Unexpected Events Research Articles

396. SHORT-TERM REVIEW: REAL-WORD EXPERIENCE OF PEMBROLIZUMAB AS FIRST-LINE CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background In Japan, Pembrolizumab, combined with standard chemotherapy (fluorouracil and cisplatin), was approved for first-line treatment of esophageal squamous cell carcinoma (ESCC) in November 2021. In advanced ESCC cases, modifications like omitting cisplatin or adding the palliative radiotherapy for malignant stenosis are sometimes necessary. The real-world application of Pembrolizumab with chemotherapy (Pem+C) in these scenarios remains uncertain. This review presents an overview of Pem+C’s short-term clinical outcomes in practice. Methods We retrospectively studied nineteen patients treated with Pem+C as the first-line chemotherapy for advanced ESCC from Nov. 2021 to Dec.2023. Response evaluation was primarily based on RECIST v1.1. Clinical worsening factored into some progression disease (PD) assessments. Adverse events were graded using CTC-AE v5.0. Kaplan-Meier survival curves were calculated by SPSS, with data cutoff on Dec. 31. 2023. Results Median age was 70 (49-83 years), PS (0/1/2):0/8/1, TPS (1≤/1≤/NE):1/2/16. Disease Status (Recurrence [locoregional/distant metastasis] /metastatic):3 [2/1] /16. Sequence of treatments (Pem+C alone/ concurrent palliative radiotherapy (pRT) consisting of 30-40Gy/ maintenance after chemoradiotherapy ):10/5/4. Three received only fluorouracil as backbone chemotherapy due to frailty. Median follow-up time, overall survival (OS) and progression free survival (PFS) were 8.3, 14.4, and 6.5 months, respectively. Responses in evaluable eighteen (CR/PR/nonCRnonPD/SD/PD):2/8/1/3/4. No unexpected severe adverse events (≥Grade3) were found. Among limited cases, concurrent pRT didn’t increased life-threatening AE; however, neutropenia ≥G3 seemed to be slightly frequent (2/5). One patient’s survival exceeded 24.8 months. Conclusion Our real-world experience with Pem+C in advanced ESCC includes diverse approaches clinical practices. The outcomes, while prelimiary, compare favorably with existing literature, without significant inferiority. The safety data and success case in the concurrent pRT group are significant, though limited by the small number of cases and short observation period. While further, more rigorous studies are necessary, adaptable Pem+C could be viable in practice.

Examining Microfinance Loan Repayment Challenges and Procedures by Small Business Owners: The Case of Vikenge Village, Morogoro, Tanzania

The research surveys the factors affecting the ability of small business owners in Vikenge village to refund microloans. This study uses institutional theory framework to investigates the constraints encountered by these firms, their means for handling these constraints, and offer hints for improvement. Applying a qualitative research design, semi-structured interviews were performed with 13 small business proprietors. Participants were purposively selected due to their experience in microfinance lending and efficient reimbursement. Through thematic analysis, substantial issues concerning repayment challenges, techniques, and recommendations for enhancement were proven. The survey reveals a variety of obstacles that influence the repayment of loans, for instance; unexpected events, personal and familial matters, fluctuations in the economy, seasonal fluctuations in business, and complications with cash flow. Methodologies to repayment include strategies like saving money daily, options for flexible repayment, clear communication, and seeking outside financial assistance. Survey respondents also offered supportive recommendations, such as using loans for their intended purposes, decreasing interest rates, allowing more flexibility in repayment schedules, providing enhanced customer education and support, ensuring loan amounts are appropriate, and improving monitoring and collection procedures. This research survey enhances value to the current body of knowledge by delivering detailed analysis on the repayment of microfinance loans in small businesses in Vikenge village. The results proposed practical recommendations for microfinance institutions to acquire tailored repayment strategies that meet the varied requirements of borrowers, eventually leading to improved financial accessibility and long-term viability.

