The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is no...The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is not a simple theoretical analysis of genetic determinism and environmental determinism in the novel’s plots. It attempts to combine the historical background and the author’s life experience to analyze how the author is deeply influenced by naturalism and pays close attention to Jack London’s contradictory philosophy of life and Fatalism. In order to make readers have a better and comprehensive understanding of the naturalistic views contained in the work.展开更多
This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affectiv...This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affective feelings and friendship in the life of the family and the polis.”The principal goal is to demonstrate the remarkable coherence of Xenophon’s concept of erōs despite the diversity of the types of manifestation and visible differences in framing between male-male and male-female relationships.In addition,it will be shown that the principle of self-mastery as a vital criterion for the evaluation of sexual conduct is subordinated to what Xenophon perceives as the primary purpose of sexual intercourse:the procreation of progeny.展开更多
Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency d...Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency decisionmaking.This study using the February 6,2023,M_(S)8.0 and M_(S)7.9 Kahramanmaras,Türkiye earthquakes as an example to estimate the ultimate number of fatalities.An early Quick Rough Estimate(QRE)based on the number of deaths reported by the Disaster and Emergency Management Presidency of Türkiye(AFAD)is conducted,and it dynamically adjusts these estimates as new data becomes available.The range of estimates of the final number of deaths can be calculated as 31384–56475 based on the"the QRE of the second day multiplied by 2–3" rule,which incorporates the reported final deaths 50500.The Quasi-Linear and Adaptive Estimation(QLAE)method adaptively adjusts the final fatality estimate within two days and predicts subsequent reported deaths.The correct order of magnitude of the final death toll can be estimated as early as 13 hr after the M_(S)8.0 earthquake.In addition,additional earthquakes such as May 12,2008,M_(S)8.1 Wenchuan earthquake(China),September 8,2023,M_(S)7.2 Al Haouz earthquake(Morocco),November 3,2023,M_(S)5.8 Mid-Western Nepal earthquake,December 18,2023,M_(S)6.1 Jishishan earthquake(China),January 1,2024,M_(S)7.2 Noto Peninsula earthquake(Japan)and August 8,2023,Maui,Hawaii,fires are added again to verified the correctness of the model.The fatalities from the Maui fires are found to be approximately equivalent to those resulting from an M_(S)7.4 earthquake.These methods complement existing frameworks such as Quake Loss Assessment for Response and Mitigation(QLARM)and Prompt Assessment of Global.展开更多
BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are require...BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.展开更多
Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 ...Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 during concurrent outbreaks in Marburg and Frankfurt,Germany,and in Belgrade,Serbia,linked to laboratory use of African green monkeys imported from Uganda.Subsequent outbreaks and isolated cases have been reported in various African countries,including Angola,the Democratic Republic of the Congo,Equatorial Guinea,Ghana,Guinea,Kenya,Rwanda,South Africa(in an individual with recent travel to Zimbabwe),Tanzania,and Uganda.Initial human MVD infections typically occur due to prolonged exposure to mines or caves inhabited by Rousettus aegyptiacus fruit bats,the natural hosts of the virus.展开更多
BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was ...BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.展开更多
This article compares the size of selected subsets using nonparametric subset selection rules with two different scoring rules for the observations. The scoring rules are based on the expected values of order statisti...This article compares the size of selected subsets using nonparametric subset selection rules with two different scoring rules for the observations. The scoring rules are based on the expected values of order statistics of the uniform distribution (yielding rank values) and of the normal distribution (yielding normal score values). The comparison is made using state motor vehicle traffic fatality rates, published in a 2016 article, with fifty-one states (including DC as a state) and over a nineteen-year period (1994 through 2012). The earlier study considered four block design selection rules—two for choosing a subset to contain the “best” population (i.e., state with lowest mean fatality rate) and two for the “worst” population (i.e., highest mean rate) with a probability of correct selection chosen to be 0.90. Two selection rules based on normal scores resulted in selected subset sizes substantially smaller than corresponding rules based on ranks (7 vs. 16 and 3 vs. 12). For two other selection rules, the subsets chosen were very close in size (within one). A comparison is also made using state homicide rates, published in a 2022 article, with fifty states and covering eight years. The results are qualitatively the same as those obtained with the motor vehicle traffic fatality rates.展开更多
BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale c...BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale cannot be fully understood due to lack of information.AIM To identify key factors that may explain the variability in case lethality across countries.METHODS We identified 21 Potential risk factors for coronavirus disease 2019(COVID-19)case fatality rate for all the countries with available data.We examined univariate relationships of each variable with case fatality rate(CFR),and all independent variables to identify candidate variables for our final multiple model.Multiple regression analysis technique was used to assess the strength of relationship.RESULTS The mean of COVID-19 mortality was 1.52±1.72%.There was a statistically significant inverse correlation between health expenditure,and number of computed tomography scanners per 1 million with CFR,and significant direct correlation was found between literacy,and air pollution with CFR.This final model can predict approximately 97%of the changes in CFR.CONCLUSION The current study recommends some new predictors explaining affect mortality rate.Thus,it could help decision-makers develop health policies to fight COVID-19.展开更多
Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Sahara...Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.展开更多
Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,partic...Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,particularly when a detailed exposure history is not provided.Patient’s Concern:A 33-year-old man inadvertently ingested an unknown liquid and presented to medical services a day later with complaints of ongoing nausea,vomiting,and diarrhea.The assessment revealed elevated serum creatinine,signaling acute kidney injury,initially thought due to gastroenteritis and dehydration.Diagnosis:Acute renal insufficiency due to paraquat poisoning.Interventions:The treatment involved fluid resuscitation and antibiotics,but his decline led to intensive care unit transfer.Subsequent chest computed tomography scans indicated lung changes indicative of paraquat poisoning.A detailed history review and comprehensive blood and urine toxicology screens confirmed the diagnosis.Subsequently,aggressive interventions such as hemoperfusion and continuous renal replacement therapy were initiated,yet there was a further decline in respiratory function,necessitating mechanical ventilation.The prognosis was poor,and ultimately,the family chose to withdraw care.Outcomes:The patient succumbed to his illness.Lessons:This case underscores the importance of promptly and accurately diagnosing paraquat poisoning,as its vague early signs can lead to diagnostic delays,crucial due to the condition’s rapid progression.Alertness to paraquat poisoning is essential in patients with sudden gastrointestinal and renal symptoms post-exposure.Additionally,it underscores the necessity for public health measures to avert paraquat ingestion and advance therapeutic approaches.展开更多
This paper examines the relationship between fatal road traffic accidents and potential predictors using multilayer perceptron artificial neural network (MLANN) models. The initial analysis employed twelve potential p...This paper examines the relationship between fatal road traffic accidents and potential predictors using multilayer perceptron artificial neural network (MLANN) models. The initial analysis employed twelve potential predictors, including traffic volume, prevailing weather conditions, roadway characteristics and features, drivers’ age and gender, and number of lanes. Based on the output of the model and the variables’ importance factors, seven significant variables are identified and used for further analysis to improve the performance of models. The model is optimized by systematically changing the parameters, including the number of hidden layers and the activation function of both the hidden and output layers. The performances of the MLANN models are evaluated using the percentage of the achieved accuracy, R-squared, and Sum of Square Error (SSE) functions.展开更多
Although there has been a slight decrease in road traffic crashes, fatalities, and injuries in recent years, HCMC (Ho Chi Minh City) will continue to encounter challenges in mitigating and preventing road crashes. Thi...Although there has been a slight decrease in road traffic crashes, fatalities, and injuries in recent years, HCMC (Ho Chi Minh City) will continue to encounter challenges in mitigating and preventing road crashes. This study analyzes road crash data from the past five years, obtained from the Road-Railway Police Bureau (PC08) and TSB (Traffic Safety Board) in HCMC. This analysis gives us valuable insights into road crash patterns, characteristics, and underlying causes. This comprehensive understanding serves as a scientific foundation for developing cohesive strategies and implementing targeted solutions to address road traffic safety issues more effectively in the future.展开更多
