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Naturalistic driving studies (NDS) generate tremendous amounts of traffic data and constitute an important component of modern traffic safety research. However, analysis of the entire NDS database is rarely feasible, as it often requires expensive and time-consuming annotations of video sequences. We describe how automatic measurements, readily available in an NDS database, may be utilised for selection of time segments for annotation that are most informative with regards to detection of potential associations between driving behaviour and a consecutive safety critical event. The methodology is illustrated and evaluated on data from a large naturalistic driving study, showing that the use of optimised instance selection may reduce the number of segments that need to be annotated by as much as 50%, compared to simple random sampling.

This year (2021), we are celebrating the 30th anniversary of Ukraine regaining its inde-pendence. Poland was the first country to recognise the independence of this Central-Eastern European country in the international arena. In this article, I would like to present and dis-cuss selected journal articles and monographs written by Polish authors as a comment to this critical event. The analysis will be based on selected histographic sources, especially those analysed in terms of ideology, but it will also be reasonable to highlight the most im-portant problems that, according to the authors, the young state may await. Often the fears for the future accompanying the authors of the 90s, unfortunately, proved to be true when we analyse the situation at the beginning of the 21st century. One thing does not change. How-ever, over the first years of bilateral relations, it is difficult to find significant press articles negatively related to this matter, and if there are negative ones, they are mostly marginal.

BACKGROUND: A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS: In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS: There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0–300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99–10.367), p

With this scoping review, we aimed to collate published studies related to cognitive incapacitation in pilots and provide a comprehensive overview of existing knowledge on this topic. This review has a second objective and advantage, that is identifying and highlighting rigorous and high-quality methods for triggering and measuring cognitive incapacitation in laboratory conditions. For more details on the Rationale, see attached document (Background).

Contemporaneous notes refer to witness accounts composed during or immediately after a critical event. Although contemporaneous notes can improve eyewitness accuracy, their influence upon juror dec...

Proteinuria in several glomerular diseases results from dysfunction of the slit diaphragm, a cell-cell junction of glomerular epithelial cells (podocytes). Ephrin-B1 and its related molecule NHERF 2 are novel essential components of the slit diaphragm. Ephrin-B1 interacts with nephrin via the extra-cellular domain and interacts with NHERF2 via the cytoplasmic site. In the proteinuric state induced by the stimulation to nephrin, nephrin and ephrin-B1 are phosphorylated, and NHERF2 is de- phosphorylated and consequent disruption of the linkage and downregulation of nephrin, ephrin-B1 and NHERF2 are a critical pathogenic event of podocyte injury. Keywords:Podocyte; Slit Diaphragm; Ephrin-B1; Nephrin; NHERF2 https://www.raftpubs.com/cjn-nephrology/articles/cjn_raft1004.php

Baseado nos catálogos das Bienais de São Paulo da década de 1950, identifico uma dominação artística francesa sobre o mundo “ocidental”, articulada na forma pela qual se narrava e pela qual se entendia a história da arte do século XX. Nesses discursos, a cidade de Paris figurava como um símbolo, internacionalmente compartilhado e capaz de indexar toda a história da arte moderna. A quinta Bienal (1959) é um evento crítico, no qual a França se recusou a participar com obras do século XX. Uma ausência institucional, que não correspondeu ao elevado número de citações que a cidade luz obteve nos textos de vários outros países, como, por exemplo, os EUA. Foi nessa meia-ausência de Paris, que uma produção jovem, aficionada pelas manchas e pelos gestos evidentes, dominou o evento tornando difícil, a diversos observadores, distinguir onde começava e onde terminava a delegação de cada nação e levando esse evento a ser apelidado de “Bienal Tachista”. Essa homogeneidade possibilitou às regiões periféricas se apresentarem, pela primeira vez, confiantes de que suas produções não denunciavam mais um déficit em relação às grandes potências.

ObjectiveCritical incident stress management (CISM) teams can be adapted in urban primary care clinics to address and process traumatic events in primary care. A guide for implementing the CISM team model within this setting is delineated.MethodsReview of existing literature and guide to implementation of CISM team in primary care.ResultsRespondents reported the team validated their reactions to the critical incident and were grateful for CISM presence.ConclusionDespite indications that vicarious traumatization, burnout, and compassion fatigue are rising (Bodenheimer & Sinsky, 2014; Coles et al., 2013; Woolhouse et al., 2012), there is little information about efforts to address this. Operating and emergency rooms and intensive care units utilize CISM (Maloney 2012; Powers, 2015); however, it's overlooked in primary care (Blacklock, 2012; Naish et al., 2002).