Experiences of water poverty in the metropolitan area of Barcelona: implications for the Global North

ABSTRACT Water poverty, primarily understood as a problem of affordability, is increasingly important in developed countries. It burdens vulnerable households with mounting debts or deprives them of this fundamental resource. Faced with this threat, households may modify their habits to reduce consumption and seek also assistance to reduce the amount of the water bill. Both strategies imply stressful efforts, often exacerbated by unexpected events like the COVID-19 pandemic. Using semi-structured interviews with 35 vulnerable households in a working-class town near Barcelona, in this paper we blend a quantitative assessment of home water habits with a qualitative analysis of strategies to reduce water bill costs. Results reveal a strong commitment to water savings but clashes with essential household needs, particularly for children. Respondents lament that despite intense water saving, bills remain high, given water's perceived expense and limited subsidy access. In sum, addressing the issue of water poverty from the subjective experience of those struggling against it in their daily lives allows to identify situations where basic physical and mental comfort of the more vulnerable is under severe stress. These experiences and perceptions are linked to sociopolitical and economic processes such as accumulation by dispossession or ecological modernization, contributing to water poverty.

Analysis of lumateperone data for patients with schizophrenia using related adverse events from the FDA adverse reporting system

ABSTRACT Background Our study utilized the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) to analyze and study the adverse event (AEs) signals of second-generation antipsychotic drug lumateperone, providing a reference for clinical safety monitoring in the treatment of schizophrenia. Methods The International Dictionary of Medical Terminology (version 26.0) was used to standardize the preferred system organ category (SOC) and preferred terminology (PT) for adverse drug events (ADE) data related to lumateperone. ADE signals were classified and described using four algorithms: reporting odds ratios (ROR), proportional reporting ratios (PRR), Bayesian confidence-propagation neural network (BCPNN) and Multinomial gamma-poisson shrinkage (MGPS). Result Among the 2542 case reports collected from the FAERS database, 1762 reports with lumateperone as a ‘principal suspect(PS)’ AEs were identified. Lumateperone-induced AEs occurred in 26 system organ categories (SOC). A total of 118 significant disproportionate preferred terms (PTs) meeting the requirements of 4 algorithms were retained, and unexpected major events, such as burning sensation, tremor, migraine etc. may also occur. The median time to onset of lumateperone-related adverse events was 9 days (interquartile range [IQR] 2–31.25 days), and most AEs occurred within the first 10 days and 1 month after initiation of lumateperone therapy. Conclusion Our research may provide a better understanding of the potential adverse events that may be caused by lumateperone and those not recorded in the drug instructions, providing valuable signals for clinical use.

Dynamic remodeling model based on chemotaxis of slime molds.

Social infrastructure networks, essential for daily life and economic activities, encompass utilities such as water, electricity, roads, and telecommunications. Dynamic remodeling of these systems is crucial for responding to continuous changes, unexpected events, and increased demand. This study proposes a new dynamic remodeling model inspired by biological mechanisms, focusing on a model based on the chemotaxis of slime molds. Slime molds adapt spontaneously to environmental changes by remodeling through the growth and degeneration of tubes. This capability can be applied to optimizing and dynamic remodeling social infrastructure networks. This study elucidated the chemotactic response characteristics of slime molds using biological experiments. The mold's response was observed by considering changes in the concentration of chemicals as environmental changes, confirming that slime molds adapt to environmental changes by shortening their periodic cycles. Subsequently, based on this dynamic response, we propose a new dynamic model (oscillated Physarum solver, O-PS) that extends the existing Physarum solver (PS). Numerical simulations demonstrated that the O-PS possesses rapid and efficient path-remodeling capabilities. In particular, within a simplified maze network, the O-PS was confirmed to have the same shortest-path searching ability as the PS, while being capable of faster remodeling. This study offers a new approach for optimizing and dynamically remodeling social infrastructure networks by mimicking biological mechanisms, enabling the rapid identification of solutions considering multiple objectives under complex constraints. Furthermore, the variation in convergence speed with oscillation frequency in the O-PS suggests flexibility in responding to environmental changes. Further research is required to develop more effective remodeling strategies.

