Uncertain Timing Research Articles

QOL-09. “I’VE DEFINITELY CHANGED WHO I AM”: A THEMATIC ANALYSIS OF CHALLENGES FACED BY PATIENTS WITH IDH-MUTANT GLIOMAS

Abstract BACKGROUND Despite their more favorable prognosis, patients with isocitrate dehydrogenase (IDH)-mutant gliomas experience significant psychological distress across their disease trajectory. The specific drivers of distress in this population are poorly understood, and interventions to support these patients are lacking. We sought to better characterize drivers of distress and ways to enhance support for patients with IDH-mutant gliomas as they confront potentially prolonged but ultimately unpredictable survival with an incurable, progressive brain tumor. METHODS Eligible individuals were English-speaking adults ages 65 and younger diagnosed with an IDH-mutant glioma at a single academic medical center. We conducted semi-structured interviews (N=20) to better understand the distress patients experience as they progress along their illness trajectories. We audio-recorded and transcribed interviews and analyzed interview content using reflexive thematic analysis. RESULTS Distress among participating patients (female = 7/20; age <40 years = 10/20) was linked to their struggles to maintain a coherent sense of identity while adapting to 1) neurocognitive changes and 2) altered life plans amidst prognostic uncertainty. Patients described feeling self-conscious and distrustful of their cognitive capacities, frequently comparing their current performance to their premorbid functioning (e.g. by checking their symptoms and indexing perceived deficits against scan results). Patients felt overwhelmed by the need to make decisions and set priorities (e.g., regarding family planning, retirement) due to the uncertain timing of their tumor’s progression and its unclear impact on their future functioning. Patients identified the transition from treatment to surveillance as a time of heightened worry, as they shifted their focus from the logistics of cancer care to the task of planning – financially, occupationally, socially – for an uncertain future. CONCLUSION These findings highlight the need for tailored supportive care to help patients with IDH-mutant gliomas cope with the distress caused by significant changes to identity and ongoing uncertainties regarding their future.

Lost and found: the late discovery of a migrated intrauterine device after 15 years - a case report

Intrauterine devices (IUDs) are a preferred reversible contraceptive choice for about 159 million women worldwide. While generally safe, they pose risks like uterine perforation and device migration, which happen in about 1 in 1000 insertions. Other common issues include insertion failure, pain, infection, and menstrual changes. This report details a rare case of IUD migration in a 40-year-old woman, discussing the diagnostic challenges and the approaches used to manage such complications. IUD migration to the bladder is uncommon but can lead to serious, often undetected issues, thus underscoring the necessity for regular follow-up after placement. Early diagnosis with imaging is critical for proper treatment, with the World Health Organization recommending surgical removal in symptom-free cases. The rarity of uterine perforation during IUD use highlights the vital need for vigilant monitoring and patient follow-ups to prevent and quickly address such complications. The uncertain timing and cause of IUD migration further stress the importance of comprehensive counseling and regular patient check-ups. Abdominal discomfort may indicate an IUD has migrated, emphasizing the need for patient awareness and routine self-monitoring after placement. CT imaging is crucial for identifying and pinpointing the location of migrated IUDs, facilitating their removal using minimally invasive methods like colonoscopy and laparoscopy. For more complicated scenarios, such as those involving deep embedment, laparotomy may be necessary.

On delivery waiting: The entanglement of gig and border temporalities in platform cities

The politics of time, and particularly practices of waiting, spring in the narratives of any border crossing. This article draws from the scholarly analysis on migratory temporalities, to shed light upon the temporalities of urban delivery platforms, strongholds of migrant labor. We focus on waiting both as a research object and analytical lens to further comprehend the intersectional precarities at work in the food-delivery sector. What does the border tempos have to do with a delivered meal? Based on ethnographic research conducted in Spain and Chile, we gathered two sets of distinct temporalities coming together: on the one hand, the codified periodization of migratory statuses; on the other, the uncertain timing of speed and still, labor and no/labor of digital gigs. The intersection where the border and delivery chronopolitics come together remains understudied. Drawing on select empirical examples, delivery waiting emerges as a central and ambivalent practice among riders’ everyday lives.

