Uncertain Start Research Articles

Obstacles and sustainability of enhanced recovery after surgery in pediatric laparoscopic pyeloplasty.

Previous studies on Enhanced Recovery After Surgery (ERAS) in pediatric Laparoscopic Pyeloplasty (LP) lacked clear control cases and discussed the obstacles in the implementation process. This article details the obstacles and lessons learned during the implementation of ERAS in patients with ureteropelvic junction obstruction (UPJO). An ERAS protocol was implemented in the UPJO population undergoing LP, which included preoperative, intraoperative, and postoperative management. The clinical data of ERAS program Before Implementation (BI) and After Implementation (AI) were collected and analyzed retrospectively. A total of 107 patients (BI 46, AI 61) were enrolled. Compared with the BI group, the AI group had an earlier normal diet (19.83 h vs. 9.53 h, p < 0.001), ambulation (39.10 h vs. 12.70 h, p < 0.001), resumption of defecation (89.88 h vs. 27.90 h, p < 0.001), less need for additional analgesia (19.5% vs. 1.6%, p = 0.002) and shorter postoperative hospital stay (POS) (6.00 d vs. 1.91 d, p < 0.001) without increasing complications and readmission rates. Patients in the AI group had a median protocol score of 17 (IQR 16-18), and the compliance rate of the ERAS protocol was negatively correlated with the length of POS (R 2 = 0.69, p < 0.001). The application of ERAS in pediatric LP is feasible and sustainable, with the potential for even greater impact as compliance improves. Common barriers were uncertain start time of surgery, lack of knowledge of ERAS among pathway participants, and support from anesthesiologists. Pre-determining the start time of surgery, strengthening preoperative education and positive communication among team members can help to promote the full implementation of ERAS program.

Defender Policy Evaluation and Resource Allocation With MITRE ATT&amp;CK Evaluations Data

Protecting against multi-step attacks of uncertain start times and duration forces the defenders into indefinite, always ongoing, resource-intensive response. To allocate resources effectively, the defender must analyze and respond to an uncertain stream of potentially undetected multiple multi-step attacks and take measures of attack and response intensity over time into account. Such response requires estimation of overall attack success metrics and evaluating effect of defender strategies and actions associated with specific attack steps on overall attack metrics. We present a novel game-theoretic approach GPLADD to attack metrics estimation and demonstrate it on attack data derived from MITRE's ATT&CK Framework and other sources. In GPLADD, the time to complete attack steps is explicit; the attack dynamics emerges from attack graph and attacker-defender capabilities and strategies and therefore reflects ‘`physics’' of attacks. This makes time a physical constraint on attack success parameters and enables comparing different defender resource allocation strategies across different attacks. We solve for attack success metrics by approximating attacker-defender games as discrete-time Markov chains and show evaluation of return on detection investments associated with different attack steps. We apply GPLADD to MITRE's ATT&CK Evaluations data and show how this methodology enables defender optimization and resource allocation against multi-step attacks.

Minimizing maximum tardiness on a single machine with family setup times and machine disruption

Due to the complexity of manufacturing processes, many industries today try to group their production components into families and use a common setup time to process every family. Also, the failure of machinery has an important impact on the planning of production systems. This paper deals with the problem of single machine scheduling with family setup times and randomly machine breakdown. It is assumed that there is disruption along the planning horizon with uncertain start and duration times based on a specific probability distribution function. The goal is to minimize the maximum expected tardiness. For this problem, a hill climbing based heuristic (HCO) and a novel hybrid variable neighborhood search metaheuristic (HVNS) have been developed. A branch and bound (BB) procedure is also proposed to optimally solve this problem using HCO and HVNS algorithms to derive upper bounds. Comparison of the solutions obtained from the presented algorithms with the mathematical programming model of the problem in small-scale instances shows that the solutions obtained from the proposed algorithms have a good quality in terms of the expected value of the objective function and the solving time. The computational results for executing the proposed algorithms on 36 series of various instances show that the BB procedure is able to solve 97.76% of the instances within the specified time frame and HVNS metaheuristic is capable to solve 41.07% of them, optimally. Also, the maximum mean deviation of HVNS solutions from the optimal solution is reported below 5% for hard instances and below 15% for instances with medium complexity. After performing a non-parametric hypothesis test, it is found that at a confidence level 99.9%, the deviation index for HVNS is less than 1.5% for difficult problems and less than 9% for semi-difficult ones. Finally, the results of solving large scale instances, demonstrate the efficiency of proposed metaheuristic.