Traffic intersections are incredibly dangerous for drivers and pedestrians. Statistics from both Canada and the U.S. show a high number of fatalities and serious injuries related to crashes at intersections. In Canada...Traffic intersections are incredibly dangerous for drivers and pedestrians. Statistics from both Canada and the U.S. show a high number of fatalities and serious injuries related to crashes at intersections. In Canada, during 2019, the National Collision Database shows that 28% of traffic fatalities and 42% of serious injuries occurred at intersections. Likewise, the U.S. National Highway Traffic Administration (NHTSA) found that about 40% of the estimated 5,811,000 accidents in the U.S. during the year studied were intersection-related crashes. In fact, a major survey by the car insurance industry found that nearly 85% of drivers could not identify the correct action to take when approaching a yellow traffic light at an intersection. One major reason for these accidents is the “yellow light dilemma,” the ambiguous situation where a driver should stop or proceed forward when unexpectedly faced with a yellow light. This situation is even further exacerbated by the tendency of aggressive drivers to inappropriately speed up on the yellow just to get through the traffic light. A survey of Canadian drivers conducted by the Traffic Injury Research Foundation found that 9% of drivers admitted to speeding up to get through a traffic light. Another reason for these accidents is the increased danger of making a left-hand turn on yellow. According to the National Highway Traffic Safety Association (NHTSA), left turns occur in approximately 22.2% of collisions—as opposed to just 1.2% for right turns. Moreover, a study by CNN found left turns are three times as likely to kill pedestrians than right turns. The reason left turns are so much more likely to cause an accident is because they take a driver against traffic and in the path of oncoming cars. Additionally, most of these left turns occur at the driver’s discretion—as opposed to the distressingly brief left-hand arrow at busy intersections. Drive Safe Now proposes a workable solution for reducing the number of accidents occurring during a yellow light at intersections. We believe this fairly simple solution will save lives, prevent injuries, reduce damage to public and private property, and decrease insurance costs.展开更多
Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his work...Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his works.The novel describes a tragic life about abeautiful girl after disgrace.This paper analyses what cause Tess' s tragic life.The first part is an introduction of Tess of the D'Urb-ervilles and its writer Thomas Hardy.And then is the analysis on the causes of her tragic life —characters of Tess,Society Influ-ence and influence of Pessimism & Fatalism of Hardy.Though Tess fought with the society,as a common person she is helpless atthat time.In the end,she turned out to be the sacrificial victim of society like all other things which disobey the morality and ethic.展开更多
The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess&#...The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess' tragedy and characters are the products of the capitalist society.展开更多
Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and im...Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among展开更多
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal a...We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.展开更多
Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,B...Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.展开更多
文摘The Call of the Wild is one of the representative works of American famous writer Jack London. This novel is full of the author’s naturalistic literary viewpoint. Different from traditional studies, this thesis is not a simple theoretical analysis of genetic determinism and environmental determinism in the novel’s plots. It attempts to combine the historical background and the author’s life experience to analyze how the author is deeply influenced by naturalism and pays close attention to Jack London’s contradictory philosophy of life and Fatalism. In order to make readers have a better and comprehensive understanding of the naturalistic views contained in the work.
文摘This article attempts to trace the status and many manifestations of erōs in Xenophon’s ethical and political thought.It examines its meaning in the narrow sense of“love and desire”and the broad sense of“affective feelings and friendship in the life of the family and the polis.”The principal goal is to demonstrate the remarkable coherence of Xenophon’s concept of erōs despite the diversity of the types of manifestation and visible differences in framing between male-male and male-female relationships.In addition,it will be shown that the principle of self-mastery as a vital criterion for the evaluation of sexual conduct is subordinated to what Xenophon perceives as the primary purpose of sexual intercourse:the procreation of progeny.