Willingness to wait outperforms delay discounting in predicting drinking severity.

Alcohol misuse ranks among the leading causes of preventable death worldwide. Therefore, discovering measures that can predict hazardous drinking is critical. The delay discounting paradigm-which assesses relative preference for immediate rewards over larger, later rewards-has frequently been used as a proxy for impulsive choice, but it does not capture how long someone is willing to wait for delayed rewards when the arrival time is uncertain. In contrast, a newer willingness-to-wait task measures how long someone is willing to wait for a delayed reward of uncertain timing before giving up. We hypothesized that performance in this willingness-to-wait task would be associated with drinking severity and that this task may even outperform delay discounting as a predictor of drinking severity. We pooled data from multiple studies of mostly college-aged adult participants. Drinking severity was assessed with the Alcohol Use Disorders Identification Test. Willingness to wait under temporal uncertainty, but not delay discounting, was associated with severity of alcohol problems among participants who drank (n = 212). Individuals engaging in hazardous drinking were less willing to wait for rewards when delays were unknown than were individuals with low-risk drinking habits. Thus, willingness to wait under temporal uncertainty may be an important predictor of problematic drinking.

Kinetic Considerations in the Interpretation of Biomonitoring of 1,3-Butadiene Exposure by Determination of Urinary Mercapturic Acids.

1,3-Butadiene (BD) is classified as a human carcinogen, and occupational exposure should be minimized. This study examined the effectiveness of personal protective equipment (PPE) during the clean-up and repair of a storage tank containing sludge contaminated with BD. A total of 66 workers participated, providing repeat urine samples before and after the shift. Overall, 1286 samples were analyzed for 1,2-dihydroxy-4-(N-acetylcysteinyl)butane (DHBMA) and the isomers 2-hydroxy-1-(N-acetylcysteinyl)-3-butene and 1-hydroxy-2-(N-acetylcysteinyl)-3-butene (MHBMA). Both DHBMA and MHBMA are urinary metabolites of BD and serve as biomarkers for recent BD exposure. Established correlations between the urinary concentrations of these biomarkers and airborne BD levels allowed for exposure assessment. However, conclusions regarding the exceedances of occupational exposure limits can vary depending on whether DHBMA or MHBMA levels are considered. This study investigated this discrepancy by estimating the apparent urinary half-lives of DHBMA and MHBMA using sequential individual post- and pre-shift samples. The results indicated that the longer urinary half-life of MHBMA (19.7 ± 3.1 h) led to its accumulation during the work week, in contrast to DHBMA, which has a shorter half-life (10.3 ± 1.9 h) and showed limited accumulation. When the kinetic information was used to adjust for the MHBMA build-up over the week, the discrepancy with DHBMA resolved, confirming that exposure limit values were not exceeded and validating the effectiveness of the PPE used. In the context of biomonitoring, this study provides valuable insights into biomarker selection based on specific objectives. MHBMA is recommended for scenarios with uncertain exposure timing and activities, whereas DHBMA is the preferred biomarker for evaluating the effectiveness of protective measures in known exposure settings.

Electrophysiological Activity Associated with a Cross-Modal Anapaest Rhythm: Evidence for the Vestibular Syncopation Hypothesis

Abstract We report an experiment that tested the vestibular syncopation rhythm hypothesis, which holds that the rhythmic effect of syncopation is a form of vestibular reflexive/automated response to a postural perturbation, for example during locomotion. Electrophysiological signals were recorded from the cerebral cortex and cerebellum during processing of rhythmic sequences in a sample of experienced participants. Recordings were made using four different stimulus modalities, auditory, axial, vestibular and visual, under different rhythmic timing conditions, irregular, regular and syncopated/uncertain. Brain current activity was measured using a model with10-dipole source regions of interest in each of the participants, each modality, each timing condition, and for each beat within the bar of the rhythm. The cross-modal spectral power in the frontal electroencephalogram (EEG) and the cerebellar electrocerebellogram (ECeG) was also analysed. The results show that the brain activity increases from the irregular to the regular and then from the regular to the uncertain timing conditions. However, the vestibular modality induces the greatest total brain activity across the regions of interest and exhibits the highest sensitivity to the interaction of beat structure with the timing conditions in both source currents and spectral power. These data provide further evidence to support the primal role of the vestibular system in human processing of rhythm.