The extreme temperature induced by fire and hot toxic smokes in tunnels threaten the trapped personnel and firefighters. To alleviate the potential casualties, fast while reasonable decisions should be made for rescuing, based on the timely prediction of fire development in tunnels. This paper targets to achieve a real-time prediction (within 1 s) of the spatial-temporal temperature distribution inside the numerical tunnel model by using artificial intelligence (AI) methods. A CFD database of 100 simulated tunnel fire scenarios under various fire location, fire size, and ventilation condition is established. The proposed AI model combines a Long Short-term Memory (LSTM) model and a Transpose Convolution Neural Network (TCNN). The real-time ceiling temperature profile and thousands of temperature-field images are used as the training input and output. Results show that the predicted temperature field 60 s in advance achieves a high accuracy of around 97%. Also, the AI model can quickly identify the critical temperature field for safe evacuation (i.e., a critical event) and guide emergency responses and firefighting activities. This study demonstrates the promising prospects of AI-based fire forecasts and smart firefighting in tunnel spaces.

This editorial sets the conceptual frame of reference for the special issue. It examines key themes at the intersection of activist leisure and critical event studies. Drawing on a wide range of so...

In time driven data-gathering, sensor nodes generate periodic data which are gathered at the base-station. Whereas in event driven data gathering, sensors remain idle until a critical event occurs and then the event information is sent quickly to the central unit. In hybrid data-gathering, the nodes switches between time and event-driven strategy. In this paper, we propose a hybrid data-gathering protocol that minimizes the critical event reporting delay, using anycasting forwarding techniques, and maximizes the network lifetime using sleep/wake scheduling. In our protocol, the sensor nodes generate periodic events and if the nodes detect a critical event, the event information is sent quickly to the central unit. We estimate the expected critical event reporting delay using stochastic approach and validate the same in a Monte-Carlo simulation. We show the effectiveness of our protocol, that minimizes the critical event reporting delay, using ns2 simulation, and compare our protocol with existing hybrid data-gathering protocols.

Günümüzde hızla değişen yaşam şartları ve artan tüketici ihtiyaçları, çalışma koşullarının sürekli farklılaşmasına sebep olmaktadır. Bu durum; çalışanlar üzerindeki baskıyı artırmakla birlikte işyerlerinde yeni tehlikeler ve risklerin oluşmasına ve bunun sonucunda kazaların meydana gelmesine ortam hazırlamaktadır. Böyle bir durumda endüstriyel tesislerin güvenlikleri için en önemli gereksinimleri; risklerin ve tehlikelerin sistematik bir şekilde belirlenip önceliklendirilmesi, gerekli önlemlerin hayata geçirilerek tehlikelerin kontrol altına alınması ve sürekliliğin sağlanması için devamlı iyileştirmenin yapılmasıdır. Bu çalışmada, tehlikeli olaylar arasından önceliklendirme yapabilmek için uluslararası kabul görmüş veri kaynaklarından kritik olay ve başlatıcı olayların meydana gelme sıklığının tespiti ve kalitatif bir risk analizinin kantitatif hale getirme yolları araştırılmıştır. Aynı zamanda petrol rafinerinde atmosferik damıtma kolonundan çıkıp sıyırıcıya giden hatta küçük boyutta sıvı sızıntısı kritik olayı üzerine örnek bir çalışma yapılmıştır. Örnek çalışmada birikinti tutuşmaması/dağılması sonucunda oluşan çevresel zararın 1, 73 10-6 yıl-1 frekans ile meydana gelme sıklığı en yüksek tehlikeli olay olurken şiddeti en yüksek tehlikeli olay olan buhar bulutu patlaması ‘nın(VCE) meydana gelme değeri ise 5,2 10-7 yıl-1 olarak hesaplanmıştır. Elde edilen sonuçlar ışığında tehlikeli olayları önlemeye ve etkilerini azaltmaya yönelik önleyici tedbirler almak için önceliklendirme yaparken şiddetin ve sıklığın aynı anda değerlendirilmesi gerektiği kanaati oluşmuştur.

The article discusses what happens when a ‘critical event’ exposes a migrant population to public view, leading them to reflect on their multiple identities and loyalties. Its focus is on twenty-fi...

Objectives: To find out the patterns of cervical lymph node metastasis in oral cavity carcinoma. Methods: This is across sectional study which was carried out in the department of Otolaryngology & Head Neck Surgery Dhaka Medical College Hospital (DMCH), Sir Salimullah Medical College Hospital (SSMC), Bangabandhu Sheikh Mujib Medical University (BSMMU) and National Institute of Cancer Research & Hospital (NICRH) from July 2013 to December 2014.Total 96 cases were included in this study. Data were collected by detail history, clinical examination, relevant investigation and result were processed manually and analyzed with the help of SPSS. Results: In this study 72 (75%) patients presented with clinically palpable neck nodes and 24 (25%) presented without neck node. Among 24 cases 7 cases was radiologically positive neck node. Out of 96 cases stage III was the highest (50.96%) followed by stage IV (27.01%), stage II (13.52%) and stage I (8.32%). That is 23 (23.92%) patients present with early stage and 73 (76.18%) patients present in late or advanced stage. Level l was the highest 49 (61.71%), followed by level all 35(44.1%), level lll 10 (12.6%). Conclusion: As cervical lymph node metastasis is a critical event for patients with squamous cell carcinoma of oral cavity, as this is the most reliable predictor of poor treatment outcomes. Thus for appropriate treatment it is very important to know this pattern of metastases. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 102-108