基金supported by the National Natural Science Foundation of China(NSFC,grant number U2039207).
文摘Earthquakes can cause significant damage and loss of life,necessitating immediate assessment of the resulting fatalities.Rapid assessment and timely revision of fatality estimates are crucial for effective emergency decisionmaking.This study using the February 6,2023,M_(S)8.0 and M_(S)7.9 Kahramanmaras,Türkiye earthquakes as an example to estimate the ultimate number of fatalities.An early Quick Rough Estimate(QRE)based on the number of deaths reported by the Disaster and Emergency Management Presidency of Türkiye(AFAD)is conducted,and it dynamically adjusts these estimates as new data becomes available.The range of estimates of the final number of deaths can be calculated as 31384–56475 based on the"the QRE of the second day multiplied by 2–3" rule,which incorporates the reported final deaths 50500.The Quasi-Linear and Adaptive Estimation(QLAE)method adaptively adjusts the final fatality estimate within two days and predicts subsequent reported deaths.The correct order of magnitude of the final death toll can be estimated as early as 13 hr after the M_(S)8.0 earthquake.In addition,additional earthquakes such as May 12,2008,M_(S)8.1 Wenchuan earthquake(China),September 8,2023,M_(S)7.2 Al Haouz earthquake(Morocco),November 3,2023,M_(S)5.8 Mid-Western Nepal earthquake,December 18,2023,M_(S)6.1 Jishishan earthquake(China),January 1,2024,M_(S)7.2 Noto Peninsula earthquake(Japan)and August 8,2023,Maui,Hawaii,fires are added again to verified the correctness of the model.The fatalities from the Maui fires are found to be approximately equivalent to those resulting from an M_(S)7.4 earthquake.These methods complement existing frameworks such as Quake Loss Assessment for Response and Mitigation(QLARM)and Prompt Assessment of Global.
文摘BACKGROUND Systemic immunoinflammatory diseases can affect multiple systems and organs.They have a severe course and severe complications,causing multiple organ failure and death.Quite often these patients are required to be hospitalized in the intensive care unit(ICU).Approximately 50% of patients with multisystem inflammatory syndrome associated with coronavirus disease 2019 in children and systemic lupus erythematosus need admission to the ICU.AIM To find early predictors of death in patients with immunoinflammatory diseases who are hospitalized in the ICU.METHODS The retrospective continuous cohort study included 51 patients(23 males,28 females)with immunoinflammatory diseases,including multisystem inflammatory syndrome associated with coronavirus disease 2019(n=18),systemic rheumatic diseases(n=24),and generalized infections(n=9).The patients ranged in age from 7 months to 17 years old and were admitted to the ICU of the clinic of Saint Petersburg State Pediatric Medical University from 2007 to 2023.RESULTS Thirteen patients(25.5%)died within 39(17;62)days after ICU admission.Patients with an unfavorable outcome were significantly older and were admitted to the ICU later than patients who survived(30 days vs 7 days,P=0.013)and had a longer stay in the ICU(30 days vs 6 days,P=0.003).The main predictors of the fatal outcome were age>162 months[odds ratio(OR)=10.7;95%confidence interval(CI):2.4-47.2,P=0.0006],time to ICU admission>26 days from the disease onset(OR=12.0;95%CI:2.6-55.3,P=0.008),preceding immune suppression treatment(OR=6.2;95%CI:1.6-24.0,P=0.013),invasive mycosis during the ICU stay(OR=18.8;95%CI:1.9-184.1,P=0.0005),systemic rheumatic diseases(OR=7.2;95%CI:1.7-31.1,P=0.004),and ICU stay over 15 days(OR=19.1;95%CI:4.0-91.8,P=0.00003).Multiple regression analysis(r^(2)=0.422,P<0.000002)identified two predictors of the fatal outcomes:Systemic rheumatic diseases(P=0.015)and ICU stay over 15 days(P=0.00002).CONCLUSION Identifying patients at high risk of an unfavorable outcome is the subject of the most careful monitoring and appropriate treatment program.Avoiding ICU stays for patients with systemic rheumatic diseases,close monitoring,and preventing invasive mycosis might improve the outcome in children with systemic immunemediated diseases.