Linear enamel hypoplasia in Homo naledi reappraised in light of new Retzius periodicities.

Among low-latitude apes, developmental defects of enamel often recur twice yearly, linkable to environmental cycles. Surprisingly, teeth of Homo naledi from Rising Star in South Africa (241-335 kya), a higher latitude site with today a single rainy season, also exhibit bimodally distributed hypoplastic enamel defects, but with uncertain timing and etiology. Newly determined Retzius periodicities for enamel formation in this taxon enable a reconstruction of the temporal patterning of childhood stress. Using high resolution casts of 31 isolated anterior teeth from H. naledi, 82 enamel defects (linear enamel hypoplasia [LEH]) were identified. Seventeen teeth are assigned to three individuals. Perikymata in the occlusal wall of enamel furrows and between the onsets of successive LEH were visualized with scanning electron microscopy and counted. Defects were measured with an optical scanner. Conversion of perikymata counts to estimates of LEH duration and inter-LEH interval draws upon Retzius periodicities of 9 and 11 days. Anterior teeth record more than a year of developmental distress, expressed as two asymmetric intervals centered on 4.5 and 7.5 months bounded by three LEH. Durations, also, show bimodal distributions, lasting 3 or 12 weeks. Short duration LEH are more severe than long duration. Relative incisor/canine rates of formation are indistinguishable from modern humans. We invoke a disease and dearth model, with short episodes of distress reflecting onset of disease in young infants, lasting about 3 weeks, followed by a season of undernutrition, possibly intensified by secondary plant compounds, spanning about 12 weeks, inferably coincident with austral winter.

Governing Online Rumor: An Uncertain Intervention Timing Model for Online Rumor Propagation from the Perspective of Government

In view of different types of online rumors, when the governance institutions (government departments) intervene to achieve the least cost and the best effect is a core issue of rumor governance. Based on the perspective of the government, under the premise of limited human, material and financial resources, and considering the different impacts of government intervention opportunities on the spread of different types of rumors, this paper establishes an uncertain multi-objective network rumor transmission intervention timing model, so as to achieve the optimal allocation of government intervention opportunities for different types of online rumors, minimize the total cost and maximize the inhibition effect of rumor spreading. Then, the equivalent form of the model is given, and the model is solved. In addition, numerical experiments are conducted on three types of rumors during the COVID-19 pandemic. The experimental results show that when the types of online rumors and the focus of government departments on cost and governance effect are different, the optimal time for intervention will change. Finally, combined with the experimental results, corresponding countermeasures and suggestions are put forward for the supervision of online rumors by government departments.

Rational social distancing in epidemics with uncertain vaccination timing.

During epidemics people may reduce their social and economic activity to lower their risk of infection. Such social distancing strategies will depend on information about the course of the epidemic but also on when they expect the epidemic to end, for instance due to vaccination. Typically it is difficult to make optimal decisions, because the available information is incomplete and uncertain. Here, we show how optimal decision-making depends on information about vaccination timing in a differential game in which individual decision-making gives rise to Nash equilibria, and the arrival of the vaccine is described by a probability distribution. We predict stronger social distancing the earlier the vaccination is expected and also the more sharply peaked its probability distribution. In particular, equilibrium social distancing only meaningfully deviates from the no-vaccination equilibrium course if the vaccine is expected to arrive before the epidemic would have run its course. We demonstrate how the probability distribution of the vaccination time acts as a generalised form of discounting, with the special case of an exponential vaccination time distribution directly corresponding to regular exponential discounting.