Cardiac t tubules undergo significant remodeling in various pathological and experimental conditions, which can be associated with mechanical or osmotic stress. In particular, it has been shown that removal of hyposmotic stress can lead to sealing of t tubules. However, the mechanisms underlying the sealing process remain essentially unknown. In this study we used dextran trapping assay to demonstrate that in adult mouse cardiomyocytes, t-tubular sealing can also be induced by hyperosmotic challenge and that both hypo- and hyperosmotic sealing display a clear threshold behavior requiring ≈100 mosmol/L minimal stress. Importantly, during both hypo- and hyperosmotic challenges, the sealing of t tubules occurs only during the shrinking phase. Analysis of the time course of t-tubular remodeling following removal of hyposmotic stress shows that t tubules become sealed essentially instantly, well before any significant reduction in cell size can be observed. Overall, the data support the hypothesis that the critical event in the process of t-tubular sealing during osmotic challenges is detachment (peeling) of the membrane from the underlying cytoskeleton due to suprathreshold stress. NEW & NOTEWORTHY This study provides new insights into how t-tubular membranes respond to osmotic forces. In particular, the data show that osmotically induced sealing of cardiac t tubules is a threshold phenomenon initiated by detachment of t-tubular membrane from the underlying cytoskeleton. The findings are consistent with the hypothesis that final sealing of t tubules is driven by negative hydrostatic intracellular pressure coincident with cell shrinking.

An initial public offering (IPO) is a critical event in a firm’s life cycle which can reshape its innovation strategy. Research suggests that after going public firms experience an increase in patent productivity. Our paper explores perceived litigation risks as a determinant of this outcome by examining US semiconductor firms. Results show that perceived patent litigation risks are positively associated with patent productivity after the IPO. Interestingly, we also find that the amount of capital raised during the IPO is positively associated with patent productivity after the IPO, successfully replicating previous findings on this relationship. These results are robust to model specifications where we attempt to account for the dynamics of self-selection of firms into IPO by considering matched control firms with similar pre-IPO characteristics, but that never went public.

Research in competitive dynamics has primarily analyzed how characteristics of observable attacks influence firms’ competitive responses. Why and how firms take action in response to critical event...

CEO turnover (or succession) is a critical event in an organization that influences organizational processes and performance. The objective of this study is to investigate whether workforce diversity (i.e., age, gender, and education-level diversity) might have a resilience effect on firm performance under the frequency of CEO turnover. Based on a sample of 409 Korean firms from 2010 to 2015, our results show that firms with more frequent CEO turnover have a lower firm performance. However, firms with more gender and education-level diversity could buffer the disruptive effect of frequent CEO turnover on firm performance to offer a benefit to the organization. Our theory and findings suggest that effectively managing diverse workforce can be a resilience factor in an uncertain organizational environment because diverse workforce has complementary skills and behaviors that can cope better with uncertainty and signals social inclusion of an organization, thus fostering a long-term exchange relationship. These findings contribute to the literature on CEO turnover (or succession) and diversity.

BACKGROUND Many cognitive aids are formatted in a step-by-step fashion with the intent that the aid will be accessed at the beginning of a critical event and that key behaviors will be performed in sequence. AIMS We hypothesized that, during simulated pediatric intraoperative critical events, anesthesia clinicians may not use cognitive aids immediately after the onset of a critical event but instead access the aid only after first performing several key behaviors. MATERIALS AND METHODS This manuscript is a re-analysis of previously published simulation data. The original study involved 89 clinicians participating in 143 pediatric intraoperative events divided into 6 types: arrhythmia, venous air embolus, hypoxemia, malignant hyperthermia, hypotension, and supraventricular tachycardia. For each trial involving cognitive aid use, we measured the time from event trigger to cognitive aid use, and the number and type of key behaviors performed by simulation participants prior to cognitive aid access. RESULTS Cognitive aid use was sought in 66 of 93 trials where it was available. Sufficient data for this analysis were available in 65 trials. The average time from event trigger to first cognitive aid use was 258 seconds. In 62/65 trials (95%), the cognitive aid was accessed after at least one key behavior had already been performed. The time from event trigger to cognitive aid use varied by type of scenario (P = .03, df 5, adjusted H 12.78), with the shortest time for "supraventricular tachycardia" (90 [66,156] seconds (median [IQR]) and the longest time for "hypoxemia" (354 [192,492] seconds). CONCLUSION In simulated critical events, anesthesia residents and student nurse anesthetists often consulted a cognitive aid only after first performing at least some key behaviors. Incorporating the possibility of delayed access into critical event cognitive aid design may facilitate the effectiveness of that aid.

