Spontaneous collapse models lead to the emergence of classicality of the Universe

Assuming that Quantum Mechanics is universal and that it can be applied over all scales, then the Universe is allowed to be in a quantum superposition of states, where each of them can correspond to a different space-time geometry. How can one then describe the emergence of the classical, well-defined geometry that we observe? Considering that the decoherence-driven quantum-to-classical transition relies on external physical entities, this process cannot account for the emergence of the classical behaviour of the Universe. Here, we show how models of spontaneous collapse of the wavefunction can offer a viable mechanism for explaining such an emergence. We apply it to a simple General Relativity dynamical model for gravity and a perfect fluid. We show that, by starting from a general quantum superposition of different geometries, the collapse dynamics leads to a single geometry, thus providing a possible mechanism for the quantum-to-classical transition of the Universe. Similarly, when applying our dynamics to the physically-equivalent Parametrised Unimodular gravity model, we obtain a collapse on the basis of the cosmological constant, where eventually one precise value is selected, thus providing also a viable explanation for the cosmological constant problem. Our formalism can be easily applied to other quantum cosmological models where we can choose a well-defined clock variable

Supporting hemodynamics: what should we target? What treatments should we use?

Assessment and monitoring of hemodynamics is a cornerstone in critically ill patients as hemodynamic alteration may become life-threatening in a few minutes. Defining normal values in critically ill patients is not easy, because 'normality' is usually referred to healthy subjects at rest. Defining 'adequate' hemodynamics is easier, which embeds whatever pressure and flow set is sufficient to maintain the aerobic metabolism. We will refer to the unifying hypothesis proposed by Schrier several years ago. Accordingly, the alteration of three independent variables - heart (contractility and rate), vascular tone and intravascular volume - may lead to underfilling of the arterial tree, associated with reduced (as during myocardial infarction or hemorrhage) or expanded (sepsis or cirrhosis) plasma volume. The underfilling is sensed by the arterial baroreceptors, which activate primarily the sympathetic nervous system and renin-angiotensin-aldosterone system, as well as vasopressin, to restore the arterial filling by increasing the vascular tone and retaining sodium and water. Under 'normal' conditions, therefore, the homeostatic system is not activated and water/sodium excretion, heart rate and oxygen extraction are in the range found in normal subjects. When arterial underfilling occurs, the mechanisms are activated (sodium and water retention) - associated with low central venous oxygen saturation (ScvO2) if underfilling is caused by low flow/hypovolemia, or with normal/high ScvO2 if associated with high flow/hypervolemia. Although the correction of hemodynamics should be towards the correction of the independent determinants, the usual therapy performed is volume infusion. An accepted target is ScvO2 >70%, although this ignores the arterial underfilling associated with volume expansion/high flow. For large-volume resuscitation the worst solution is normal saline solution (chloride load, strong ion difference = 0, acidosis). To avoid changes in acid-base equilibrium the strong ion difference of the infused solution should be equal to the baseline bicarbonate concentration

Nonequilibrium Quantum Thermodynamics of a Particle Trapped in a Controllable Time-Varying Potential

Many advanced quantum techniques feature non-Gaussian dynamics, and the ability to manipulate the system in that domain is the next stage in many experiments. One example of meaningful non-Gaussian dynamics is that of a double-well potential. Here we study the dynamics of a levitated nanoparticle undergoing the transition from a harmonic potential to a double well in a realistic setting, subjected to both thermalization and localization. We characterize the dynamics of the nanoparticle from a thermodynamic point of view, investigating the dynamics with the Wehrl entropy production and its rates. Furthermore, we investigate coupling regimes where the the quantum effect and thermal effect are of the same magnitude, and look at suitable squeezing of the initial state that provides the maximum coherence. The effects and the competitions of the unitary and the dissipative parts onto the system are demonstrated. We quantify the requirements to relate our results to a bonafide experiment with the presence of the environment, and discuss the experimental interpretations of our results in the end

Contribution of red blood cells to the compensation for hypocapnic alkalosis through plasmatic strong ion difference variations