文摘Marburg virus disease(MVD)is a highly fatal illness,with a case fatality rate of up to 88%,though this rate can be significantly reduced with prompt and effective patient care.The disease was first identified in 1967 during concurrent outbreaks in Marburg and Frankfurt,Germany,and in Belgrade,Serbia,linked to laboratory use of African green monkeys imported from Uganda.Subsequent outbreaks and isolated cases have been reported in various African countries,including Angola,the Democratic Republic of the Congo,Equatorial Guinea,Ghana,Guinea,Kenya,Rwanda,South Africa(in an individual with recent travel to Zimbabwe),Tanzania,and Uganda.Initial human MVD infections typically occur due to prolonged exposure to mines or caves inhabited by Rousettus aegyptiacus fruit bats,the natural hosts of the virus.
文摘BACKGROUND Most species of aconite contain highly toxic aconitines,the oral ingestion of which can be fatal,primarily because they cause ventricular arrhythmias.We describe a case of severe aconite poisoning that was successfully treated through venoarterial extracorporeal membrane oxygenation(VA-ECMO)and in which detailed toxicological analyses of the aconite roots and biological samples were performed using liquid chromatography-tandem mass spectrometry(LC-MS/MS).CASE SUMMARY A 23-year-old male presented to the emergency room with circulatory collapse and ventricular arrhythmia after ingesting approximately half of a root labeled,“Aconitum japonicum Thunb”.Two hours after arrival,VA-ECMO was initiated as circulatory collapse became refractory to antiarrhythmics and vasopressors.Nine hours after arrival,an electrocardiogram revealed a return to sinus rhythm.The patient was weaned off VA-ECMO and the ventilator on hospital days 3 and 5,respectively.On hospital day 15,he was transferred to a psychiatric hospital.The other half of the root and his biological samples were toxicologically analyzed using LC-MS/MS,revealing 244.3 mg/kg of aconitine and 24.7 mg/kg of mesaconitine in the root.Serum on admission contained 1.50 ng/mL of aconitine.Beyond hospital day 2,neither were detected.Urine on admission showed 149.09 ng/mL of aconitine and 3.59 ng/mL of mesaconitine,but these rapidly decreased after hospital day 3.CONCLUSION The key to saving the life of a patient with severe aconite poisoning is to introduce VA-ECMO as soon as possible.
文摘This article compares the size of selected subsets using nonparametric subset selection rules with two different scoring rules for the observations. The scoring rules are based on the expected values of order statistics of the uniform distribution (yielding rank values) and of the normal distribution (yielding normal score values). The comparison is made using state motor vehicle traffic fatality rates, published in a 2016 article, with fifty-one states (including DC as a state) and over a nineteen-year period (1994 through 2012). The earlier study considered four block design selection rules—two for choosing a subset to contain the “best” population (i.e., state with lowest mean fatality rate) and two for the “worst” population (i.e., highest mean rate) with a probability of correct selection chosen to be 0.90. Two selection rules based on normal scores resulted in selected subset sizes substantially smaller than corresponding rules based on ranks (7 vs. 16 and 3 vs. 12). For two other selection rules, the subsets chosen were very close in size (within one). A comparison is also made using state homicide rates, published in a 2022 article, with fifty states and covering eight years. The results are qualitatively the same as those obtained with the motor vehicle traffic fatality rates.