This paper examines responses to the 2015 terror attack on Charlie Hebdo, a French satirical magazine, amongst students in a secondary school in Berlin-Neukölln, Germany. The Charlie Hebdo attack occurred in the final weeks of a 19-month ethnographic study in the community. By analyzing the responses in the school to this critical event, we identify what is at stake for Muslim students. Students presented many explanations for why the attack happened, and opinions on whether the attackers’ actions were justified. Staff were alarmed about students’ viewpoints that they considered “extreme”. These dynamics resulted in conflicts and misunderstandings amongst students, and between students and staff. Yet, we show that, rather than the violence itself, or questions about its legitimacy, it was everyday processes in students’ lives – e.g., bullying, peer pressure and discrimination, and feelings of being misrepresented and misunderstood – that were central to students’ reactions to the event. We suggest that to understand students’ reactions, both the immediate and the broader socio-political contexts must be considered, particularly rising xenophobia and processes of polarization in Germany and Europe at large. We thus conclude that to understand young people’s reactions to terrorist acts, we need to look beyond initial statements and explore ethnographically how wider contexts shape the actions, reactions, and future orientations of young Muslims in Europe.

Quantitative risk assessment (QRA) techniques methodically assess the likelihood, impact, and subsequently the risk of adverse events. In a typical QRA method, one of the main intentions is to identify the critical root events which mostly contribute to the risk of the top event (TE) and requiring subsequent corrective actions (CAs). Finding the critical events which contribute to the risk is significantly dependent on the assumptions and methods applied to integrate the probabilities of different events and these events may have really low probability of occurrence. Thus, the probability reduction of the critical root events and subsequently the system’s failure does not lead to an optimal solution. For this reason, ranking the CAs without consideration of several aspects such as their influence on root events probability, inter-relationships, and direct/indirect cost, is not an appropriate approach. This study aims to introduce an approach to deal with the aforementioned situations. A novel extension to DEMATEL (decision making trial and evaluation laboratory) named Pythagorean fuzzy DEMATEL is proposed on a common probabilistic safety analysis. As a case study, a collapse in an offshore facility platform (including 42 basic events and corresponding 30 CAs) is considered to illustrate the effectiveness of the presented approach. The application of the model confirms its robustness in prioritizing critical root events and CAs compared with a conventional model, consideration of the influencing factors, and a dynamic and flexible structure.

Driver distraction is one major cause of road traffic accidents. In order to avoid distraction-related accidents it is important to inhibit irrelevant stimuli and unnecessary responses to distractors and to focus on the driving task, especially when unpredictable critical events occur. Since inhibition is a cognitive function that develops until young adulthood and decreases with increasing age, young and older drivers should be more susceptible to distraction than middle-aged drivers. Using a driving simulation, the present study investigated effects of acoustic and visual distracting stimuli on responses to critical events (flashing up brake lights of a car ahead) in young, middle-aged, and older drivers. The task difficulty was varied in three conditions, in which distractors could either be ignored (perception-only), or required a simple response (detection) or a complex Go-/NoGo-response (discrimination). Response times and error rates to the critical event increased when a simultaneous reaction to the distractor was required. This distraction effect was most pronounced in the discrimination condition, in which the participants had to respond to some of the distracting stimuli and to inhibit responses to some other stimuli. Visual distractors had a stronger impact than acoustic ones. While middle-aged drivers managed distractor inhibition even in difficult tasks quite well (i.e., when responses to distracting stimuli had to be suppressed), response times of young and old drivers increased significantly, especially when distractor stimuli had to be ignored. The results demonstrate the high impact of distraction on driving performance in critical traffic situations and indicate a driving-related inhibition deficit in young and old drivers.

The complexity of the process control systems within the industrial environment increases rapidly over the years. This may not be the critical issue for the design of the control system itself, but human limitations place operators in a difficult position facing an increasing level of complexity of the Human- Machine Interface (HMI) with growing amounts of data and control parameters. This paper proposes a lightweight web-based software solution in the form of the addition to the existing control system that monitors desired segments of the controlled process in real-time and aids the operator in timely detection of the recurring critical situation based on the initial operator's observation. The proposed solution does not rely on machine learning or any demanding computational task and therefore can coexist with existing control systems without the need for additional computational power. Furthermore, there is no need for additional client software on any working station used for process control as it is accessed via the web browser.

