Unexpected Difficulties Research Articles

Unexpected difficulty in performance of a monocyte monolayer assay when using RBCs from a patient with sickle cell disease.

Unexpected difficulty in performance of a monocyte monolayer assay when using RBCs from a patient with sickle cell disease.

Stability and Stabilization for Delay Delta Fractional Order Systems: An LMI Approach

The well-known delta fractional calculus is widely used in system analysis and synthesis. However, the irregular stable region brings many unexpected difficulties and challenges. The simple linear matrix inequality (LMI) condition, especially α(1,2), is lacking. This brief constructs a circular region to approximate the true stable region. Afterwards, the sufficient conditions in terms of LMIs are derived. It is shown that the elaborated results are valid and effective.

Researchers’ responsibilities in resource-constrained settings: experiences of implementing an ancillary care policy in a vaccine trial in the Democratic Republic of the Congo

In this paper, we discuss challenges associated with implementing a policy for Ancillary Care (AC) for related and unrelated (serious) adverse events during an Ebola vaccine trial conducted in a remote area of the Democratic Republic of the Congo. Conducting clinical trials in resourceconstrained settings can raise context-related challenges that have implications for study participants’ health and wellbeing. During the Ebola vaccine study, three participants were injured in road traffic accidents, but there were unexpected difficulties when trying to apply the AC policy. First, because of the nature of the adverse events, the insurer refused to cover the costs. Second, the AC policy did not address treatments by traditional medicine, even though traditional medicines are frequently used and highly trusted in the study community. This highlighted a contrast between the researchers’ well-intentioned AC approach and the participants’ legitimate preferences. The way in which researchers should address their responsibility to provide AC is not straightforward; it requires contextualization. Our experience highlights the importance of involving community representatives and the local ethics committee to ensure development of an AC policy that is culturally and ethically appropriate. Additionally, the insurance contract should clearly stipulate which adverse events are linked to the trial participation, and thus eligible for coverage, to avoid controversies when claims are made.

PhD graduates’ professional transitions and academic habitus. The role of tacit knowledge

ABSTRACT PhD graduates are dealing with a lack of opportunities regarding long-term careers: the chances of eventually obtaining a stable position in university are hardly higher than a few per cent and slimmer when geographical constraints are set. The current scenario prospects a panoply of professional destinations for PhD graduates beyond university walls, but the doctoral education system is still primarily designed as a preparatory phase for an academic career and academic employment remains the preferred option for the majority. The concrete risks of this situation are connected to over-skilling, lack of recognition and problems in transferring skills during transitions from university to other workplaces. The article focuses on one underestimated dimension of these processes: the tacit knowledge implicitly acquired in HE institutions and structuring a peculiar ‘academic habitus’ which plays a crucial role in terms of unexpected difficulties as well as unexplored learning potential. Doctoral training may represent a strategic place where students can begin to interpret the complex issues involved in transition processes not as signs of inadequacy or lack of preparation, but as challenges engaging one’s agency in dealing with a different organisational habitus. Individual strategies are, in fact, essential in making a difference when a disorienting dilemma emerges and they configure a proper meta-competence to be developed and fostered. More broadly the article argues that, in order to sustain the potential of PhD graduates’ knowledge it is necessary to overcome a reductionist and instructional perspective in approaching learning outcomes.

Price and Income Elasticities of Hungarian Household Energy Demand: Implications for Energy Policy in the Context of the Energy Crisis

The energy crisis that began in the second half of 2021, exacerbated by the Russian-Ukrainian war, created unexpected difficulty for European Union Member States in terms of shaping their energy policies. Hungary was one of the most vulnerable countries, whose economic development was fraught with severe risk due to the strong dependence on Russian energy sources and regulated energy prices for households, significantly slowing down the transition to green energy. The sharp change in energy prices due to the introduction of a price cap in 2013-2014 and the partial adjustment in 2022 draws attention to the situation of Hungarian energy demand. This study describes the absolute short-term price elasticities of Hungarian household natural gas and electricity demand and gas and electricity cross-price and income elasticities of the former for income deciles between 2010 and 2021 using the midpoint percentage method. The results show that electricity demand is more elastic than gas demand, implying that Hungarian household consumers are more responsive to changes in electricity prices than those of gas. In addition, low-income Hungarian households are more sensitive to changes in both of the latter than high-income households, while no consistent pattern is identified in the relationship between income and energy demand. Accordingly, the study recommends the implementation of a multi-tariff pricing strategy based on the energy burden of the income deciles. This should particularly target the first two deciles, which are the most vulnerable and sensitive to energy price changes.