Hard Nanomaterials in Time of Viral Pandemics.

The SARS-Cov-2 pandemic has spread worldwide during 2020, setting up an uncertain start of this decade. The measures to contain infection taken by many governments have been extremely severe by imposing home lockdown and industrial production shutdown, making this the biggest crisis since the second world war. Additionally, the continuous colonization of wild natural lands may touch unknown virus reservoirs, causing the spread of epidemics. Apart from SARS-Cov-2, the recent history has seen the spread of several viral pandemics such as H2N2 and H3N3 flu, HIV, and SARS, while MERS and Ebola viruses are considered still in a prepandemic phase. Hard nanomaterials (HNMs) have been recently used as antimicrobial agents, potentially being next-generation drugs to fight viral infections. HNMs can block infection at early (disinfection, entrance inhibition) and middle (inside the host cells) stages and are also able to mitigate the immune response. This review is focused on the application of HNMs as antiviral agents. In particular, mechanisms of actions, biological outputs, and limitations for each HNM will be systematically presented and analyzed from a material chemistry point-of-view. The antiviral activity will be discussed in the context of the different pandemic viruses. We acknowledge that HNM antiviral research is still at its early stage, however, we believe that this field will rapidly blossom in the next period.

Remarks by Lt. Col. Sean Watts

We are still in the early days of the relationship between cyberspace and international law. In many respects, it is a relationship off to an unsteady and uncertain start. But a slow and sporadic trickle of governmental efforts to express or even to shape that relationship has emerged. To date, the most significant multinational clarification from states has been the deceptively modest concession that international law applies fully to cyberspace. States have at least made clear that the novelty and seemingly virtual nature do not exempt cyberspace from existing in international law.

Visual Encodings of Temporal Uncertainty: A Comparative User Study.

A number of studies have investigated different ways of visualizing uncertainty. However, in the temporal dimension, it is still an open question how to best represent uncertainty, since the special characteristics of time require special visual encodings and may provoke different interpretations. Thus, we have conducted a comprehensive study comparing alternative visual encodings of intervals with uncertain start and end times: gradient plots, violin plots, accumulated probability plots, error bars, centered error bars, and ambiguation. Our results reveal significant differences in error rates and completion time for these different visualization types and different tasks. We recommend using ambiguation - using a lighter color value to represent uncertain regions - or error bars for judging durations and temporal bounds, and gradient plots - using fading color or transparency - for judging probability values.

Nigeria's Economic Outlook in 2015

2015 is likely to be a year of contrasts in which a difficult and uncertain start will most probably give way to a promising end, as renewed post-election economic reform efforts to address fiscal, structural, and financial challenges highlighted by low oil price and weak capital inflows on the eve of election will open up new growth and investment opportunities, thereby brightening the outlook. Thus, while the twin external shocks on the eve of general elections had imposed short term challenges and created significant uncertainties about the economic outlook in 2015, they have also beneficially elevated the place of economic and fiscal reforms in the pre-election conversation. A strong consensus for reforms has fortuitously been built among the populace that it makes sense to expect a high pace of reforms after the election. This will brighten the outlook for the second half of 2015 and beyond. Specifically the three big gains within Nigeria’s reach are: (a.) Nigeria’s fiscal outlook can easily be stabilized by revenue reforms that provides the fiscal space required for growth and stability; (b.) Breaking government monopoly in key potentially large economic sectors and allowing entry of reputable private firms will release fresh growth and investment impetus; (c.) Foreign longer-term financial inflows that will be attracted to the liberalized sectors will reduce Nigeria’s dependence on volatile short term capital inflows. Nigeria is clearly coming up with a better contemplation of her economic and financial future, and it should be easier to engage others to come and invest in that future.

