Search Results (74)

Practical Byzantine Fault Tolerance (PBFT) has been widely used in consortium blockchain systems; however, it suffers from performance degradation and susceptibility to Byzantine faults in complex environments. To overcome these limitations, this paper proposes RE-BPFT, an enhanced consensus algorithm that integrates a nuanced node credibility model considering direct interactions, indirect reputations, and historical behavior. Additionally, we adopt an optimized ID3 decision-tree method for node classification, dynamically identifying high-performing, trustworthy, ordinary, and malicious nodes based on real-time data. To address issues related to centralization risk in leader selection, we introduce a weighted random primary node election mechanism. We implemented a prototype of the RE-BPFT algorithm in Python and conducted extensive evaluations across diverse network scales and transaction scenarios. Experimental results indicate that RE-BPFT markedly reduces consensus latency and communication costs while achieving higher throughput and better scalability than classical PBFT, RBFT, and PPoR algorithms. Thus, RE-BPFT demonstrates significant advantages for large-scale and high-demand consortium blockchain use cases, particularly in areas like digital traceability and forensic data management. The insights gained from this study offer valuable improvements for ensuring node reliability, consensus performance, and overall system resilience. Full article

This study evaluates the link between economic voting and electoral behavior in the 2024 European Parliament (EP) elections. This study is grounded in both selective perception and economic voting theories, examining how different independent factors could interact with electoral behavior. In this regard, the research aims to achieve several research directions: (i) the evaluation of the statistical differences in voters’ turnout in 2024 EP elections by geographical regions; (ii) the analysis of the interaction between voters’ perceptions of the current or future economic situations and voter turnout; (iii) the analysis of the interaction between objective economic conditions and electoral behavior. Using both multiple linear regression and logistic models, the study highlights that voter turnout and incumbent party reelection are significantly related to voters’ perceptions of the current or future state of the national economy. The results reveal that regional differences in voter turnout are largely explained by significant differences in voters’ economic perceptions, while the decision to vote for the incumbent party is driven by future economic expectations. The empirical findings underscore the pivotal role played by subjective perceptions in shaping electoral behavior, illustrating that political attitudes and behaviors are derived from personal interpretation of the national economic situations. Beyond theoretical perspectives that highlight the link between psychological processes and voting, the paper might have several practical implications for academics or decision makers interested in the field of electoral behavior. Full article

The veterinary profession is rapidly evolving, requiring curricular renewal to address emerging challenges and enhance graduate preparedness. A survey was conducted among students and alumni of the School of Medicine and Biomedical Sciences of the University of Porto (n = 279), Portugal, to evaluate the need for an updated veterinary curriculum. Respondents conveyed a strong preference for companion animal medicine, likely influenced by sociocultural factors and media representation. To address current and future demands, it was recommended to re-evaluate curricular structures (e.g., course duration and electives), incorporate non-technical skills, and enhance practical education. Additional reforms should be supported by feedback mechanisms and stakeholder consultations. Alumni expressed dissatisfaction with the job market, which should be addressed through continuous education and specialization and greater intervention of the Portuguese Veterinary Board. In summary, areas for improvement and increased stakeholder involvement were identified as opportunities for veterinary curricular renewal. Full article

Objective: The neutrophil–lymphocyte ratio (NLR) is an inexpensive and easily available inflammatory marker for cardiovascular disease. The aim of the present study is to evaluate a possible association between preoperative NLR value and popliteal artery aneurysm (PAA) repair outcomes. Methods: A single-center retrospective study on all patients, who underwent urgent or elective PAA repair from June 2010 to October 2022, was performed. Study outcomes were immediate technical success, 30-day and mid-term primary patency, reintervention, limb salvage, and mortality rates. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and, according to the literature, a cut-off of five has been considered as a possible threshold for the analysis. Results: Eighty-two patients (80 male) with a total of 97 popliteal artery aneurysms were enrolled in this study. The mean preoperative NLR was 2.9 ± 2.4. In 10 (10.3%) PAAs, the NRL was >5 (High-NLR group), and, in the remaining 87 (89.7%), the NLR was <5 (Low-NLR group). The preoperative NLR for urgent procedures was higher than elective cases (4.37 vs. 2.30; p < 0.001). However, no significant differences were found as far as immediate 24 h technical success (p = 0.48) and 30-day primary patency (p = 39). At mean follow-up, the primary patency rate was significantly higher in the Low-NLR group (p = 0.0044), without statistical differences for re-operation (p = 0.27), limb salvage (p = 0.09), and mortality rates (p = 0.51). The Kaplan–Mayer analysis showed a significant difference in freedom from major amputation in patients with an NLR > 5 compared to the ones with an NLR < 5 (p = 0.038), without any differences in terms of survival, primary patency, and the need for reintervention rates. The multivariable Cox regression analysis identified the NLR value as an independent predictor of better outcomes regarding freedom from the amputation rate (p = 0.25). Conclusions: Our experience indicates that a preoperative NLR value > 5 can identify high-risk patients affected by a PAA and may negatively influence the surgery’s long-term outcomes. Therefore, this selected group of patients could need a more tailored approach and closer monitoring over time. Full article

