers are taking stock of the valuable information from the unanticipated occurrence of the COVID-19 pandemic. Thus, diversification in the form of portfolio switches towards foreign currency-denominated assets may be effective in the case of a depreciation of the domestic currency.

COVID pollution: impact of COVID-19 pandemic on global plastic waste footprint

Plastic products have played significant roles in protecting people during the COVID-19 pandemic. The widespread use of personal protective gear created a massive disruption in the supply chain and waste disposal system. Millions of discarded single-use plastics (masks, gloves, aprons, and bottles of sanitizers) have been added to the terrestrial environment and could cause a surge in plastics washing up the ocean coastlines and littering the seabed. This paper attempts to assess the environmental footprints of the global plastic wastes generated during COVID-19 and analyze the potential impacts associated with plastic pollution. The amount of plastic wastes generated worldwide since the outbreak is estimated at 1.6 million tonnes/day. We estimate that approximately 3.4 billion single-use facemasks/face shields are discarded daily as a result of COVID-19 pandemic, globally. Our comprehensive data analysis does indicate that COVID-19 will reverse the momentum of years-long global battle to reduce plastic waste pollution. As governments are looking to turbo-charge the economy by supporting businesses weather the pandemic, there is an opportunity to rebuild new industries that can innovate new reusable or non-plastic PPEs. The unanticipated occurrence of a pandemic of this scale has resulted in unmanageable levels of biomedical plastic wastes. This expert insight attempts to raise awareness for the adoption of dynamic waste management strategies targeted at reducing environmental contamination by plastics generated during the COVID-19 pandemic.

Experimental research of single - rotor helicopter unintentional yaw rotation

Aviation accidents related to unintentional rotation may periodically occur while flying single-rotor helicopters. On-time and correct actions may help the pilot to find the way out of this hazardous situation. But it is also important to understand the situation which contributes to the unanticipated yaw occurrence, and whether there are any factors which can stop the pilot from preventing such unintentional rotation, in order to avoid these conditions. Literature analysis shows that researchers studying this phenomenon don’t have the shared vision on unanticipated yaw occurrence conditions. In regards to this fact the decision to carry out a series of wind tunnel experiments using helicopter model and propeller was taken. The main object of research was a radio-controlled model of the Blade 130 x helicopter, mounted on a platform rotating around a vertical axis, which was installed on a vertical strut. Research-laboratory aerodynamic complex belonging to the Aerodynamics, Design and Aircraft Strength Chair of Moscow State Technical University of Civil Aviation was used to generate airflow. A set of dynamic experiments was carried out to determine the conditions contributing to unanticipated yaw occurrence. The analysis of the experiments has shown that there is a range of sliding angles at a certain speed of the incoming air flow which makes the helicopter yaw balancing impossible, and if the helicopter occasionally gets into this range, it inevitably leads to the unintended rotation of the helicopter on the yaw occurrence. Helicopter yaw trim inability occurs at negative sideslip angles because of tail rotor thrust decrease due to the incoming airflow blowing which decreases the blades angles of attack and worsens helicopter airframe aerodynamic moment that coincides in direction with main rotor torque if helicopter airframe possesses directional stability. In these conditions the required tail rotor pitch is greater than the available pitch so the pilot is not able to counteract the initiated unanticipated yaw rotation of the helicopter that has begun. The possibility of helicopter unanticipated yaw rotation caused by the impact of the main rotor on the tail rotor was not experimentally confirmed. It was impossible to create the conditions of unanticipated yaw occurrence during the experiments because of the tail rotor vortex ring state.

Cardiac arrest at rest and during sport activity: causes and prevention.

In the Western Countries, cardiovascular diseases are still the most frequent cause of death, which is often sudden. Sudden death (SD) in the young population occurs at a rate of 1/100 000/year and carries a profound social impact both for the young age of the victims and the unanticipated occurrence. Physical effort is a triggering risk factor, in fact SD occurs three times more frequently in athletes than in non-athletes. The screening for sport activity fitness can identify apparently healthy subjects carrying a silent abnormality able to trigger sudden cardiac death during sport activity, thus the fitness screening could be lifesaving. The spectrum of cardiovascular conditions identified at post-mortem examination is quite extensive, and include: coronary, myocardial, valvular diseases, as well as conduction system abnormalities. In 20% of the cases, the heart is normal, and sudden cardiac death is ascribed to ionic channel disease. The diagnosis of cardiomyopathy is possible with the integration of electrocardiogram and echography, thus decreasing significantly the occurrence of SD of athletes in Italy, but early diagnosis of coronary artery disease still remains challenging. The best strategy to further decrease sudden cardiac death during sport activities consists in combining early diagnosis with widespread availability of defibrillators on site.