Gastrulation is a critical event in vertebrate morphogenesis driven by cellular processes, and characterized by coordinated multi-cellular movements that form the robust morphological structures. How these structures emerge in a developing organism and vary across vertebrates remains unclear. Inspired by experiments on the chick, we derive a theoretical framework that couples actomyosin activity to tissue flow, and provides a basis for the dynamics of gastrulation morphologies. Our model predicts the onset and development of observed experimental patterns of wild-type and perturbations of chick gastrulation as a spontaneous instability of a uniform state. Varying the initial conditions and a parameter in our model, allows us to recapitulate the phase space of gastrulation morphologies seen across vertebrates, consistent with experimental observations in the accompanying paper. All together, this suggests that early embryonic self-organization follows from a minimal predictive theory of active mechano-sensitive flows.

BACKGROUND AND AIM: Ongoing climate variability and change is altering the timing of spring onset, a critical event that signifies the start of tree pollen season in North America. There is a pauci...

A breast cancer diagnosis is a critical event with a potentially traumatic nature. In recent years there has been an increase of this illness in women aged under-fifty, a group of particular scientific interest. In this article the authors review the recent scientific literature on psychological impact of breast cancer experiences in under-50 women. Our results highlight three trajectories: clinical psychological risks; feminine-specific concerns; resources between individual and relational aspects. This overview illustrates the complexity of the effects of breast cancer in under-50women allowing to think about theoretical and psychosocial models to provide support for under-50 women during the illness experience.

New Experimental Approach to Retinal Degeneration Loss of retinal photoreceptor cells is a critical event in loss of vision. A new, albeit tentative, strategy to rectify the loss of photoreceptor c...

Dysfunctional beliefs are the central element in cognitive-behavioral conceptualizations of obsessive–compulsive disorder (OCD). The purpose of this study was to further elucidate the etiological role of preexisting dysfunctional beliefs in the occurrence of unwanted intrusive thoughts and neutralizing behaviors after a critical event by examining their predictive value and specificity in a prospective study with undergraduate students. The dysfunctional belief domains importance/control of thoughts (ICT), responsibility/threat (RT), and perfectionism/certainty (PC) were assessed at baseline 8 weeks prior to the critical event “exam situation” in N = 169 students. Exam-related unwanted intrusive thoughts and neutralizing behaviors, anxiety, and depression were assessed during the week immediately before the exam. Complete data for both baseline and follow-up were available for 79 participants (46%). After controlling for baseline obsessive–compulsive symptoms, anxiety, and depression, ICT but not RT or PC prospectively predicted exam-related intrusive thoughts and neutralizing behaviors, ICT also prospectively predicted depressive symptoms but not anxiety, and RT and PC both prospectively predicted anxiety but not depressive symptoms. Findings are partially consistent with cognitive models of OCD. They support the idea that ICT is a cognitive vulnerability factor for unwanted intrusive thoughts and neutralizing behaviors during a stressful event. Its predictive power was small and not specific to unwanted intrusive thoughts and neutralizing behaviors.

Embryo implantation is one of the pivotal steps during mammalian pregnancy, since the quality of embryo implantation determines the outcome of ongoing pregnancy and fetal development. A large number of factors, including transcription factors, signalling transduction components, and lipids, have been shown to be indispensable for embryo implantation. Increasing evidence also suggests the important roles of epigenetic factors in this critical event. This review focuses on recent findings about the involvement of epigenetic regulators during embryo implantation.

Fire is the foremost critical event for road tunnels' safety. Therefore, the European Commission introduced the Directive 2004/54/EC for enhancing tunnels' safety since they constitute a key element of the Trans-European Road Network. The Directive has established a common ground for tunnels' safety evaluation providing certain minimum requirements while introducing officially the use of risk assessment. Despite the significant progress, this paper illustrates that further efforts are needed. Through a comparative review of the risk assessment methods, questions about the level of harmonisation of the framework are raised. Moreover, considerable problems are highlighted, like the incorporation of the new trends emerging from the literature or the deficiencies on addressing significant issues of the analysis, such as the risk acceptance criteria and the behaviour of trapped-users. These problems can affect the risk assessment process causing both significant discrepancies and deficiencies at the estimated level of tunnels' safety. Uncovering, thus, the deficiencies and limitations of the methods, this paper contributes to i) the discourse for initiating relevant studies to enhance tunnels’ fire safety in Europe and worldwide, and ii) the harmonisation of risk assessment methods. Keywords: Road tunnel, Safety, Fire, Risk assessment