Evaluation of cannabis product mislabeling: The development of a unified cannabinoid LC-MS/MS method to analyze e-liquids and edible products

The 2018 Agricultural Improvement Act federally legalized the cultivation of hemp and manufacture and sale of cannabidiol (CBD). The overproduction of CBD led to a significant drop in price. To maintain profitability, manufacturers began producing synthetic and semi-synthetic cannabinoids, marketing them as “legal” and “hemp-derived” due to their synthesis from CBD. The cannabis industry is adaptable, and laboratories have struggled to keep up with the rapid emergence of new compounds. This has resulted in products with unlabeled or mislabeled cannabinoids, causing unexpected adverse events. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the separation and quantitation of 21 cannabinoids. The method was applied in the analysis of 55 commercially available products. Results demonstrate significant issues with quality assurance and labeling in the unregulated cannabis market. Many products either did not contain the cannabinoids listed on their labels or contained cannabinoids that were not listed. When cannabinoids were present, their concentrations were often incorrect, with some products showing high concentrations that could pose a potential health risk. Moreover, safety, dosing, and other pharmacological data of these newly proliferated cannabinoids are lacking. Reports of adverse events are increasing to poison controls centers and emergency departments following cannabis product use. Often, the actual cannabinoids involved in the case reprots are not determined. It is critical to develop more comprehensive testing methodologies to determine the content of cannabis products and to implement stronger quality assurance measures and regulations to protect the public from low-quality and potentially dangerous products.

The contronymity of project accounting for performing the relevance of project outcomes

PurposeThis paper aims to advance recent literature on the performativity of accounting by examining how project accounting affects a project organization’s ability to deliver a relevant project outcome, such as a product or a building, for a receiving client organization.Design/methodology/approachThe paper draws on a longitudinal case study of a 41.4-billion-kroner (5.5-billion-euro) Danish project of constructing 16 new public hospitals. Its objective was to reduce the average unit costs and improve the quality of patient care. Each hospital construction was managed by a separate project organization and handed over to a separate receiving hospital organization. The project organizations applied a common approach to project accounting. The paper relies on Michel Callon’s concepts of performativity and sociotechnical agencement – approaching project accounting as an arrangement of devices.FindingsThe paper shows that the project-accounting agencement simultaneously supported and undermined the project organizations’ ability to deliver hospitals relevant to the receiving hospital organizations. The agencement performed hospital designs, disciplined project actors and guided decision-making, thus supporting the overall work of the project organizations. It also, however, compelled the project organizations to compromise on hospital designs when unexpected events occurred. These compromises led to the delivery of hospitals, which largely prevented the receiving hospital organizations from achieving the project’s objective.Originality/valueThis paper advances our limited understanding of the dynamic and complex relationship between project accounting and the relevance of project outcomes. It introduces the concept of a “contronymity device” to capture the way project accounting simultaneously produces two opposing consequences, both supporting and undermining the enactment of a particular reality. The paper lastly enriches our understanding of how project-accounting devices impact hospital organizations’ operating cost structures and challenge patient care capabilities.

Adebrelimab plus chemotherapy and sequential thoracic radiotherapy as first-line therapy for extensive-stage small–cell lung cancer (ES-SCLC): a phase II trial

This phase II prospective trial aimed to investigate the efficacy and safety of adebrelimab (PD-L1 antibody) plus first-line chemotherapy followed by sequential thoracic radiotherapy (TRT) combined with adebrelimab in extensive-stage small-cell lung cancer (ES-SCLC). Biomarkers associated with potential therapeutic effects were also explored. Patients with previously untreated ES-SCLC were enrolled at Shandong Cancer Hospital and Institute (Jinan, China). Patients received 4-6 cycles of adebrelimab (20mg/kg, D1, Q3W) combined with EP/EC (etoposide, 100mg/m2, D1-3, Q3W and cisplatin, 75mg/m2, D1, Q3W or carboplatin, AUC=5, D1, Q3W). Then patients with response sequentially underwent consolidative TRT (≥30Gy in 10 fractions or≥50Gy in 25 fractions, involved-field irradiation), and maintenance adebrelimab until disease progression or intolerable adverse events (AEs). The primary endpoint was overall survival (OS). Genomic and circulating tumour DNA (ctDNA) profiling were also analyzed with tumour tissues and peripheral blood. This trial was registered with ClinicalTrials.gov, NCT04562337. From October 2020 to April 2023, 67 patients diagnosed with ES-SCLC were enrolled and received at least one dose of study treatment. All patients were included in the efficacy and safety analyses. 45 patients received sequential TRT as planned. The median OS and progression-free survival (PFS) was 21.4 months (95% CI: 17.2-not reached months) and 10.1 months (95% CI: 6.9-15.5 months), respectively. The confirmed objective response rate was 71.6% (48/67, 95% CI: 59.3-82.0%) and disease control rate was 89.6% (60/67, 95% CI: 79.7-95.7%). There were no treatment-related deaths. The most common grade 3 or higher treatment-related adverse events (TRAEs) were hematological toxicities. The incidence of any grade and G3+ pneumonitis was 25% (17/67) and 6% (4/67), respectively. No unexpected adverse events were observed. Patients without co-mutations of TP53/RB1 in both tissue and peripheral blood displayed longer PFS (tissue, P=0.071; ctDNA, P=0.060) and OS (tissue, P=0.032; ctDNA, P=0.031). Adebrelimab plus chemotherapy and sequential TRT as first-line therapy for ES-SCLC showed promising efficacy and acceptable safety. This study was funded by the National Natural Science Foundation of China (82172865), Jiangsu Hengrui Pharmaceuticals Co., Ltd. and Amoy Diagnostics Co., Ltd.