With a little help from my friends: Cultivating serendipity in online shopping environments

Many important findings and discoveries in science and everyday life are the result of serendipity, that is, the unanticipated occurrence of happy events such as the finding of valuable information. Consumers are increasingly seeking serendipity in online shopping, where information clutter and preprogramed recommendation systems can make product choice frustrating or mundane. However, it is notoriously difficult to design online shopping environments that induce it. In this study, we explore how social media affordances such as obtaining access to peer-generated content and being connected to online friends can help create the right conditions for serendipity in online shopping. We supplement this analysis with an account of two individual factors that are also likely to be instrumental in a shopping context, namely, the intensity of shoppers’ information search and their aversion to risk when faced with a product choice. Our investigation relies on a conceptualization of serendipity that has two defining elements: unexpectedness and informational value. The results of an experimental study in which we manipulated an online product search environment reveal the superiority of designs that incorporate online friendships, and these results support the positive effects of search effort and risk aversion on serendipity. This study contributes by developing a theoretical framework for the analysis of serendipity and by explaining how social commerce, that is, the integration of social media and electronic commerce, can cultivate serendipity.

Observation of glycine zipper and unanticipated occurrence of ambidextrous helices in the crystal structure of a chiral undecapeptide

BackgroundThe de novo design of peptides and proteins has recently surfaced as an approach for investigating protein structure and function. This approach vitally tests our knowledge of protein folding and function, while also laying the groundwork for the fabrication of proteins with properties not precedented in nature. The success of these studies relies heavily on the ability to design relatively short peptides that can espouse stable secondary structures. To this end, substitution with α, β-dehydroamino acids, especially α, β-dehydrophenylalanine (ΔPhe) comes in use for spawning well-defined structural motifs. Introduction of ΔPhe induces β-bends in small and 310-helices in longer peptide sequences.ResultsThe present report is an investigation of the effect of incorporating two glycines in the middle of a ΔPhe containing undecapeptide. A de novo designed undecapeptide, Ac-Gly1-Ala2-ΔPhe3-Leu4-Gly5-ΔPhe6-Leu7-Gly8-ΔPhe9-Ala10-Gly11-NH2, was synthesized and characterized using X-ray diffraction and Circular Dichroism spectroscopic methods. Crystallographic studies suggest that, despite the presence of L-amino acid (L-Ala and L-Leu) residues in the middle of the sequence, the peptide adopts a 310-helical conformation of ambidextrous screw sense, one of them a left-handed (A) and the other a right-handed (B) 310-helix with A and B being antiparallel to each other. However, CD studies reveal that the undecapeptide exclusively adopts a right-handed 310-helical conformation. In the crystal packing, three different interhelical interfaces, Leu-Leu, Gly-Gly and ΔPhe-ΔPhe are observed between the helices A and B. A network of C-H...O hydrogen bonds are observed at ΔPhe-ΔPhe and Gly-Gly interhelical interfaces. An important feature observed is the occurrence of glycine zipper motif at Gly-Gly interface. At this interface, the geometric pattern of interhelical interactions seems to resemble those observed between helices in transmembrane (TM) proteins.ConclusionThe present design strategy can thus be exploited in future work on de novo design of helical bundles of higher order and compaction utilizing ΔPhe residues along with GXXG motif.

De Novo Design and Characterization of a Helical Hairpin Eicosapeptide: Emergence of an Anion Receptor in the Linker Region

De novo design of supersecondary structures is expected to provide useful molecular frameworks for the incorporation of functional sites as in proteins. A 21 residue long, dehydrophenylalanine-containing peptide has been de novo designed and its crystal structure determined. The apolar peptide folds into a helical hairpin supersecondary structure with two right-handed helices, connected by a tetraglycine linker. The helices of the hairpin interact with each other through a combination of C-H···O and N-H···O hydrogen bonds. The folding of the apolar peptide has been realized without the help of either metal ions or disulphide bonds. A remarkable feature of the peptide is the unanticipated occurrence of an anion binding motif in the linker region, strikingly similar in conformation and function to the “nest” motif seen in several proteins. The observation supports the view for the possible emergence of rudimentary functions over short sequence stretches in the early peptides under prebiotic conditions.