Convolutionary, Evolutionary, and Revolutionary: What’s Next for Brains, Bodies, and AI?

The flexibility, adaptability, and resilience of even simple brains are unmatched by any current technology. Recent unexpected difficulties in realising truly autonomous vehicles, making reliable medical diagnoses, detecting offensive online content and even just recognising faces, show that brains remain significantly functionally more capable than we can currently emulate. Fittingly, in recent years we have made significant progress identifying computational principles that underlie neural function. We are beginning to dispense with the overly simplistic stimulus-driven encode/transmit/decode doctrine. Instead we must embrace the brain’s inherent dynamic complexity and emergent properties and explain how plasticity moulds the dynamics to capture useful couplings across brain regions and between the brain, the body, and the world. While certainly not complete, we have sufficient evidence that a synthesis of these ideas could result in a deeper understanding of neural computation and which could potentially be used to construct new AI technologies with unique capabilities. I discuss the relevant neuroscientific principles, the advantages they have for computation, and how they can benefit AI. Limitations of current AI are now generally recognised. I postulate that we understand enough about the brain to immediately offer novel AI formulations.

How do ESG activities affect corporate performance?

AbstractThis study investigates the impact of a company's environmental, social, and governance (ESG) activities on its financial performance. The COVID‐19 pandemic has caused unexpected difficulties in the operations of most companies, leading to a significant deterioration in their financial performance. We use empirical analysis to examine whether a company's ESG activities affect its financial performance. We employ the context‐dependent data envelopment analysis (DEA) model to evaluate the performance and provide a benchmark‐learning roadmap for 27 photoelectric companies in Taiwan. We also compare the marketability, innovation ability, and profitability of three sub‐industries: camera modules, optical component lenses, and optical components. Furthermore, we utilize a combination of classical DEA, stratification DEA, measurement of attractiveness, and progress for company evaluation. The results indicate that validating sustainability reports has a positive information effect, and high‐quality Global Reporting Initiative‐based external third‐party confirmed reports possess relatively high credibility, readability, and information value. The content and quality of these reports have an impact on performance. These findings offer insights into the role of ESG activities in the photoelectric industry and can help managers reflect upon and justify their choice to invest in specific ESG activities. Therefore, this research highlights the importance of green operations for firms.

Platform for Teaching Speaking Skills Online in the Pandemic Era

Educators were faced with the unexpected difficulty of primarily teaching online. Many challenges arose as a result of the necessity to redesign instructional activities, including inconsistency, challenging time management, maintaining students' interest, and increasing cheating in online tests. Because of the COVID-19 epidemic, the Indonesian government has implemented policies in the school sector. Previously, the teaching and learning process, particularly in higher education, was conducted face to face, and it has now transitioned to entirely online learning. This scenario requires the teachers and students to use online learning, which has an impact on their learning experiences. Speaking skill is very essential for human beings in, with an order to be able to communicate with society. During the pandemic era, teachers and students face difficulties to study because of lockdown in some areas. Here, the platforms categorized as Vacaroo, Voki, Fotobubble, and VoiceThread for learning speaking in a fun way, and cherish.

"I Have to Use My Son's QR Code to Run the Business": Unpacking Senior Street Vendors' Challenges in Mobile Money Collection in China

Mobile payment systems have become an infrastructural component in citizens' socio-economic life in China. The rapid shift to a cashless society demands vendors of all ages to quickly adapt themselves to the ubiquitous mobile payment era. However, how this trend may impact senior vendors, a group that typically uses less technology, remains unknown despite its significance in inclusive mobile payment design. This work aims to address this gap by investigating the challenges and strategies of senior vendors in mobile payment adoption. Particularly, we focus on a traditional low-resource setting with a large volume of senior vendors: street vending. We conduct a qualitative study incorporating field observations on 33 senior street vendors and semi-structured interviews with 15 of them (aged 53-78), and take Moneywork as an analytical lens to unpack their challenges in physical and social interactions. We find that senior street vendors are a group passively adopting mobile payments due to business requirements instead of recognizing their advantages. Vendors with relatively low digital literacy have to take an alternative method - using family members' QR codes - to run the business as family-dependent money receivers. With limited considerations for senior vendors' situational vulnerabilities, unexpected difficulties of payment confirmation emerge during transactions, such as reduced confirmation efficacy under noisy surroundings and degraded hearing. Transaction security issues also appear when mobile payment-based frauds target both confirmation interfaces (e.g., fake sounds of successful payment) and trust systems (e.g., showing half-done proof to flee without paying) in street vending. Finally, we raise a less visible yet critical concern of family-dependent vendors on the lost money freedom when their income flows into their families' wallets. We propose design implications for mobile payment systems to support more secure, efficient and accessible money collection services to underrepresented groups.