Evaluating potential unexpected adverse events and mortality after oral analgesics administration in fracture care-A cohort study.

Analgesic selection per individual's tolerance is essential to avoid risks. The study evaluated current oral analgesic prescription practice, analgesic adverse effects-related factors, unexpected events, and mortality post-fracture surgery. Present prospective cohort study from June 2022 to July 2023 enrolled a total of 198 proximal femoral, ankle, and hindfoot trauma fracture patients. Stratification was done for oral analgesics prescribed at hospital discharge and 1 week with their accompanying toxicity assessed for 2 weeks. Analyzed Kaplan-Meier curve and the absolute risk for possible analgesics-related deaths. Following oral analgesics administration, 122 (62%) patients experienced adverse events. In seven expiries, five were possibly due to acetaminophen added tramadol combined with any of pregabalin, diclofenac, etoricoxib, or gabapentin (absolute risk 2.5%, 97.5% proportion 2 weeks survival). Three (2% of 122) patients taking acetaminophen added tramadol or diclofenac experienced unexpected serious adverse events. Elderly diabetic and hypertensive hip fracture patients expired or experienced unexpected events. Data suggest that oral acetaminophen added tramadol combined with any of pregabalin, diclofenac, etoricoxib, or gabapentin might increase the death risk or unexpected serious adverse events in elderly diabetic and hypertensives suffering from intertrochanteric/femoral neck fracture. Safe analgesic selection is necessitated for at-risk patients.

A traffic-weather generative adversarial network for traffic flow prediction for road networks under bad weather

Traffic flow prediction is pivotal in providing reliable information for intelligent traffic systems. Unexpected events, such as bad weather, unavoidably impact the precision of traffic flow prediction. Therefore, to achieve accurate traffic flow prediction results in road networks under bad weather, a novel Traffic-Weather Generative Adversarial Network (TWeather-GAN model) is developed. This model comprises a Generator and a Discriminator. The Generator incorporates both the traffic and weather modules to extract the spatiotemporal patterns hidden in traffic flow and weather data. In the traffic and weather modules, the gated convolutional layer, Encoder-Decoder architecture, and attention mechanism are established. In the Discriminator, the gated convolutional layer and bidirectional long short-term memory neural network are introduced. Traffic flow data under fog, strong wind, and heavy rain are selected to test the seven baseline models and the proposed model, and the ablation experiments are conducted to analyze the mechanism of the proposed model. The experiments demonstrate that the TWeather-GAN model outperforms the baseline models under bad weather, and makes the prediction error have an average reduction of 0.20%–34.81%, 3.21%–35.22%, and 9.46%–39.10%, respectively, under one-step prediction, three-step prediction, and six-step prediction. Furthermore, establishing the gated convolutional layer and the weather module enhances the accuracy of traffic flow prediction under bad weather. Results show that traffic flow fluctuations and distributions differ under fog and strong wind, and heavy rain affects the trend of traffic flow over one day.