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Debriefing after an actual critical event is an established good practice in medicine, but a gap exists between principle and implementation. The authors’ objective was to understand barriers to debriefing, characterize quantifiable patterns and qualitative themes, and learn potential solutions through a mixed-methods study of actual critical events experienced by anesthesia personnel. Methods At a large academic medical center, anesthesiology residents and a small number of attending anesthesiologists were audited and/or interviewed for the occurrence and patterns of debriefing after critical events during their recent shift, including operating room crises and disruptive behavior. Patterns of the events, including event locations and event types, were quantified. A comparison was done of the proportion of cases debriefed based on whether the event contained a critical communication breakdown. Qualitative analysis, using an abductive approach, was performed on the interviews to add insight to quantitative findings. Results During a 1-yr period, 89 critical events were identified. The overall debriefing rate was 49% (44 of 89). Nearly half of events occurred outside the operating room. Events included crisis events (e.g., cardiac arrest, difficult airway requiring an urgent surgical airway), disruptive behavior, and critical communication breakdowns. Events containing critical communication breakdowns were strongly associated with not being debriefed (64.4% [29 of 45] not debriefed in events with a communication breakdown vs. 36.4% [16 of 44] not debriefed in cases without a communication breakdown; P = 0.008). Interview responses qualitatively demonstrated that lapses in communication were associated with enduring confusion that could inhibit or shape the content of discussions between involved providers. Conclusions Despite the value of proximal debriefing to reducing provider burnout and improving wellness and learning, failure to debrief after critical events can be common among anesthesia trainees and perhaps anesthesia teams. Modifiable interpersonal factors, such as communication breakdowns, were associated with the failure to debrief.

Ferroptosis is a recently recognized cell death modality that is morphologically, biochemically and genetically distinct from other forms of cell death and that has emerged to play an important role in cancer biology. Recent discoveries have highlighted the metabolic plasticity of cancer cells and have provided intriguing insights into how metabolic rewiring is a critical event for the persistence, dedifferentiation and expansion of cancer cells. In some cases, this metabolic reprogramming has been linked to an acquired sensitivity to ferroptosis, thus opening up new opportunities to treat therapy-insensitive tumours. However, it is not yet clear what metabolic determinants are critical for therapeutic resistance and evasion of immune surveillance. Therefore, a better understanding of the processes that regulate ferroptosis sensitivity should ultimately aid in the discovery of novel therapeutic strategies to improve cancer treatment. In this Perspectives article, we provide an overview of the known mechanisms that regulate sensitivity to ferroptosis in cancer cells and how the modulation of metabolic pathways controlling ferroptosis might reshape the tumour niche, leading to an immunosuppressive microenvironment that promotes tumour growth and progression.

A veterinary anesthesia simulated environment (VASE) with clinical scenarios has been integrated into the pre-clinical curriculum at Midwestern University College of Veterinary Medicine to simulate anesthesia of a live patient within a surgical suite. Although this modality was shown to significantly improve veterinary students’ perceived preparedness to perform anesthesia on live patients, whether this would improve anesthesia competency in the actual clinical environment, described as operational performance, remained unclear. Our goal was to examine the relationship between anesthesia simulation training and student anesthesia operational performance. Anesthesia operational performance assessment of students was determined by quantifying critical event occurrences that negatively impacted patient safety during the anesthesia of 287 patients during students’ initial surgical experience in 2015 and 2016. The relationship between total numbers of critical incidents to students having anesthesia simulation training was determined through evaluation of anesthesia records from 2015 and 2016, where students did not have anesthesia simulation training or they had pre-clinical training, respectively. Results showed a significant relationship between simulation training and critical incident occurrence, with a critical incident more likely to occur during patient anesthesia for students who did not experience pre-clinical anesthesia simulation training. Of the total critical incidents that occurred in the two-year study, 88% were in patients anesthetized by students who did not have simulation training. Our findings suggest that students who were given the opportunity to participate in anesthesia-focused simulations before a live-animal anesthesia encounter demonstrated significant improvements in anesthesia operational performance and improved patient safety.

The ways through which we define fetuses and pregnant women has consequences in matters of abortion rights, in care following pregnancy loss and in the emotional experience of loss itself. Considering that maternal-fetal body, fetus status and maternal subjectivity are ontologically ambiguous, socially and technologically constructed and that they endure political tensions, this autoethnographic reflection on my cervical ectopic pregnancy focuses on how diverse medical-technological devices formed a semiotic and material field that modified my subjectivity making and unmaking a mother and transformed the status of personhood of my embryo from a quasi-child into a sort of cancer. By differentiating maternal status from maternal subjectivity, I also show how in western societies the maternal status of pregnant women is strictly linked to a pregnant body and to an existing and living fetus or embryo, but in the critical event of pregnancy loss, maternal subjectivity can follow other paths, paths that lack social recognition.