Sidney &amp; Sydney: Third Grade Mix-Up by Michele Jakubowski (review)

Reviewed by: Sidney & Sydney: Third Grade Mix-Up by Michele Jakubowski Jeannette Hulick Jakubowski, Michele. Sidney & Sydney: Third Grade Mix-Up; illus. by Luisa Montalto. Picture Window/Capstone, 2013. [128p]. Trade ed. ISBN 978-1-4048-8001-6 $17.99 Paper ed. ISBN 978-1-4048-8104-4 $8.95 Reviewed from galleys R Gr. 2–4. Can a third-grade boy and a third-grade girl really be friends? Sidney, the new boy in town, and Sydney, an art-loving girl, make a go of it after an uncertain start: Sydney mistakes Sidney’s classroom name tag for her own and both get embarrassed by the teasing that results from the mix-up. The two then discover, however, that they share more than just a similar-sounding name, including an interest in photography, Paris, and the game Galaxy Conquest. When both of their best friends are bummed about Halloween—one is diabetic and the other’s health-conscious mother has forbidden all sweets—Sidney and Sydney formulate a plan that will allow their pals (and themselves) to still have fun on Halloween without all the candy. This observant and humorous story is the first book in a series that refreshingly promises to appeal to both boys and girls. Sydney and Sidney alternately narrate (each chapter’s narrator is identified by an illustrative headpiece) and each of their perspectives is credible on both age and gender levels. The text moves quickly and effortlessly, and the kid-centered scenarios will resonate with middle-graders. The frequent full-color illustrations are stylish and attractive, and Sidney and Sydney have a wide-eyed, loose-limbed appeal slightly reminiscent of an older Charlie and Lola from Child’s series. Consider this for a refreshing classroom readaloud, for mixed-gender book groups, or for encouraging more friendships that cross the middle-grade gender divide. Copyright © 2013 The Board of Trustees of the University of Illinois

Drug Trial Offers Uncertain Start in Race to Save Children With Progeria

This week marks the publication of a paper describing the first clinical trial of a drug for progeria, an ultrarare syndrome that seemingly ages children at warp speed.

A harvest area measurement system based on ultrasonic sensors and DGPS for yield map correction

Unknown crop width entering into the header and the delay time caused by the uncertain start and stop of cutting are the two main error sources in a yield map. A harvest area measurement system (HAMS) is presented in this article. The system has ultrasonic sensors mounted on both sides of the harvest header to detect the presence of crop, which was used to start or stop data recording, as well as measure the cutting width. A high-precision Differential Global Positioning System (DGPS) receiver was used to measure the travelled distance. Field tests were conducted to evaluate the performance of the system. Results showed that: Firstly, the developed HAMS can be used to reduce the area error and the data collected by the HAMS can be used to correct the yield data. In a yield map, the area error reached 6.89% relative to the actual area calculated based on the DGPS tracks. The travelled distance error accounted for about 1.08% and the cutting width error accounted for the other 5.81%. However, the error of the area measured by the HAMS decreased to 0.95%. The position offset of yield points could be calculated and the correction coefficient at each sampling point was determined. Secondly, ultrasonic sensors could replace the header position sensors in most yield monitoring systems, as ultrasonic sensors can detect the presence of the crop, which can be used to start or stop data recording. Finally, the HAMS also provides a potential solution to realize online correction of yield data. The time delay estimated by the HAMS between cutting and sensing was 3–6 s at the start of cutting, and was 1–7 s at the end of cutting. An online correction model of yield data was proposed.

Shaky start to year for NMC as best candidate declines top job

The Nursing and Midwifery Council (NMC) faces an uncertain start to the year after the candidate chosen to take over as chief executive rejected the job offer.

Private-label grocery shopping attitude and behaviour: A cross-cultural study

While the marketing phenomenon of the private-label grocery brand has been studied in considerable depth in Western countries, particularly in Britain and major parts of Europe, this has not been the case in developing Far Eastern markets, perhaps in part because the established retail formats have not been conducive to their growth. The recent broad-scale introduction of private-label grocery brands in one of these markets (Thailand), provides an opportunity to question why such brands have experienced an uncertain start in many Eastern countries. This study attempts to understand the attitudinal and behavioural factors associated with private-label grocery shopping through simultaneous surveys conducted among residents of Wichita, Kansas, USA and Prakanong-Bangna in Greater Bangkok, Thailand.