Multi-level traffic-responsive tilt camera surveillance through predictive correlated online learning

In urban traffic management, the primary challenge of dynamically and efficiently monitoring traffic conditions is compounded by the insufficient utilization of thousands of surveillance cameras along the intelligent transportation system. This paper introduces the multi-level Traffic-responsive Tilt Camera surveillance system (TTC-X), a novel framework designed for dynamic and efficient monitoring and management of traffic in urban networks. By leveraging widely deployed pan–tilt-cameras (PTCs), TTC-X overcomes the limitations of a fixed field of view in traditional surveillance systems by providing mobilized and 360-degree coverage. The innovation of TTC-X lies in the integration of advanced machine learning modules, including a detector–predictor–controller structure, with a novel Predictive Correlated Online Learning (PiCOL) methodology and the Spatial–Temporal Graph Predictor (STGP) for real-time traffic estimation and PTC control. The TTC-X is tested and evaluated under three experimental scenarios (e.g., maximum traffic flow capture, dynamic route planning, traffic state estimation) based on a simulation environment calibrated using real-world traffic data in Brooklyn, New York. The experimental results showed that TTC-X captured over 60% total number of vehicles at the network level, dynamically adjusted its route recommendation in reaction to unexpected full-lane closure events, and reconstructed link-level traffic states with best MAE less than 1.25 vehicle/hour. Demonstrating scalability, cost-efficiency, and adaptability, TTC-X emerges as a powerful solution for urban traffic management in both cyber–physical and real-world environments.

Unveiling the challenges encountered by newly graduated nurses during night shifts: A descriptive qualitative study

ObjectivesNewly graduated nurses commence night shifts during a phase of heightened vulnerability to reality shock, exacerbating the challenges faced by these graduates. Therefore, this study aimed to identify the challenges experienced by newly graduated nurses when undertaking night shifts in order to help identify a strategy for supporting their adaptation to these shifts. MethodsSemi-structured personal interviews were used to collect data. Fifteen newly graduated nurses were selected to participate in the study by purposive sampling method from November 2021 to March 2022 in one of four general hospitals situated in the southwestern region of Japan. Semi-structured interviews were analyzed by using thematic analysis. ResultsThe analysis revealed five central themes and nine subthemes: challenges in task efficiency (task organization challenges, challenges in time-constrained task performance), challenges in responding to patients’ changing conditions (challenges in responding to patients’ irregular conditions, challenges in responding to nighttime changes in patients’ behaviors), challenges in independent practice (challenges in engaging in independent nursing practice, challenges in dealing with unexpected events), challenges in establishing collaborative relationships (challenges in working closely with other staff, challenges in establishing collaborative relationships during night shifts with limited resources), challenges in adapting to shift work (challenges in managing physical conditions for shift work). ConclusionsNewly graduated nurses often encounter challenges in performing their tasks during the transition period. When working night shifts, they face additional hurdles unique to nocturnal duties. The findings underscore the necessity for these graduates to develop night shift-specific readiness to effectively navigate the demands inherent in such work schedules.

The movement pattern changes of population following a disaster: Example of the Aegean Sea earthquake of October 2020

Unexpected seismic events can have a significant impact on our daily lives. Examining post-disaster population movement patterns contributes to disaster response and recovery operations. While most studies analyze population movement or displacement data, only a few examine multi-level movement patterns and consider public transportation demand. This paper aims to analyze changes in movement patterns following a major earthquake that severely affected İzmir in Türkiye, mainly using movement data from the Data for Good platform of Meta. According to the findings, on the first day following the earthquake, those traveling within İzmir considered the areas least damaged to be safer, despite the higher seismic intensity. The timeframe alignment between aftershock activity and the number of people traveling within İzmir suggests the routine movement pattern within the city was regained as the aftershocks decreased day by day. Unlike intra-city travel routines, there was an increase in the number of people moving to summer houses, located far from the center of İzmir. By November 2, 2020, three days after the earthquake, intra-city movements reached a new normal, as confirmed by public transportation use. However, intra-city travel patterns were impacted for approximately one month. This study reveals key findings from the evaluation of post-earthquake movements to improve disaster management decision making and aid crisis response and recovery operations.