Objectives: In order to reduce the abdominal aortic aneurysm (AAA)-related complication rate in endovascular aneurysm repair (EVAR) procedures, manufacturers recommend following the instructions for use (IFU). However, IFU is considered too conservative in many centers. In this context, we present our experience and patient follow-up data with 248 consecutive patients with or without IFU eligibility. Methods: A total of 248 patients who underwent elective EVAR for AAA between 2014 and 2019 were included. In total, 190 patients were in the IFU group and 58 in the non-IFU group. Patients were evaluated for baseline demographic and anatomic data; unexpected periprocedural intervention; and postoperative data such as development of endoleaks during follow-up, need for re-intervention, development of complications, EVAR patency, and mean 5-year survival rate. Results: The patients did not differ in terms of basic demographic data. The basic anatomical data were suitable for the IFU standard. Intraoperative endoleak development was significantly higher in the non-IFU group. In addition, the development of endoleaks at any time, the need for re-intervention, and the development of complications were higher in the non-IFU group at postoperative follow-up. Survival analysis showed no difference in the mean 5-year follow-up. The EVAR patency rate was higher in the IFU group. Conclusions: We believe that the decision for a non-IFU EVAR should be patient-specific and that the results of the subjective medical assessment should definitely be taken into account. However, we should not forget that EVAR patients, especially non-IFU patients, are susceptible to future changes in the aorta and prone to the development of endoleaks and re-interventions. Full article

Background: In the era of personalized medicine, tools for risk stratification after cardiovascular interventions are crucial to reduce mortality and morbidity, especially in the aging population. Biomarker-based approaches, in particular, have gained significant importance. Mid-regional pro-adrenomedullin (MR-proADM) represents an easily assessable biomarker that mirrors cardiac function and fibrosis. Therefore, we aimed to investigate the prognostic potential of MR-proADM in patients undergoing elective cardiac surgery. Methods: Patients undergoing elective cardiac bypass and/or valve surgery were prospectively enrolled between May 2013 and August 2018. The primary endpoint was the composite of hospitalization for heart failure (HHF) or cardiovascular (CV) mortality. Results: In total, 500 patients (146 female [29.2%]; median age 69.8 years (IQR 60.6–75.5 years) were included. Individuals were stratified into risk categories based on their MR-proADM values (Low Risk ≤ 0.63 nmol/L, Intermediate Risk > 0.63 and ≤0.84, High Risk > 0.84). A significant increase in 5-year event rates for HHF/CV mortality in patients in the high-risk category (Low Risk 8.6% vs. High Risk 37.7%, p < 0.001) was observed. MR-pro ADM showed an independent association with HHF/ CV mortality (adjusted HR of 3.43, 95% CI 1.83–6.42; p < 0.001 comparing the High-Risk group to the Low-Risk group). Conclusions: MR-pro ADM was found to be a strong and independent predictor for HHF/CV mortality in patients undergoing elective cardiac surgery. Considering a personalized diagnostic and prognostic work-up, a standardized preoperative evaluation of MR-proADM levels might help to identify patients at risk for major adverse events and early re-hospitalization. Full article