Indonesian Legal Policy in Treating International Refugees Based on Human Rights Approach

Indonesia is one of the countries that is often a transit point for immigrants who want to seek asylum in other countries. This illegal arrival is certainly very detrimental to Indonesia. This is because the arrival of these refugees is considered a threat to national security and resilience. The trend of the number of refugees that continues to increase every year has caused various problems in handling foreign refugees in Indonesia. Indonesia did not ratify the 1951 Refugee Convention and the 1967 Protocol, but on the basis of human rights. As a transit country, Indonesia is experiencing a build-up of refugee flows due to the uncertain timing of the status granting process from UNHCR and moreover third countries limit the acceptance of refugees. However, Indonesia continues to provide various forms of assistance in dealing with the problems faced by refugees. The government has also issued several regulations including Presidential Decree Number 125 of 2016 and other technical regulations. Indonesia also collaborates with non-governmental institutions, such as academics, humanitarian activists, and faith and charity-based organizations. This collaboration has implications for the existence of asylum seekers and refugees in Indonesia. It is hoped that with this regulation and cooperation, it can provide legal certainty regarding solutions to refugee problems in Indonesia.

Coronary angiography after resuscitation without ST‐Elevation: Indication remains elusive

Key Points Survivors of out of hospital cardiac arrest without ST‐segment elevations present uncertain indications and timing for coronary angiography. Patients without ST‐elevations who undergo angiography tend to be younger, with better neurologic status, and more rapid resuscitation. Outcomes between patients whether they had angiography early, later, or never, were similar suggesting further work on discriminating the best care pathway for these patients is needed.

Reduced sensorimotor beta dynamics could represent a “slowed movement state” in healthy individuals

It is well established that the amplitude of beta oscillations (∼13–30 Hz)—recorded over the sensorimotor cortex—distinctly change throughout movement. Specifically, a movement-related beta decrease (MRBD) occurs before and during movement, and a post-movement beta rebound (PMBR) follows. We investigated how the magnitude of the MRBD and PMBR vary when participants are put in an experimentally induced slow versus fast movement state. Individuals performed a task with blocks that elicited longer reaction times (RTs) and shorter RTs (SLOW and FAST blocks, respectively) while scalp-electroencephalography (EEG) was recorded. The timing of an upcoming movement was also modulated to create blocks with certain and uncertain response timing (FIXED and VARIED blocks, respectively). We found that beta modulation was reduced in SLOW blocks compared to FAST blocks (i.e., a less negative MRBD and less positive PMBR). For the movement certainty manipulation, we saw mixed behavioral and EEG results. Our primary finding of reduced beta modulation during an experimentally induced “slowed movement state” aligns with previous work showing reduced movement-related beta activity in patients with Parkinson's disease.

Time series of hydrothermal vent fluid chemistry at Main Endeavour Field, Juan de Fuca Ridge: Remote sampling using the NEPTUNE cabled observatory

Seafloor hydrothermal fluids play a critical role in regulating a wide range of geochemical and biological processes. Chemical and physical changes to venting fluids undoubtedly occur in response to geological events, at depth or near the seafloor, with corresponding effects on vent fluid chemistry, mineralization, and biological activity. However, the uncertain timing of such events makes it impractical to anticipate their occurrence. Thus, the temporal evolution of seafloor vent fluids and coexisting mineral deposits is most often inferred from observations made using conventional deep submergence assets that may be non-continuous for a specific vent field. The recent development of submarine volcanic observatories operated by Ocean Networks Canada (ONC) and the Ocean Observatory Initiative (OOI) in the U.S. that deliver power to instruments on the seafloor and communications via high-speed fiber optic cable permits real-time communication and monitoring of seafloor vents. Here, we describe the development and application of a remotely operated hydrothermal fluid sampler that enables repeat on-demand sampling of high-temperature vent fluids triggered through the internet. The sampler was deployed from September 2019 to June 2020 at the S&M vent area, in the southern portion of Main Endeavour Field (MEF), Juan de Fuca Ridge, on ONC's NEPTUNE ocean observatory. Nine vent fluid samples were acquired over a period of nine months. Analyses of these samples confirm the moderately high-temperature origin of the source fluid, as indicated, for example, by dissolved chloride depletion relative to seawater (vapor-rich) and moderately high silica concentrations. These and other dissolved species, such as methane, a known hallmark of MEF vent fluids, are in excellent agreement with the reported composition of S&M vent fluids over the past 15 years or more, suggesting overall chemical stability and rock-dominated alteration processes. On the other hand, short-term variability of dissolved Mg, sulfate and barium indicate entrainment of conductively heated and partially reacted seawater. Both before and after the incursion of the “secondary” seawater derived fluid, however, samples reveal the lowest Mg and sulfate concentrations yet reported for seafloor hydrothermal vent fluid samples. Accordingly, these data provide new insight on the solubility of these and other elements coexisting with minerals close to the Axial Magma Chamber (AMC), from which the primary source fluid is ultimately derived. A separate noteworthy event characterized by ∼20 °C decrease in temperature and associated 24–77% decrease in dissolved Fe concentration was observed toward the end of the deployment, with implications for hydrothermal transition metal fluxes and linked biogeochemical processes. On-demand remote acquisition of a continuous series of high-temperature vent fluid samples from a single vent permits the temporal evolution of heat and mass transfer processes to be studied with a heretofore unavailable perspective. Furthermore, deployment of this sampler within the NEPTUNE ocean observatory opens the door to future studies based on comparative analysis of contemporaneous datasets.