Concurrent extremes in mid-latitude Asia triggered by resonance of multi-scale zonal wind

Abstract Climatic changes worsen concurrent extreme climate events. In July and August of 2022 and 2020, respectively, unexpected concurrent extreme events occurred in mid-latitude Asia. The sudden and severe consequences highlight the importance of a thorough understanding of the drivers of such extreme events, which is crucial for improving predictions and implementing preventive measures to mitigate future risks. By applying multi-scale window transform methodology, a unique mechanism of multi-scale zonal wind resonance is identified, which manifests as a quasi-stationary co-coupling with low-frequency zonal winds. This resonance leads to barotropic instability, triggering abnormal low-frequency Rossby wave behavior in the entrance and exit regions of the quasi-stationary jet stream. Simultaneously, the intensified meridional wind, coupled with adiabatic atmospheric warming, amplifies baroclinic instability, resulting in an enhanced wave pattern and the high concurrence events of 2022. Under long term future global warming levels of 4 °C, the concurrence, strengthened by multi-scale zonal wind resonance, is expected to persist. The mechanism evident in 2022 plays a broader and more significant role in concurrent events compared to the mechanism in 2020. Under the process of warming, resonance phenomena, as observed in 2022, are projected to become more frequent.

Foreign Director Exit in the Midst of Deteriorating Bilateral Political Relations

Amid global geopolitical realism pushing for a race of hegemonic rivalry nowadays, an outflow of global human talents is a pressing organizational concern. Our study draws attention to the underexamined phenomenon of the exit of foreign directors from their host countries during geopolitical tensions. Theorizing from a sensemaking logic, we posit that the deterioration of bilateral political relations serves as an unexpected event that activates foreign directors’ schemas for dual identity conflict, propelling them to react behaviorally to such identity threats by exiting the board in the host country. In addition, we further posit that the sensemaking process is contingent on how the foreign director draws cues from the embedded social context, including organizational identification, socialization and homophily effect, and socioemotional climate. Our empirical analyses from a sample of 1,014 foreign directors in China from 1999 to 2018 provide strong and robust support for the hypotheses. This study instills important theoretical insights into the transcending impacts of international relations and geopolitics, international governance and foreign directors, and the situated cognitive process of sensemaking regarding the intertwining effects of cognitive schema and social contexts.

The complement model disease paroxysmal nocturnal hemoglobinuria.

We describe initial, current, and future aspects of complement activation and inhibition in the rare hematological disease paroxysmal nocturnal hemoglobinuria (PNH). PNH is a rare but severe hematological disorder characterized by complement-mediated intravascular hemolysis resulting in anemia and severe thrombosis. Insights into the complement-mediated pathophysiology ultimately led to regulatory approval of the first-in-class complement inhibitor, eculizumab, in 2007. This anti-complement C5 therapy resulted in the stabilization of many hematologic parameters and dramatically reduced the often fatal, coagulant-resistant thrombotic events. Despite the remarkable clinical success, a substantial proportion of PNH patients experience suboptimal clinical responses during anti-C5 therapy. We describe the identification and mechanistic dissection of four unexpected processes responsible for such suboptimal clinical responses: (1) pharmacokinetic and (2) pharmacodynamic intravascular breakthrough hemolysis, (3) continuing low-level residual intravascular hemolysis, and (4) extravascular hemolysis. Novel complement therapeutics mainly targeting different complement proteins proximal in the cascade attempt to address these remaining problems. With five approved complement inhibitors in the clinic and many more being evaluated in clinical trials, PNH remains one of the complement diseases with the highest intensity of clinical research. Mechanistically unexpected breakthrough events occur not only with C5 inhibitors but also with proximal pathway inhibitors, which require further mechanistic elaboration.