Unexpected Procedure Difficulties Increasing the Complexity of Transvenous Lead Extraction: The Single Centre Experience with 3721 Procedures.

Transvenous lead extraction (TLE) should be completed, even when facing difficulties which have yet to be described. The aim was to explore unexpected TLE obstacles (the circumstances of the occurrence and influence on TLE outcome). The retrospective analysis of a single centre database containing 3721 TLEs. Unexpected procedure difficulties (UPDs) occurred in 18.43% of cases (singles in 12.20% of cases and multiples in 6.26% of cases). These included blockages in the lead venous approach in3.28% of cases, functional lead dislodgement in 0.91% of cases, and loss of broken lead fragment in 0.60% of cases. All of them, including implant vein-in 7.98% of cases, lead fracture during extraction-in 3.84% of cases, and lead-to-lead adherence-in 6.59% of cases, Byrd dilator collapse-in 3.41% of cases, including the use of an alternative prolonged the procedure but had no influence on long-term mortality. Most of the occurrences were associated with lead dwell time, younger patient age, lead burden, and poorer procedure effectiveness and complications (common cause). However, some of the problems seemed to be related to cardiac implantable electronic devices (CIED) implantation and the subsequent lead management strategy. A more complete list of all tips and tricks is still required. (1) The complexity of the lead extraction procedure combines both prolonged procedure duration and the occurrence of lesser-known UPDs. (2) UPDs are present in nearly one fifth of the TLE procedures, and can occur simultaneously. (3) UPDs, which usually force the extractor to expand the range of techniques and tools, should become part of the training in transvenous lead extraction.

Feasibility and preliminary outcomes of intensive mindfulness and yoga on prisoners with personality disorders: A randomised controlled preliminary study

This study was the first to test the feasibility of mind-body interventions with a randomised control research design in a sample that contains all ten types of personality disorders, and the first to provide a preliminary evaluation of responses using a combination of psychological, genomic, neural, and behavioural measures. Thirty prisoners with personality disorders were recruited within a clinical unit of a high security prison and assigned to a mindfulness intervention (n=10), a yoga intervention (n=10), or a wait-list control group (n=10). Both mindfulness and yoga interventions were held simultaneously and lasted three hours per day on five consecutive days. At baseline and after the intervention, we measured inflammation-related gene expression through venous blood; attention with a cognitive task; event-related potentials (ERPs) with EEG; and stress, emotion regulation and mindfulness with questionnaires. Here we show that recruitment and dropout rates were satisfactory, and data collection was successful despite its length and complexity. The only exception were blood samples where 60% of participants refused to give blood, but this was expected because 47% of recruited participants had a diagnosis of paranoid personality disorder. Unexpected difficulties occurred when participants did not fully adhere to randomisation procedures, and a riot took place during the final day of the interventions. This study was underpowered to detect changes on primary or secondary outcome measures, but despite that 80% of examined inflammation-related genes showed medium and large effect sizes suggesting this as an important outcome measure in future studies. Minor adjustments to the study design are necessary before a larger scale study can be conducted to precisely determine the effects of mindfulness and yoga as an additional treatment for prisoners with personality disorders.

Intraoperative gastroscopy during laparoscopic sleeve gastrectomy after gastric band surgery with unrecognized hiatal hernia—a case report

Obesity is the civilizational disease of our era, and often leads to comorbidity, hypertension, diabetes and obstructive sleep apnea. Contemporary non-surgical treatment for obesity is frequently inefficient, resulting in the increased prominence of surgical procedures, specifically, laparoscopic sleeve gastrectomy (LSG). In our case report, we present a case in which LSG was not feasible in reference to the traditional surgical technique due to severe hiatal hernia (HH), which inexplicably went undetected during preoperative examinations, however, with the help of intraoperative gastroscopy, the problem was effectively solved. The patient, a middle-aged Caucasian male, underwent removal of a gastric band due to gastric band migration, and was presented for LSG due to repeated weight gain. During the operation, the insertion of the bougie proved unsuccessful after several attempts. Through intraoperative gastroscopy, a severe HH was discovered. The endoscope was inserted into the compromised passageway leading into the stomach, effectively substituting the role of bougie used in the traditional surgical procedure. Unexpected difficulty or inability to insert a bougie is rare in consideration of LSG, however, in this case, surgery could not have been performed in the conventional manner. During intraoperative gastroscopy, the gastroscope is inserted into the stomach using visual control, and effectively substitutes the bougie function. The likelihood of rare, yet severe, life-threatening complications from the insertion of a bougie is reduced and surgery can be performed in the traditional sense. We have no knowledge of cases in which a HH prevents the conventional surgical technique. However, in extreme cases in which the traditional non-surgical technique and other types of surgery are deemed unsuitable, intraoperative gastroscopy provides a simple and safe solution.