Future directions of thoracic surgery in Europe (directions of ESTS and EACTS): 'from paradise to nowhere and back' [corrected

It is my great honour to present this lecture on the future of thoracic surgery in Europe to such a distinguished Society. As many of you know, I come from Szczecin, Poland, from quite a large center of thoracic surgery—not the largest nor the most famous one. I think my position as President of this Society proves very well that ESTS offers excellent possibilities for any thoracic surgeon for whom the future of our specialty is precious. ESTS represents highly ranked academic surgeons and pure clinicians, surgeons working in large units and surgeons from small hospitals, surgeons from west, east, north and south. Thoracic surgery is the oldest of medical specialties. It started in the garden of Eden. Just look at Orvieto’s sculpture in Italy of God performing a rib resection. Anaesthetists might claim that someone had to give anesthesia, but I think it was done by one almighty person. Eons later, almost 100 years ago, Ferdinand Sauerbruch from Wroclaw invented his chamber allowing safe open thoracic surgery. It was an uncertain start to the history of our specialty but definitely we can name it as one of the milestones. Rapid development of thoracic surgery in the 20th century resulted in a very fruitful period of many (sometimes very important) publications and congresses. But surprisingly, unlike our American colleagues, professional societies at a European level were established relatively late (European Association for Cardiothoracic Surgery in 1986, European Society of Thoracic Surgeons in 1993). From this particular point of view, which concerns scientific societies of European level we had lived on a desert. In the early years of the EACTS cardiac surgery was the predominant specialty represented, with an underrepresentation of thoracic surgery, resulting in a rebellion by thoracic surgeons—the formation of ESTS. I strongly believe that this was necessary even if a difficult event to find our identity in a rapidly changing cardiothoracic world. Fortunately, when both societies matured, people started to look for cooperation rather than competition and has resulted in the promotion of many different joint initiatives run by both societies together. I can enumerate the common Section of Cardiothoracic Surgery within the UEMS, Bergamo School, European Journal of Cardiothoracic Surgery, European Database project, “Structure of general thoracic surgery in Europe” document and the international exchange project. This autumn we will meet in Leipzig for the third joint meeting. The initiatives I have listed are in various stages of completion, but all reflect the will to find solutions rather than problems. The cooperation is defined until 2005 when both societies will analyze it and decide about further initiatives. When I joined the society the number of members slightly exceeded 100. Right now we have more than 500 members and the number is still growing. Our junior membership is increasing particularly well—it confirms that we are not only the society of old-fashioned professors and heads of departments, but a dynamic body open to young surgeons where there are opportunities for them to serve their society. Shortly after this meeting our representatives are heading to Toronto to the AATS meeting to present ourselves as a leading force in European Thoracic Surgery to our American friends, and we are the leading force in fact. Some of us are members of both the cooperating societies but the difference between the number of thoracic members of EACTS and our membership is ever increasing. We offer a reduced ESTS membership fee to all thoracic members of EACTS and most European EACTS thoracic surgeons are members of both

South Africa 1999: The ANC and Democratic Consolidation

Two days before South Africa’s national election on June 2, 1999, Business Day—the country’s “quality” national daily newspaper—pronounced that “on balance” its vote was going to the African National Congress (ANC) for the job it had done since 1994. The government’s performance could have been better, it opined, but it could also have been a lot worse:The ruling party deserves credit for the relative social stability SA has enjoyed since 1994. Its macroeconomic management, while not flawless, has been impressive. It has resisted taking the populist route. That it has been able and willing to do so is thanks, in part, to the strong 62% majority it won at the last election. ANC leaders might have felt less able to resist populist pressures had the majority been narrower.After an uncertain start, the ANC has begun to deliver the improvements to the quality of life of its primary constituency, the black majority. Maintaining fiscal discipline while delivering on at least some election promises in the midst of an emerging markets crisis has been a remarkable balancing act.Nevertheless, we cannot overlook some severe flaws and failures. The school system is a mess. Crime could have been more effectively dealt with. The performance of many ANC-run provincial governments has been abysmal. Notwithstanding its anti-corruption talk, it has displayed a reluctance to act firmly against culprits seen as party loyalists. All of which emphasizes the need for an effective opposition—if one can be found.