After his questionable re-election in 2018, Venezuelan President Nicolás Maduro Moros (NMM) began a campaign to attract the attention of evangelical leaders, apostles, prophets, pastors, and church members to secure their votes for the 2024 campaign. The main reason for this move was the surprising growth of the evangelical population in the country, which reached almost 30% by the end of 2023. Several independent churches and denominations accepted NMM’s invitation to meet and participate in government programs specifically targeted at evangelical churches. Despite allegations of human rights abuses, corruption, and violations of the Venezuelan constitution, some evangelicals created a narrative about NMM as the “protector of families” and as God’s chosen one to usher in a new era of prosperity for the nation. Through acts of “identificational” repentance staged at the Miraflores Palace, a contrite NMM received prophetic declarations and prayers from apostles and pastors, and the country was cleansed of curses and satanic influences. This article seeks to document, analyze, and situate these discourses in relation to contemporary theological trends, as an important case of evangelical alignment with left-wing politics in Latin America. Moreover, the article also seeks to show how these events relate to the evolution of Venezuelan evangelical involvement in national politics, particularly under 25 years of socialist governments of Hugo Chávez Frías and Nicolás Maduro Moros. Full article

Background/Objectives: The general use of triclosan-coated suture material (TCSM) for wound closure to prevent surgical site infections (SSIs) remains controversial. There is no conclusive evidence in the literature to support this and recommendations by professional organizations are contradictory. Therefore, the main objective of the study was to evaluate the 30-day rate of surgical site infections (SSIs) after elective open abdominal surgery using triclosan-coated versus uncoated running sutures (NCSM) for skin closure. Methods: This prospective, randomized, double-blinded study enrolled patients scheduled for open elective abdominal surgery, intraoperatively assigned to either the use of triclosan-coated or non-coated sutures for skin closure. The follow up was 30 days after surgery to detect SSIs. Secondary endpoints were wound dehiscence and reoperation rate due to wound dehiscence within 30 days, all-cause 30-day mortality and length of hospital stay. Potential risk factors for poor wound healing were evaluated in multivariate analysis. Data were analyzed in an intention to treat analysis. Results: In total, 364 patients (171 males [47%]) were randomized, 182 in either group. Six underwent urgent reoperation prior to first visit and were excluded from analysis. In the full analysis set (FAS), 358 were analyzed. SSI within 30 days occurred in 22 [12.2%] patients in the control group compared to 32 [18%] in the study group. The risk difference was not statistically significant (5.8%; 95% confidence interval (CI) −1.6–13.2%; p = 0.128). The wound dehiscence rate within 30 days was 14 of 179 [7.8%] in the NCSM group vs. 19 of 178 [10.7%] in the TCSM group. The difference in re-operation rates due to wound dehiscence was 0 of 179 [2.8%] vs. 5 of 178 [2.8%] in either group and not statistically significant (p = 0.0706). Among all patients recruited, 8 died within 30 days after surgery. Three of them died before the first assessment of the primary endpoint on day 3 and were therefore excluded from the FAS. The 30-day mortality rate was 2 of 180 [1.1%] in the NCSM group vs. 3 of 178 [1.7%] in the TCSM group. The majority of SSIs occurred in the superficial layer of the wound in both study groups (8.9% vs. 9.6%). The median [inter quartile range (IQR)] length of hospital stay was 13 [9.0, 19.2] days in the NCSM group vs. 11 [9.0, 16.8] days in the TCSM group There was a tendency towards shorter hospitalization in the study group (0.72 days [6%]). Conclusions: Our prospective randomized controlled trial could not confirm the superiority of TCSM for skin closure after elective open abdominal surgery in terms of SSI rates in a 30-day follow up period. Therefore, based on our results, a general recommendation for its use in all surgical fields cannot be justified. Full article

Despite leading a violent insurrection to overturn the results of the 2020 presidential election, dozens of pending felony counts against him, and massive civil fines leveled against him, Donald Trump is poised to not only be the Republican presidential nominee in 2024; but rather, he stands a very plausible chance of being re-elected. This is true, despite the increasingly authoritarian tone of his rhetoric of late and concrete plans that he and those allied with him have openly espoused that, if implemented, will fundamentally dismember the tenets of American democracy. Yet, many Americans appear to be “sleepwalking toward dictatorship”. This essay argues that Donald Trump represents a singularly unique, existential threat to American democracy and outlines specifically how a second Trump administration will destroy American democracy as we have previously known it. Full article