文摘BACKGROUND The spread of the severe acute respiratory syndrome coronavirus 2 outbreak worldwide has caused concern regarding the mortality rate caused by the infection.The determinants of mortality on a global scale cannot be fully understood due to lack of information.AIM To identify key factors that may explain the variability in case lethality across countries.METHODS We identified 21 Potential risk factors for coronavirus disease 2019(COVID-19)case fatality rate for all the countries with available data.We examined univariate relationships of each variable with case fatality rate(CFR),and all independent variables to identify candidate variables for our final multiple model.Multiple regression analysis technique was used to assess the strength of relationship.RESULTS The mean of COVID-19 mortality was 1.52±1.72%.There was a statistically significant inverse correlation between health expenditure,and number of computed tomography scanners per 1 million with CFR,and significant direct correlation was found between literacy,and air pollution with CFR.This final model can predict approximately 97%of the changes in CFR.CONCLUSION The current study recommends some new predictors explaining affect mortality rate.Thus,it could help decision-makers develop health policies to fight COVID-19.
文摘Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.
文摘Rationale:Paraquat,a highly toxic bipyridyl herbicide lacking a specific antidote,poses severe risks upon ingestion.However,the diagnosis of paraquat poisoning is complicated by its nonspecific initial symptoms,particularly when a detailed exposure history is not provided.Patient’s Concern:A 33-year-old man inadvertently ingested an unknown liquid and presented to medical services a day later with complaints of ongoing nausea,vomiting,and diarrhea.The assessment revealed elevated serum creatinine,signaling acute kidney injury,initially thought due to gastroenteritis and dehydration.Diagnosis:Acute renal insufficiency due to paraquat poisoning.Interventions:The treatment involved fluid resuscitation and antibiotics,but his decline led to intensive care unit transfer.Subsequent chest computed tomography scans indicated lung changes indicative of paraquat poisoning.A detailed history review and comprehensive blood and urine toxicology screens confirmed the diagnosis.Subsequently,aggressive interventions such as hemoperfusion and continuous renal replacement therapy were initiated,yet there was a further decline in respiratory function,necessitating mechanical ventilation.The prognosis was poor,and ultimately,the family chose to withdraw care.Outcomes:The patient succumbed to his illness.Lessons:This case underscores the importance of promptly and accurately diagnosing paraquat poisoning,as its vague early signs can lead to diagnostic delays,crucial due to the condition’s rapid progression.Alertness to paraquat poisoning is essential in patients with sudden gastrointestinal and renal symptoms post-exposure.Additionally,it underscores the necessity for public health measures to avert paraquat ingestion and advance therapeutic approaches.
文摘This paper examines the relationship between fatal road traffic accidents and potential predictors using multilayer perceptron artificial neural network (MLANN) models. The initial analysis employed twelve potential predictors, including traffic volume, prevailing weather conditions, roadway characteristics and features, drivers’ age and gender, and number of lanes. Based on the output of the model and the variables’ importance factors, seven significant variables are identified and used for further analysis to improve the performance of models. The model is optimized by systematically changing the parameters, including the number of hidden layers and the activation function of both the hidden and output layers. The performances of the MLANN models are evaluated using the percentage of the achieved accuracy, R-squared, and Sum of Square Error (SSE) functions.
文摘Although there has been a slight decrease in road traffic crashes, fatalities, and injuries in recent years, HCMC (Ho Chi Minh City) will continue to encounter challenges in mitigating and preventing road crashes. This study analyzes road crash data from the past five years, obtained from the Road-Railway Police Bureau (PC08) and TSB (Traffic Safety Board) in HCMC. This analysis gives us valuable insights into road crash patterns, characteristics, and underlying causes. This comprehensive understanding serves as a scientific foundation for developing cohesive strategies and implementing targeted solutions to address road traffic safety issues more effectively in the future.