South Africa 1999: The ANC and Democratic Consolidation

Two days before South Africa’s national election on June 2, 1999, Business Day —the country’s “quality” national daily newspaper—pronounced that “on balance” its vote was going to the African National Congress (ANC) for the job it had done since 1994. The government’s performance could have been better, it opined, but it could also have been a lot worse: The ruling party deserves credit for the relative social stability SA has enjoyed since 1994. Its macroeconomic management, while not flawless, has been impressive. It has resisted taking the populist route. That it has been able and willing to do so is thanks, in part, to the strong 62% majority it won at the last election. ANC leaders might have felt less able to resist populist pressures had the majority been narrower. After an uncertain start, the ANC has begun to deliver the improvements to the quality of life of its primary constituency, the black majority. Maintaining fiscal discipline while delivering on at least some election promises in the midst of an emerging markets crisis has been a remarkable balancing act. Nevertheless, we cannot overlook some severe flaws and failures. The school system is a mess. Crime could have been more effectively dealt with. The performance of many ANC-run provincial governments has been abysmal. Notwithstanding its anti-corruption talk, it has displayed a reluctance to act firmly against culprits seen as party loyalists. All of which emphasizes the need for an effective opposition—if one can be found.

Franchised Degree Teaching What Can Educators Learn From Business?

Abstract In order to achieve rapid growth in student numbers, a number of Higher Education Institutions have borrowed some of the concepts of franchising from the private service sector. A franchise involves one party — the franchisor — developing a service and monitoring standards, whilst a second party — the franchisee, delivers the service in return for a share of the reward. This article draws comparisons between private sector and higher education franchising and analyses the franchise strategies open to the HE sector. It concludes that if managed correctly, franchising will bring benefits to the higher education sector, colleges of further education and students alike. The uncertain start to higher education franchising mirrors the early days of private sector franchising, but like the latter, it has potential subsequently to achieve rapid mutually beneficial growth.

Trade Unions and the State in Solomon Islands

Among small island states of the South Pacific, Solomon Islands has the third largest trade union movement after Papua New Guinea and Fiji. Unionism had an uncertain start in the early 1960s, then became more firmly established with the formation of the Solomon Islands General Workers Union in 1975. This union, which later became the Solomon Islands National Union of Workers, took a more militant and political approach to getting recognition for unionism and improving worldng conditions. This regularly put it into conflict with the state as well as employers. More recently it has been joined by two large public sector unions, just as militant in their wage negotiations and ready to confront the power of the state. The growth of unionism and the conflicts which have arisen out of this show the way in which emergent class formation is proceeding.

The Copley Medal: The establishment of a reward system in the Royal Society, 1731-1839

The Copley Medal represents one of the oldest surviving honorary reward systems not only in the Royal Society but also in European science. After the first few years of its award it came increasingly to represent the recognition by the Society of the highest scientific distinction. Its history is, therefore, closely associated with the development of modern science, particularly in Britain. It is surprising that no one has attempted a history of the Copley Medal. Historians of the Royal Society deal with the subject only summarily, or sometimes there is an incidental mention of the medal in connection with a particular recipient. It seems, therefore, that it would be a worthwhile task to look at the foundation of the award and its subsequent history over a considerable period, and we have chosen to examine a time span of approximately a century. This study covers the period from the establishment of Sir Godfrey Copley’s legacy to the late 1830s, by which time various reform movements within the Society had begun to take effect. In fact the period chosen for review corresponds to the award of precisely 100 medals. Our research shows that, after a rather uncertain start over the first 25 years, the Copley Medal thereafter became established as a major award. In the early 19th century the Medal gained ever wider publicity by its award to several distinguished foreign scientists, so that by the end of our period it had become recognized as a real mark of international distinction.

Uncertain start in Montreal

Uncertain start in Montreal