Because current automated vehicles have operational limitations, it is important to ensure that the fallback-ready driver is able to perform appropriately when required to take over control of the vehicle. However, time-related increase in driver drowsiness is well-known, and drowsy driving can affect response to take-over request (TOR). It was previously reported that a scheduled period of manual driving during automated driving was beneficial in maintaining driver arousal level. The present driving simulator study investigates the effects of scheduled manual driving on driver drowsiness and performance, as well as age differences therein. A total of 115 participants, whose gender was balanced and age was distributed uniformly from 20 to 70 years, drove an automated vehicle for 31 min, and a TOR was prompted before a collision event. A between-subjects design comprised two conditions: with versus without a scheduled 10-min interval of manual driving that ended 10 min before TOR. The Karolinska Sleepiness Scale and eyeblink durations estimated from electrooculograms (EOG) were used to subjectively and objectively measure participant’s drowsiness. Reaction time, standard deviation of steering wheel angle, and minimum Time-to-Collison (TTC) were extracted to measure driver performance in response to TOR. The alleviating effect on drowsiness of 10-min scheduled manual driving became non-significant after another 10-min period of automated driving. Although the scheduled manual driving had no significant effect for younger drivers, older drivers reacted significantly more slowly in both steering and braking at the critical event. These findings provide essential insights for human-vehicle interactions: Scheduled manual driving cannot maintain drivers’ arousal level for 10 min afterwards, and for older drivers, it would be better to avoid unnecessary task-switching between manual and automated driving.

Soil moisture is a key state variable in terrestrial water cycles, which links various land surface and hydrological processes. Owing to the significant spatiotemporal variability in soil moisture, collecting sufficient soil moisture data for relevant studies can be an astonishingly difficult task. Here, a statistical method based on the concept of depth functions was used to define Critical Events (CE) of soil moisture, which was hypothesized to contain disproportionally more system information on soil moisture dynamics. To test the feasibility of applying the CE concept for quantifying soil moisture dynamics, a long-term soil moisture dataset was retrieved from the Automated Weather Data Network (AWDN) located in the continental United States. The method of Temporal Stability Analysis (TSA) was adopted to examine the information embedded in soil moisture data that were collected under different conditions. The results showed that similar information on the relative as well as absolute wetness conditions at the AWDN sites was extracted from the entire time series and CEs of soil moisture, the latter of which contained much less soil moisture observations. Finally, the field data revealed that the occurrence of CEs of soil moisture in the study area was mainly affected by soil depth and interannual variability in precipitation. The number of CEs of soil moisture tended to be larger at deeper soil depths as well as in either dry or wet years than in normal years, suggesting that more soil moisture measurements under those conditions were needed to provide adequate information on soil moisture systems.

A cascade approach toward the tetracyclic core of akuammiline alkaloids which features high modularity and convergence is reported. Distinct substitution pattern can be readily introduced to the tetracyclic core by varying three building blocks with similar complexity. The critical event in the cascade is a regio- and stereoselective 1,2-shift enabled by a carbocation that sets up the core.

Stent infection after drug-eluting stent implantation is uncommon but is a critical event. In this study, we describe two such cases of coronary stent infection but with varied presentation. The first patient presented with recurrent stent thrombosis and acute coronary syndrome while the second patient was erroneously diagnosed as having tubercular pericarditis and was started on anti-tubercular therapy. Due to their possible fatal outcome, we herein report our experience with this uncommon clinical entity to help in rapid diagnosis and treatment. .

Ebola is examined as a Critical Event which shaped the communities in Bundibugyo district. The local framing of ebola epidemic 2007-8 as a curse to the particular ethnic groups affected the social networks and individual identities within communities. Ethnographic interviews and observations among victims of ebola were used as data, and a phenomenological approach was used to guide the research process. The paper recovers the lost moments and experiences of ebola survivors. The epidemic altered the socio-cultural set-up of the community and its impact have lasted for a long time; including stigma, discrimination, trauma, poverty and the orphan problem.Keywords: Ebola, Bundibugyo, Constructions, Critical Events

Natalia Walter, Internetowe wsparcie społeczne [Online social support]. Interdyscyplinarne Konteksty Pedagogiki Specjalnej, nr 23, Poznań 2018. Pp. 29-58. Adam Mickiewicz University Press. ISSN 2300-391X. DOI: https://doi.org/10.14746/ikps.2018.23.02 New media are the tools that support human’s intellectual functioning. For many people with disabilities they may become the sole opportunity for accessing information, communicating, learning or working. On the other hand, new media also provide a space for social interactions that could affect the process of coping with critical events, both ordinary and traumatic ones. The key concept for the discussion is internet-based social support, defined as support available online to a person dealing with a critical event which needs to be overcome with external resources coming from virtual groups comprising people experiencing difficulties of a similar nature, in the past or currently. The author posed the question whether internet social support is ubiquitous, and what it manifests itself. To answer this, she conducted quantitative and qualitative research. The data collected then became thebasis for analysis and theoretical considerations.