Online state estimation in water distribution systems via Extended Kalman Filtering

Operators of water distribution systems (WDSs) need continuous and timely information on pressures and flows to ensure smooth operation and respond quickly to unexpected events. While hydraulic models provide reasonable estimates of pressures and flows in WDSs, updating model predictions with real-time sensor data provides clearer insights into true system behavior and enables more effective real-time response. Despite the growing prevalence of distributed sensing within WDSs, standard hydraulic modeling software like EPANET do not support synchronous data assimilation. This study presents a new method for state estimation in WDSs that combines a fully physically-based model of WDS hydraulics with an Extended Kalman Filter (EKF) to estimate system flows and heads based on sparse sensor measurements. To perform state estimation via EKF, a state-space model of the hydraulic system is first formulated based on the 1-D Saint-Venant equations of conservation of mass and momentum. Results demonstrate that the proposed model closely matches steady-state extended-period models simulated using EPANET. Next, through a holdout analysis it is found that fusing sensor data with EKF produces flow and head estimates that closely match ground truth flows and heads at unmonitored locations, indicating that state estimation successfully infers internal hydraulic states from sparse sensor measurements. These findings pave the way towards real-time operational models of WDSs that will enable online detection and mitigation of hazards like pipe leaks, main bursts, and hydraulic transients.

An interactional practice of registering expectation discrepancy: the use of the turn-initial token are in Japanese

ABSTRACT This conversation analytic study offers an empirical analysis of the Japanese turn-initial interjection are. The interjectional are is said to be pragmatized from its use as a distal demonstrative and has been considered as an expression of a speaker’s internal state of being surprised at something. In contrast, this study argues that are is meticulously used for interactional purposes. Through the analysis of video- and audio-recorded noninstitutional conversation data, this study examines how speakers, by utilizing the turn-initial are, signal discrepancy in their expectation, assumption, or prior knowledge to accomplish various interactional tasks. This study does so by documenting are’s workings in two different sequential contexts, (i) are-prefaced display of noticing unexpected physical events during embodied activities and (ii) are-prefaced repair initiation as remediation in understanding. This research also examines prosodic features of are and points out a possible correlation between are’s prosodic features and are’s sequential locations.

Assessment of Stress and Anxiety in Parents of Neonates Admitted in a Tertiary Care Neonatal Intensive Care Unit (NICU).

Background A newborn's admission into the Neonatal Intensive Care Unit (NICU) is one unexpected event capable of causing much stress and anxiety amongparents. The current study aims to evaluate and compare parental stress and anxiety levels between mothers and fathers. Methodology This cross-sectional study was conducted in the NICU of a tertiary care center, in Uttarakhand where a total of 306 mothers and fathers were enrolled. Data was compiled using a questionnaire consisting of demographic details of parents and infants' clinical profiles,Parental Stressor Scale (PSS) NICU, and State-Trait Anxiety Inventory (STAI) scales were used to evaluate stress and anxiety, respectively. Results Mothersmean stress levels were greater and statistically significant. The most affected subscale in both parents was the change in parental role (M: 4.4/F: 3.3; p < 0.001). Parents with high trait anxiety also had high state anxiety (M: 51.3/F: 45.5; p < 0.001). Mothers were found to have higher trait and state anxiety than fathers. Conclusion Parents of newborns admitted in the NICU experience significant stress and anxiety. Mothers had higher levels of stress and anxiety; similar findings have been recorded previously in Indian and western literature.

Factors Driving Unexpected Drought-Induced Nothofagus dombeyi Mortality in a Valdivian Temperate Rainforest, Argentina

Understanding the drivers of drought-induced tree mortality remains a significant scientific challenge. Here, we investigated an unexpected mortality event of Nothofagus dombeyi (Mirb.) Oerst. following the 2014–15 drought in a Valdivian rainforest, Argentina. Our focus was on long-term growth trend differences between vital and dead trees, and how the mixing of species in tree neighbourhoods drives tree growth during drought. The inter-annual variation of basal area increments of vital and 2014–15-dead N. dombeyi trees showed a similar pattern through the 1930–2015 period, while the climate–growth relationships indicated that precipitation during the growing season promoted growth in both vitality classes, regardless of whether they were in the wettest location. For the period 1990–2015, both vitality classes showed similar estimated growth regardless of competition level, whereas species mingling in the neighbourhood significantly affected the dead tree growth. Network analysis revealed that drought performance covaried positively with a neighbourhood dominated by species functionally different from the focal species only in vital trees. These findings suggest a nuanced response of N. dombeyi to drought, shaped by multifaceted interactions at both the individual tree and neighbourhood levels. This research underscores that species-specific relationships under different mixtures imply different tree responses within a stand, and add complexity to understanding drought response at the individual level.