An alternative method for the reliability differentiated transmission pricing

The reliability of power systems covers all aspects of the ability of the system to satisfy the customer requirements concerning the continuity of supply. The underlying concept is that the transmission reliability margin (TRM) must be secured for the overall system to survive the sudden and unanticipated occurrence of any possible disturbance that may be represented by the mostly common index-forced outage rate. In this regard, this paper explores the probabilistic approach to the calculating of all market participants’ contributions to the TRM by taking into account the forced outage rate of each circuit across the entire network. With these reliability contributions, we can allocate the reliability cost to the users in a more reasonable way. Finally, the proposed method is applied to a 3-bus test system, which is very comprehensive and self-explanatory.

MIVACURIUM APNOEA: A TRAP FOR THE UNWARY

SUMMARYWe present a case of unanticipated postoperative apnoea in a patient with associated medical illness to illustrate the diagnostic difficulty that can arise in the detection and subsequent management of mivacurium apnoea. A high index of suspicion is essential in the presence of concomitant medical conditions that may cause prolonged apnoea. To our knowledge, no report exists documenting the unanticipated occurrence of mivacurium apnoea in a patient with previously undiagnosed pseudoCholinesterase deficiency and concomitant medical illness who has previously undergone ‘balanced’ general anaesthesia.

Prolonged Neuromuscular Block After Mivacurium

Mivacurium is a new short acting synthetic bis-benzylisoquinolinium diester nondepolarizing muscle relaxant. The reported ED95 in adults and children is 0.07–0.08 mg/kg (1,2) and 0.10--0.11 mg/kg (3,4), respectively. A dose two times the ED95 provides tracheal intubating conditions within 2.5 min (1,2,5). Usual duration of action is 15–30 min, one-third to one-half that of the intermediate acting nondepolarizing agents (6). Like succinylcholine, mivacurium depends primarily on plasma cholinesterase (pseudocholinesterase) for metabolism and termination of clinical effect (5,7). The in vitro rate of hydrolysis of mivacurium in pooled human plasma experiments ranges from 70% to 88% that of succinylcholine (5,7). Duration of drug action will vary in patients with reduced plasma cholinesterase activity. Ali et al. (6), for example, demonstrated a significant correlation between the infusion rate of mivacurium required to maintain 95% twitch depression and the plasma cholinesterase activity in individual subjects. Individuals known to have pseudocholinesterase deficiencies have been studied with mivacurium and demonstrate prolonged neuromuscular block (8). No reports exist documenting the unanticipated occurrence of prolonged neuromuscular block after mivacurium. We present a case of prolonged neuromuscular block in a patient with previously undiagnosed homozygous atypical pseudocholinesterase deficiency.

Commercial impracticability in contract law: An economic analysis

Most of the papers which discuss this subject from an economic point of view deal with the issue of in the broadest terms, placing commercial impossibility (or impracticability), physical impossibility and frustration of purpose side by side. In the broad perspective currently adopted, possible range from international crises, making a commodity unexpectedly scarce and thus dramatically raising the cost of performance under supply contracts, to the destruction by fire of the factory in which the buyer intended to install the machinery which he had ordered, from a sudden burst of inflation to the passing of a statute prohibiting the use for which a building has been leased, from the coronation cases to the closure of the Suez Canal, requiring ships to sail around Africa in order to perform cargo contracts. The analysis of Posner and Rosenfield, subsequently taken up and complemented by other authors, suggests that the question of whether or not to excuse the non-performing party in such is one of choosing which party should bear the risk of the economic loss resulting from the unanticipated occurrence. According to these authors, economic efficiency requires first that, if the parties have expressly assigned the risk to one of them, this assignment should be honoured. In the absence of any express contractual provision to such effect, the loss should be placed upon the party who is the superior risk bearer, either because he is in a better position to prevent the risk from materializing or because he is