The growth in number of events, their attendance, and associated media coverage have contributed to a corresponding groundswell of interest in event studies (Baum, Lockstone-Binney, & Robertson, 2013). Since the mid-2000s, in part owing to Getz’s (2007) seminal work in the area, event studies have been widely explored in research, beginning with a plethora of management-related studies and pro-gressing beyond to conceptual and theoretical explo-rations (Lamond & Platt, 2016; Page & Connell, 2012; Thomas & Bowdin, 2012). The popularity of event studies is unsurprising given the ubiqui-tous nature of events, with the general populace exposed to a myriad of organized events, ranging from small-scale, private celebrations to highly commercialized sport mega-events. The ubiqui-tous nature of events is greatly helped by their ability to make use of existing infrastructure, supplemented by the use of temporary structures designed and built especially. Often, events make use of public space and infrastrucutre, which makes adequate and effective event management imperative to the local community’s acceptance of an event.

The critical event in KRAS signaling and oncogenic transformation is activation of the RAF–MEK–MAPK cascade. This requires assembly of a multiprotein–lipid complex on the plasma membrane. In a tour de force of modeling, Mysore et al. now provide the first glimpse of what this structure may actually look like.

Critical event debriefing (CED) or ‘hot debriefings’ (HoDs) can be described as a trigger-based, immediate postevent, interprofessional, expertly facilitated conversation where clinicians recount, reflect on, and improve personally and as a team.1 The process and experience of clinicians who cared for the patient is more complex and involves thoughts and emotions that go beyond the ‘case’ or ‘resuscitation’ and the debriefing itself.2 The American Heart Association guidelines for neonatal resuscitation highlight ‘team debriefing’ as a key step in their cognitive aid.3 There is evidence that implementing a ‘Cold Debrief’ programme for teams that care for patients in cardiac arrest improves outcomes4 yet in practice 33% of events are routinely debriefed.5 Critical events in anaesthesia are debriefed infrequently and those associated with communication breakdowns were even less likely to be debriefed6. How do we fuel …

The oral explanation (OE) is a critical event during new marketing authorisation procedures in the European Union (EU). The primary objective of the present study was to investigate how many procedures, having an OE in front of the Committee for Medicinal Products for Human Use (CHMP), resulted in a regulatory approval for oncology products. Procedures for new marketing authorisation applications (MAAs) and Type II variations (new indication) for oncology products with at least one OE (with or without a Scientific Advisory Group (SAG) meeting) and for which the outcome took place between 31 January 2016 to 31 January 2020 were included in the analysis. Publicly available agendas/meeting minutes and assessment reports were used to obtain information on the products. An OE occurred in about 20% of procedures (n = 28/150) for oncology products during the review period. The majority of procedures having an OE (61%), with or without any SAG meeting, led to MAA/Type II variation approval in the Centralised Procedure. It was also observed that in 41% of the cases a successful outcome was contingent upon willingness of the applicant to restrict the indication. A majority of oncology procedures that had an OE resulted in a positive outcome suggesting that such agency interaction is an important opportunity for the applicant to have a last chance to resolve any outstanding issues at the final stage of the procedure.

In the management of IP networks, the collection and classification of notifications is a critical task. In addition to unexpected events, such as hardware and software failures, the collected notifications are important to make the proper diagnosis of the failure that occurred and based on that, propose and apply efficient solutions to the problems presented. This work develops a critical event manager using the “Ingenias” methodology for the analysis and design of the prototype. The developed software agent has the characteristic of being proactive, for which it permanently listens to notifications from a network of IP routers and interacting with it to mitigate problems and propose solutions to network failures.

The situation caused by the appearance of Covid-19 can be viewed as a critical event: typologically, it is an unprecedented event, which requires and shapes new forms of historical action hitherto unknown in the given context. Critical events serve as strong value and emotional landmarks in the cultural cognition of each social environment, and form the basis for a meaningful determination towards other events. Using material collected primarily from the online versions of electronic and printed media, we consider how the reality they presented is shaped through the news through the statements of politicians and medical doctors in Serbia. We trace how the narrative transformation of socio-cultural reality took place from the time before the of Covid-19 outbreak in our country to the time immediately after the lifting of the state of emergency declared due to that infection. The premise of all that is being done to tackle the infection is not a purpose in itself, but aims to enable a return to the life we were accustomed to before the outbreak of the epidemic. Covid-19 destabilizes our everyday life – a life that consists of work or study, use of free time, socializing etc. Such everyday life is a reference point of "normalcy". Socio-cultural normalcy refers to all that is understood as a normal and undisturbed course of everyday life. The appearance of Covid-19 gave rise to the notion of the "new normal", that is, a course of everyday life that is similar to normal, ordinary life, but with adherence to measures aimed at preventing the spread of infection by the authorities. In the paper we deal with the period that begins just before the outbreak of Covid-19 in our country, and ends with the period after the lifting of the state of emergency, to show the discursively produced picture of social reality in which the concept of the "new normal" serves as a cultural cognitive tool for understanding a situation in which one has to live with Covid-19 in order to one day be able to return to the way of life that existed before it.