文摘Traffic intersections are incredibly dangerous for drivers and pedestrians. Statistics from both Canada and the U.S. show a high number of fatalities and serious injuries related to crashes at intersections. In Canada, during 2019, the National Collision Database shows that 28% of traffic fatalities and 42% of serious injuries occurred at intersections. Likewise, the U.S. National Highway Traffic Administration (NHTSA) found that about 40% of the estimated 5,811,000 accidents in the U.S. during the year studied were intersection-related crashes. In fact, a major survey by the car insurance industry found that nearly 85% of drivers could not identify the correct action to take when approaching a yellow traffic light at an intersection. One major reason for these accidents is the “yellow light dilemma,” the ambiguous situation where a driver should stop or proceed forward when unexpectedly faced with a yellow light. This situation is even further exacerbated by the tendency of aggressive drivers to inappropriately speed up on the yellow just to get through the traffic light. A survey of Canadian drivers conducted by the Traffic Injury Research Foundation found that 9% of drivers admitted to speeding up to get through a traffic light. Another reason for these accidents is the increased danger of making a left-hand turn on yellow. According to the National Highway Traffic Safety Association (NHTSA), left turns occur in approximately 22.2% of collisions—as opposed to just 1.2% for right turns. Moreover, a study by CNN found left turns are three times as likely to kill pedestrians than right turns. The reason left turns are so much more likely to cause an accident is because they take a driver against traffic and in the path of oncoming cars. Additionally, most of these left turns occur at the driver’s discretion—as opposed to the distressingly brief left-hand arrow at busy intersections. Drive Safe Now proposes a workable solution for reducing the number of accidents occurring during a yellow light at intersections. We believe this fairly simple solution will save lives, prevent injuries, reduce damage to public and private property, and decrease insurance costs.
文摘Tess of the D'Urbervilles was written by Thomas Hardy who was a famous critical realistic writer at the turn of the 19 thcentury in England.Tess of the D'Urbervilles is the most influential one of all his works.The novel describes a tragic life about abeautiful girl after disgrace.This paper analyses what cause Tess' s tragic life.The first part is an introduction of Tess of the D'Urb-ervilles and its writer Thomas Hardy.And then is the analysis on the causes of her tragic life —characters of Tess,Society Influ-ence and influence of Pessimism & Fatalism of Hardy.Though Tess fought with the society,as a common person she is helpless atthat time.In the end,she turned out to be the sacrificial victim of society like all other things which disobey the morality and ethic.
文摘The thesis analyzes the origins of Tess' tragedy both from external and internal factors, with a view to point out that her tragic fate is inevitable. Being related with the author'pessimistic fatalism, Tess' tragedy and characters are the products of the capitalist society.
文摘Introduction: Poorly controlled Type 2 diabetes is considered a major public health problem and associated with adverse outcomes in Jordan. Good diabetes knowledge may facilitate adaptation of healthy behaviors and improve patients’ adherence to their diabetes management plans. Purpose: To gain an in-depth understanding of attitudes, perceptions and knowledge of patients which underpin their behaviors in Jordan. Methods: 8 focus groups with 38 patients with poorly controlled Type 2 diabetes were conducted. The focus group sessions were audio recorded and transcribed. Thematic analysis was employed to analyze the qualitative data. All transcripts were uploaded into the qualitative data analysis software pack NVivo. Results: Patients reported the different ways in which they were diagnosed with Type 2 diabetes. Most of the patients visited the health facility after experiencing signs and symptoms of diabetes, often for some time before seeking medical help. Stress and family history were perceived as causes of developing diabetes and reasons for poorly controlled diabetes. Fatalistic beliefs were shared when the patients were talking about the causes of diabetes, the reasons for developing diabetes and their inability to control their blood glucose levels. Patients also associated fatalistic attitudes with religious beliefs and the power of God as illness being in God’s hands. Patients’ responses also showed a poor understanding of the basic knowledge of diabetes. Conclusions: Effective health education programs need to be tailored to meet the individual needs of patients. Patients need to be provided with accurate information about medications, side effects and therapeutic effects. An educational program may rectify misconceptions among
文摘We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.
文摘Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.