Background: Aortic coarctation, a condition characterized by localized narrowing of the aorta, can be managed with either surgical or endovascular techniques. This study aims to compare these approaches concerning long-term outcomes, particularly re-coarctation rates and late arterial hypertension. Methods: We retrospectively analyzed data from patients with native, isolated aortic coarctation treated by surgical or endovascular methods between 2015 and 2024. Clinical and demographic data were collected from electronic health records. Blood pressure was measured using oscillometric devices, and transthoracic echocardiography (TTE) was performed by an experienced sonographer. The primary endpoint was to identify which treatment predicted re-coarctation during follow-up, while the secondary endpoint assessed the incidence of late arterial hypertension. Results: Sixty-nine patients were included, with a mean age of 18.14 ± 8.18 years (median 16 years; range 8 to 37 years) and a median follow-up of 3 years (range 6 months to 8 years). Of these, 67 (97.1%) underwent elective repairs. Repair techniques included endovascular treatment (24.6%), surgical end-to-end anastomosis (47.8%), and surgical patchplasty (27.5%). The endovascular group was significantly older (29.82 ± 5.9 years vs. 14.33 ± 4.25 years, p = 0.056) and had shorter procedure durations and hospital stays. One-year freedom from reintervention was significantly higher in the surgical group (98.7%) compared to the endovascular group (88.23%) (p < 0.001). Conclusions: Both techniques effectively treat aortic coarctation, but surgical repair offers better long-term outcomes, while endovascular repair provides shorter recovery times. These findings should inform the choice of treatment modality based on patient-specific factors and clinical priorities. Full article

Background/Objectives: In recent years, manufacturers have developed new low-profile stent grafts to allow endovascular treatment of abdominal aortic aneurysms (AAA) in patients with small access vessels. We evaluated the early and mid-term outcomes of the Incraft (Cordis Corp, Bridgewater, NJ, USA) ultra-low profile endograft implantation in a high-volume single center. Methods: Between 2014 and 2023, 133 consecutive endovascular aneurysm repair (EVAR) procedures performed using the Incraft endograft were recorded in a prospective database. Indications included infrarenal aortic aneurysms, common iliac aneurysms, and infrarenal penetrating aortic ulcers. Mid-term results were analyzed using the Kaplan–Meier method. Results: During the study period, 133 patients were treated with the Cordis Incraft endograft, in both elective and urgent settings. The Incraft graft was the first choice for patients with hostile iliac accesses, a feature characterizing at least one side in 90.2% of the patients in the study cohort. The immediate technical success rate was 78.2%. The intraoperative endoleak rate was 51.9% (20.3% type 1 A, 0.8% type 1 B, and 30.8% type 2 endoleak). Within 30 days, technical and clinical success rates were both 99.3%; all type 1A and 1B endoleaks were resolved at the 30-day follow-up CT-angiogram. After a mean follow-up of 35.4 months, the actuarial freedom from the re-intervention rate was 96.0%, 91.1%, and 84.0% at 1, 3, and 5 years, respectively. The iliac leg patency rate was 97.1%, 94.1%, and 93.1% at 1, 3, and 5 years, respectively. No statistically significant differences were observed between hostile and non-hostile access groups, nor between the groups with grade 1, grade 2, and grade 3 access hostility. Conclusions: The ultra-low profile Cordis Incraft endograft represents a valid option for the endovascular treatment of AAA in patients with hostile iliac accesses. The procedure can be performed with high rates of technical and clinical success at 30 days and the rates of iliac branch occlusion observed during the follow-up period appear acceptable in patients with poor aorto-iliac outflow. Full article

Ruptured abdominal aortic aneurysms (rAAAs) are life-threatening and require emergent surgical therapy. Endovascular aortic repair for rupture (rEVAR) has become the leading strategy due to its minimal invasive approach with expected lower morbidity and mortality, especially in patients presenting with hemodynamic instability and relevant comorbidities. Following rEVAR, intraoperative angiography or early postinterventional computed tomography angiography have to exclude early type 1 or 3 endoleaks requiring immediate reintervention. Persistent type 2 endoleaks (T2ELs) after rEVAR, in contrast to elective cases, can cause possibly lethal situations due to continuing extravascular blood loss through the remaining aortic aneurysm rupture site. Therefore, early identification of relevant persistent T2ELs associated with continuous bleeding and hemodynamic instability and immediate management is mandatory in the acute postoperative setting following rEVAR. Different techniques and concepts for the occlusion of T2ELs after rEVAR are available, and most of them are also used for relevant T2ELs after elective EVAR. In addition to various interventional embolization procedures for persistent T2ELs, some patients require open surgical occlusion of T2EL-feeding arteries, abdominal compartment decompression or direct surgical patch occlusion of the aneurysm rupture site after rEVAR. So far, in the acute situation of rAAAs, indications for preemptive or intraoperative T2EL embolization during rEVAR have not been established. In the long term, persistent T2ELs after rEVAR can lead to continuous aneurysm expansion with the possible development of secondary proximal type I endoleaks and an increased risk of re-rupture requiring regular follow-up and early consideration for reintervention. To date, only very few studies have investigated T2ELs after rEVAR or compared outcomes with those from elective EVAR regarding the special aspects of persisting T2ELs. This narrative review is intended to present the current knowledge on the incidence, natural history, relevance and strategies for T2EL management after rEVAR. Full article