A contingency perspective on manufacturing configurations for the circular economy: Insights from successful start-ups

While the circular economy offers a hopeful prospect for the future in terms of environmental sustainability, the main barrier regarding the industrial adoption is its financial viability. Supply characteristics such as heterogeneous quality, insufficient quantities and uncertain timing of used products often constrain manufacturing activities, consequently leading to mediocre financial viability. Building on contingency theory, this paper sets out to explore how to configure circular manufacturing activities in alignment with supply characteristics. Building on a sample of 96 successful circular start-ups, we collected data on the manufacturing activities in terms of grading and sorting activities, the production type and the product transformation as well as the supply characteristics in terms of heterogeneous quality, insufficient quantities, uncertain timing and the residual value of the used products. Qualitative Comparative Analysis (QCA) reveals three manufacturing configurations used by successful circular start-ups to extend product value, extend resource value and process used products. Each configuration is applied under different supply characteristics. As such, the research highlights the contingency factors for when, when not and how to adopt a given manufacturing configuration in the context of the circular economy. Moreover, by analyzing the manufacturing configurations, this study redirects the focus towards the until now under-researched circular economy in the process industry instead of the more heavily researched discrete remanufacturing activities. The three manufacturing configurations and the supply characteristics in which to apply them serve as a starting point for further research.

In Situ Direct Magnetic Loss Measurement With Improved Accuracy for Lossier Magnetics

Magnetic loss often tops the power converter’s loss breakdown chart. The optimization of a magnetic component is, therefore, crucial in developing an efficient power converter. However, it is difficult to verify the design of magnetic components <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><i>in situ</i></b> , while they operate in the desired condition. The accurate, direct magnetic loss measurement is severely hindered by an uncertain timing skew between the measurement channels. This unknown timing skew could introduce an intolerable error in the measured magnetic loss. This article presents a novel method that avails the accurate, direct, and <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"><i>in situ</i></b> magnetic loss measurement. An improved mathematical model of the measured magnetic loss in a power converter is developed with respect to the timing skew. Nonidealities in a practical magnetic component are also incorporated in the model for improved accuracy. The new method termed as triple-curve derivative (TCD) method is introduced and analyzed in detail to determine the actual timing skew and real magnetic loss with an enhanced accuracy, compared to the known methods. The TCD method is validated in simulation and verified in the experiment under various circuit design parameters based on a dc–dc step-down buck converter.

Early Integration of High Dose Methotrexate to Frontline DLBCL Therapy Does Not Impact CNS Relapse Compared to End of Treatment Delivery: A Multicentre International Analysis of 1384 Patients

Early Integration of High Dose Methotrexate to Frontline DLBCL Therapy Does Not Impact CNS Relapse Compared to End of Treatment Delivery: A Multicentre International Analysis of 1384 Patients

Low-Process–Voltage–Temperature-Sensitivity Multi-Stage Timing Monitor for System-on-Chip Applications

High performance and complex system-on-chip (SoC) design require a throughput and stable timing monitor to reduce the impacts of uncertain timing and implement the dynamic voltage and frequency scaling (DVFS) scheme for overall power reduction. This paper presents a multi-stage timing monitor, combining three timing-monitoring stages to achieve a high timing-monitoring resolution and a wide timing-monitoring range simultaneously. Additionally, because the proposed timing monitor has high immunity to the process–voltage–temperature (PVT) variation, it provides a more stable time-monitoring results. The time-monitoring resolution and range of the proposed timing monitor are 47 ps and 2.2 µs, respectively, and the maximum measurement error is 0.06%. Therefore, the proposed multi-stage timing monitor provides not only the timing information of the specified signals to maintain the functionality and performance of the SoC, but also makes the operation of the DVFS scheme more efficient and accurate in SoC design.