The impact of COVID-19 on the delivery of preservice teacher education: a scoping review

The COVID-19 pandemic and the ensuing lockdowns have transformed the mode of delivering preservice teacher education from face-to-face to online, causing unexpected challenges and difficulties. This scoping review aims to synthesize the empirical evidence to explore the reported effects of COVID-19 on preservice early-childhood teacher education programs. The search identified 17 studies in international peer-reviewed journals between February 2020 and February 2022. Four themes of concern emerged: program preparation, program delivery, teaching practicum, and psychological well-being. This study also identified literature gaps in online preservice teacher education and highlighted the need to conduct cross-country comparisons with large sample sizes.

‘God is against Nationalism’: Averbuch and the Jewish Christians of Interwar Romania

The Romanian government encountered unexpected difficulties after the First World War with the increase of religious minorities, particularly evangelicals in the newly acquired border region of Bessarabia. International affiliations and increasing success in rural areas led government officials and the Romanian Orthodox Church to label these groups as foreign pawns or socially deviant sectarians. The Baptist Church in Chișinău proved a special case of concern as its leadership included a Jewish man, Lev Averbuch. Averbuch's congregation was a diverse religious community, filled with Romanians, Russians, Bulgarians, Jews, Greeks, and others. Their multi-ethnic composition, multi-lingual services, ties to international organisations, and controversial sermons speaking out against nationalism and antisemitism were used by police and Orthodox Church authorities to paint them as a threat to national security. The analysis of Averbuch's interwar community of Jewish Christians in Chișinău shows the region was not a homogenous religious space and that religious identity was of greater value than national identity. It provides insight into the fluidity of religious, ethnic, and even geographic borders, and how policies of national consolidation were challenged at the local level by religious minorities during Europe's tumultuous interwar years.

Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature.

Direct laryngoscopy (DL) and videolaryngoscopy (VL) have been the most commonly used airway management modalities in the last several decades. Meanwhile, various optional airway tools (e.g., supraglottic devices, fiberoptic bronchoscopes) have been used for alternative rescue modalities when anticipated or unexpected difficulties in airway management has occurred. In recent decades, optical stylets and video-assisted intubating stylets have become another option for difficult airway scenarios. In contrast to other approaches, we have adopted the Shikani video-assisted intubating stylet technique (VS) for both routine and difficult airway management scenarios. In this case series report, we present the video-twin technique, combining a videolaryngoscope with a video-assisted intubating stylet in various clinical case scenarios. We propose that such a combination is easy to learn and employ and is particularly beneficial in situations where an expected difficult airway (EDA) is encountered.

Green-Tech CAV: Next Generation Computing for Traffic Sign and Obstacle Detection in Connected and Autonomous Vehicles

In recent years, advanced technologies are used in automobiles, which make it simpler to drive on roads. However, driving is not trouble-free considering the unexpected hindrances and difficulty in recognizing traffic signs while driving at high speeds. Due to the advancement in technologies such as image recognition, several automated vehicles and techniques are developed to assist the drivers while driving. In this paper, an integrated intelligent system is designed using YOLO V3 neural architecture for recognizing the obstacles and visualizing the traffic sign through the input image from the camera of the moving vehicle. A Vehicular Adhoc Network (VANET) is being used with 5G connectivity to share the information to the other passing vehicles present in the vicinity. Apart from this, a notification is sent to the nearby centre for clearing any obstacle if found on roads during transportation. Real-time images of every possible obstacle such as a crack on roads along with traffic signs are trained using machine learning algorithms, thereby making the system more efficient and accurate. These techniques are developed in order to provide an pollution free environment and reduce accidents in roads with the concepts of green computing. The proposed automated system performs exemplary in recognizing the obstacle and traffic sign, making it easy for the drivers to drive more freely and reducing the pollution thereby producing a eco-friendly environment. According to the algorithms proposed in this paper, the results show that the algorithm used produces accurate results compared to the existing techniques.

Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality.