Introduction Chloride shift is the movement of chloride between red blood cells (RBC) and plasma (and vice versa) caused by variations in pCO2. The aim of our study was to investigate changes in plasmatic strong ion diff erence (SID) during acute variations in pCO2 and their possible role in the compensation for hypocapnic alkalosis.Methods Patients admitted in this year to our ICU requiring extracorporeal CO2 removal were enrolled. Couples of measurements of gases and electrolytes on blood entering (v) and leaving (a) the respiratory membrane were analyzed. SID was calculated as [Na+] + [K+] + 2[Ca2+] \u2013 [Cl\u2013] \u2013 [Lac\u2013]. Percentage variations in SID (SID%) were calculated as (SIDv \u2013 SIDa) x 100 / SIDv. The same calculation was performed for pCO2 (pCO2%). Comparison between v and a values was performed by paired t test or the signed-rank test, as appropriate. Results Analysis was conducted on 205 sample-couples of six enrolled patients. A signifi cant diff erence (P <0.001) between mean values of v\u2013a samples was observed for pH (7.41 \ub1 0.05 vs. 7.51 \ub1 0.06), pCO2 (48 \ub1 6 vs. 35 \ub1 7 mmHg), [Na+] (136.3 \ub1 4.0 vs. 135.2 \ub1 4.0 mEq/l), [Cl\u2013] (101.5 \ub1 5.3 vs. 102.8 \ub1 5.2 mEq/l) and therefore SID (39.5 \ub1 4.0 vs. 36.9 \ub1 4.1 mEq/l). pCO2% and SID% signifi cantly correlated (r2 = 0.28, P <0.001). Graphical representation by quartiles of pCO2% is shown in Figure 1. Conclusions As a reduction in SID decreases pH, the observed movement of anions and cations probably limited the alkalinization caused by hypocapnia. In this model, the only source of electrolytes are blood cells (that is, no interstitium and no infl uence of the kidney is present); it is therefore conceivable to consider the observed phenomenon as the contribution of RBC for the compensation of acute hypocapnic alkalosi

Clinical review : Extracorporeal membrane oxygenation

The H1N1 fl u pandemic led to a wider use of extracorporeal membrane oxygenation (ECMO), proving its power in hypoxemic emergencies. The results obtained during this pandemic, more than any randomized trial, led to the worldwide acceptance of the use of membrane lungs. Moreover, as centers that applied this technique as rescue therapy for refractory hypoxemia recognized its strength and limited technical challenges, the indications for ECMO have recently been extended. Indications for venovenous ECMO currently include respiratory support as a bridge to lung transplantation, correction of lung hyperinfl ation during chronic obstructive pulmonary disease exacerbation and respiratory support in patients with the acute respiratory distress syndrome, possibly also without mechanical ventilation. The current enthusiasm for ECMO in its various aspects should not, however, obscure the consideration of the potential complications associated with this life-saving technique, primarily brain hemorrhage

A description of the methodology used in an overview of reviews to evaluate evidence on the treatment, harms, diagnosis/ classification, prognosis and outcomes used in the management of neck pain

Background: Neck Pain (NP) is a common musculoskeletal disorder and the literature provides conflicting evidence about its management. Objective: To describe the methodology used to conduct an overview of reviews (OvR) and to characterize the distribution and risk of bias profiles across the evidence for all areas of NP management. Methods: Standard systematic review (SR) methodology was employed. MEDLINE, CINAHL, EMBASE, ILC, Cochrane CENTRAL, and LILACS were searched from 2000 to March 2012; Narrative and SR and clinical practice guidelines (CPG) evaluating the efficacy of treatment (benefits and harms), diagnosis/classification, prognosis, and outcomes were eligible. For treatment, articles were limited to SRs from 2005 forward. Risk of bias of SR was assessed with the AMSTAR; the AGREE II was used to critically appraise the CPGs. Results: From 2476 articles, 508 were eligible for full text screening. A total of 341 articles were included. Treatment (n=117) had the greatest yield. Other clinical areas had less literature (diagnosis=54, prognosis=16, outcomes=27, harms=16). There were no SR for classification and narrative reviews were problematic for this topic. There was great overlap across different databases within each clinical area except for those for outcome measures. Risk of bias assessment using the AMSTAR of eligible SRs showed a similar trend across different clinical areas. Conclusion: A summary of methods used to review the literature in five clinical areas of NP management have been described. The challenges of selecting and synthesizing eligible articles in an OvR required customized solutions across different areas of clinical focus