Transplant Flight Plan and Huddle: Simple Intervention to Improve Communication in Pediatric Heart Transplantation

<h3>Purpose</h3> As the medical and surgical complexity of pediatric heart transplants (PHTx) continues to increase, individualized treatment plans are increasingly important. Given the uncertain timing of heart transplant surgeries and the involvement of several different providers, multi-disciplinary communication at the time of transplant surgery is critical to safe execution of the transplant plan. <h3>Methods</h3> A pre-transplant flight plan (FP) and huddle (PTH) developed by Stanford University was implemented as a quality improvement project at Children's Medical Center of Dallas. The FP is a detailed pre-, peri-, and post-operative management plan developed at listing by all involved stakeholders, and updated monthly until PHTx.(Figure 1) After organ acceptance, the FP is reviewed by the on-call multidisciplinary team at a PTH. Project impact is evaluated with multidisciplinary pre- and post-implementation surveys. Pre-implantation surveys included all Heart Center professionals. Professionals who participated in a huddle participated in the post-implementation survey. The key outcome metric is 30-day post-transplant survival. <h3>Results</h3> 7 transplants included a FP/PTH, with a 30-day survival of 100%. A pre-implementation survey (n=169) indicated the minority of respondents (24%), agreed or strongly agreed that peri-transplant communication was good. Post-implementation survey (n=16) demonstrated that 87.5% agreed or strongly agreed that the FP/PTH improved multi-disciplinary peri-transplant communication, and 87.5% agreed or strongly agreed peri-transplant multi-disciplinary communication was good. <h3>Conclusion</h3> A transplant FP/PTH improves multi-disciplinary communication at the time of PHTx. Key lessons include ability to conduct PTH through virtual platform, standard data definitions, and EMR optimization for flight plan. Long-term data collection will indicate whether the flight plan improves delivery of care and/or patient outcomes.

A generational west coast gas shakeup looms

From record high prices, a decade ago, to record low prices more recently, Australia’s west coast gas market is heading towards a structural shakeup that will challenge the status quo for producers, buyers and policymakers. The Western Australian (WA) gas market has been soft recently but is poorly understood, and prices may materially tighten this decade in wake of uncertain new supply timing, liquefied natural gas (LNG) producer recalcitrance towards domestic market, lack of new discoveries (outside Perth Basin), upward pressure on US gas pricing and government policy flexibility towards the emergence of LNG ullage. We believe a bifurcated WA gas market could emerge, whereby policy targets cheap gas to underpin new manufacturing, while existing gas buyers are left to compete against much higher LNG netback parity pricing.

Policy Mix During a Pandemic Crisis: A Review of the Debate on Monetary and Fiscal Responses and the Legacy for the Future

We review the debate on the monetary and fiscal policy measures that were adopted in response to the pandemic shock in advanced economies, as well as others that could be taken in the near future, once the health emergency is over. The pandemic is an exceptional global health shock, which has negatively affected the income, liquidity, and financial conditions of households and firms worldwide. Policy responses adopted in advanced economies in 2020 – based on extraordinary large-scale, swift, targeted monetary and fiscal measures – were appropriate to sustain liquidity, income, and aggregate demand and, thus, helped to avert a devastating financial crisis. Once the health emergency is over, the legacies of the shock will be a recovery of uncertain strength and timing, a low interest rate environment, and high corporate and public debts. Support measures should be removed with caution. A cross-country coordinated policy mix based on (i) accommodative monetary policies (if consistent with central bank objectives), (ii) public investments and (iii) a gradual rebalancing of government accounts, could be effective in sustaining a strong global recovery and reduce private and public debt.