The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) were used here to understand and elucidate potential systems issues that may contribute to preventable deaths. ANZASM data relating to 30-day mortality after thyroidectomy, parathyroidectomy, and adrenalectomy from 2009 to 2020 were reviewed. Mortality rates were calculated using billing data. Thematic analysis of independent assessor reports was conducted to produce a coding framework. A total of 67 deaths were reported, with an estimated mortality rate of 0.03-0.07 per cent (38 for thyroidectomy (0.03-0.06 per cent), 16 for parathyroidectomy (0.03-0.06 per cent), 13 for adrenalectomy (0.15-0.33 per cent)). Twenty-seven deaths (40 per cent) were precipitated by clinically significant adverse events, and 18 (27 per cent) were judged to be preventable by independent ANZASM assessors. Recurrent themes included inadequate preoperative assessment, lack of anticipation of intraoperative pitfalls, and failure to recognize and effectively address postoperative complications. Several novel themes were reiterated, such as occult ischaemic heart disease associated with death after parathyroid surgery, unexpected intraoperative difficulties from adrenal metastasis, and complications due to anticoagulation therapy after thyroid surgery. This study represents a large-scale national report of deaths after endocrine surgery and provides insights into these rare events. Although the overall mortality rate is low, 27 per cent of deaths involved systems issues that were preventable following independent peer review.

Airway management, procedural data, and in-hospital mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19).

PurposeAlthough unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse.MethodsIn this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and in-hospital mortality records.ResultsForty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27–74) days. The median (range) time to hospital discharge was 53.5 (10–85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03).ConclusionIn patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.

장창선 스포츠영웅의 첫 국제대회인 1962년 4회 자카르타 아시아경기대회 참가 과정 재조명: 1960년부터

The purpose of this study is to review how Jang Chang-sun participated in the 4th Asian Games(1962, Jakarta), and what he achieved through the competition. In each stage growing as a world hero, he had been faced with unexpected difficulties. During the final round of the National Game for the Rome Olympic(1960), Kim Ji-kang and he ended in a tie, so Korea Wrestling Association didn’t allow them to compete in the Olympics. Unfortunately, After losing the final round to compete at the World Wrestling Championships(1961, Yokohama), he was unable to take part in the international level. The fact that he couldn’t be a member of the national team embarrassed him. That’s why he gave up exercising for a while. His mother and supporters, however, encouraged him to try again for the Olympics. As a result, in the 4th Asian Games(1962, Jakarta), he won his first silver medal in the Asian Games. His achievement at the Asian Games made him one of the greatest world wrestlers, As a Korean, He won his first silver medal at the Tokyo Olympic(1964), and his first gold medal at World Wrestling Championships(1966).

Extending the Transformative Potential of Mindfulness Through Team Mindfulness Training, Integrating Individual With Collective Mindfulness, in a High-Stress Military Setting.

Mindfulness has come to be considered an important approach to help individuals cultivate transformative capacity to free themselves from stress and suffering. However, the transformative potential of mindfulness extends beyond individual stress management. This study contributes to a broadening of the scope of contemplative science by integrating the prominent, individually focused mindfulness meditation literature with collective mindfulness scholarship. In so doing, it aims to illuminate an important context in which mindfulness interventions are increasingly prevalent: workplaces. Typically, the intended effect of workplace mindfulness training is to help workers manage stress better. Since mindfulness in organizations impacts individual and collective processes, the study blends the above literatures to create a cross-level “next-generation” Team Mindfulness Training (TMT) pilot. Its potential in helping individuals and teams to manage work stress better is investigated via a two-phase mixed-methods research study in high-stress military work populations, and compared to a conventional (“first-generation”) 8-week mindfulness meditation program based on mindfulness-based stress reduction (MBSR). Results suggest that compared to the “first-generation” mindfulness program, TMT seems no less effective in raising individual stress management skills, and may hold more promise in generating collective capacity to manage stress and unexpected difficulty, linked to an apparent interdependence between collective and individual mindfulness capacity development. Based on these empirical results, the study contributes to theory in three important ways: first, it outlines how individual and collective mindfulness in workplaces may be interdependent. Second, it explains why “next-generation” workplace training interventions should apply a cross-level approach. And third, it illustrates how its transformative potential for people at work, individually as well as collectively, can be extended by moving beyond an inward-looking meditation focus in mindfulness training. The study contributes to practice by providing a detailed outline of the pilot TMT program, and offers a series of follow-up research opportunities to inspire further scientific innovation in workplace mindfulness training, especially for high-stress work populations. The study’s ultimate aim is to prompt a shift away from adapting clinically oriented, self-focused “first-generation” mindfulness training protocols, and towards mindfulness as team sport: a more prosocially oriented mindfulness science intent on generating wisdom and compassion, for one and all.