This article investigates reasons to participate in non-deterministic elections, where the outcomes incorporate elements of chance beyond mere tie-breaking. The background context situates this inquiry within democratic theory, specifically non-deterministic voting systems, which promise to re-evaluate fairness and power distribution among voting blocs. This study aims to explore the normative implications of such electoral systems and their impact on our moral duty to vote. We analyze instrumental reasons for voting, including prudential and act-consequentialist arguments, alongside non-instrumental reasons, assessing their validity in the context of non-deterministic systems. The results indicate that non-deterministic elections could strengthen the case for voting based on prudential and act-consequentialist grounds due to their proportional nature and the increased influence of each vote. We conclude that, while non-deterministic elections strengthen our duty to vote overall, they do not strengthen it for all the arguments in the literature. This paper contributes to the discourse on electoral systems by critically evaluating the moral obligation to vote in non-deterministic elections. Full article

It is expected that the number of elected female mayors in local government will increase globally, yet no major progress has been registered lately despite the increased focus on the topic. At the European level, no country exceeds 40% female mayors or other leaders of the municipal council (or equivalent), with the highest descriptive representation of 39.1% in Iceland. Following the 2020 elections in Romania, only around 5% of mayors were female with a strong over-representation of male mayors. The current study aims to analyze the male–female distribution of mayors, the degree of re-election, the relationship between the number of candidates and re-election of incumbents, and how these factors impact female political representation at the local level in Romania. Thus, we argue that a high degree of re-election of incumbents may be a barrier to women’s access to the position of mayor. In addition, it is important to determine whether female incumbents are as successful as their male counterparts in being re-elected. While there is an extensive body of literature on incumbency that covers a range of topics, there is a gap in the literature regarding the proposed subject. The present research aims to fill the gap and contribute to a better understanding of the political representation of women in Eastern Europe. We utilized a dataset of Romanian elections from 2008 to 2020 to test our hypotheses. Our findings indicate that during the studied period, more than 95% of mayors were male, the re-election was a frequent occurrence in Romania with a percentage ranging from 70.82% (2008–2012) to 72% (2012–2016 and 2016–2020), and female incumbents were just as likely to be re-elected as their male counterparts. Full article

Around the world, the development of large dams has been increasingly contested. India is no exception and has seen the mobilisation of powerful domestic and transnational socio-environmental movements against dams over more than four decades. In this context, the State of Sikkim in northeast India has been entangled in prolonged hydropower development conflicts since the late 1990s. This article analyses these conflictive entanglements between the Government of India, the State Government of Sikkim, power companies and Sikkim’s autochthonous tribe, the Lepchas. It zooms in on the period of 2011–2017, which saw an abrupt escalation of the conflicts to analyse the messy, deeply political and often unpredictable and contradictory world of dam construction and its contestations. Our analysis is informed by the power cube framework developed by John Gaventa. Our analysis shows how hydropower development is deeply intertwined with local patronage relationships. We show how local elections bring out dam conflict and the operation of power into the open, sometimes leading to abrupt and unexpected switches in positions in relation to hydropower development. We show that these switches should be seen not only as “strategic electoral tactics” but also and importantly as contentious political struggles that (re)configure power in the region. We show how in this process, powerful political actors continuously seek to stabilise power relations among the governing and the governed, choreographing a specific socio-hydraulic order that stretches way beyond simple pro- and anti-dam actors and coalitions as it is embedded in deep hydro(-electro) politics and power plays. Full article