Emotions, Intuitions and Risk Perception in Critical Care

The theory of decision-making as it applies to bioethics and healthcare assumes a rational decision maker: someone who knows all his alternatives, has clear preferences, can rank and weigh risks and benefits of an intervention, and always acts in his own best interests. However, the growing body of research from the field of decision science shows that, in reality, such a purely rational decision maker does not exist. Instead, patients are rational within personal or environmental constraints such as uncertainty or ambiguity in which non-rational approaches such as emotion and intuition are instrumental. This issue is particularly important in critical care. To ensure that patients receive the end-of-life care that they want, especially considering the increase in futile care, proper risk communication is necessary. While the move from paternalism to the current emphasis on patient empowerment and shared decision-making means that patients and surrogates want comprehensive and understandable information about their conditions and treatment in order to participate fully in decisions about their care, emotions complicate this decision-making. Though there is a great deal of empirical research on emotions and risk perception, there is a lack of philosophical research on this topic, especially when it comes to futility considerations in critical care. This research asserts that emotions should be considered a necessary component of ethical assessment of risk and communication about risk, especially in the field of critical care. It explores the existing literature on how people employ emotions and deliberation in their decision-making, and it questions the existing bias among normative scholars that decisions resulting from deliberation are inherently better or superior to those grounded in intuition. Furthermore, this research attempts to determine the value of autonomy in designing health policies grounded in behavioral economics. While providers want patients to make decisions that promote their own interests, this task is rarely achieved when patients are left alone to make important decisions. This research questions whether providers should let their patients make decisions that divert them from their own health goals or intervene by actively directing patients toward choices that are most likely to promote their goals

An Analysis of the Similarities and Differences Between Two Vital Roles in Medicine: Physicians and Physician Assistants

Research has been done analyzing nurse practitioners (NP) versus physician assistants (PA) and medical doctors (MDs) versus doctor of osteopathic medicine (DOs), but there is a lack of research on PAs versus MD/DOs. This thesis aims to outline the similarities and differences between the physician profession and the physician assistant profession. Interviews were conducted with physicians and physician assistants from the Nebraska Medicine Emergency Department to get insight from professionals currently in the field and to gain multiple perspectives. Along with interviews, research was conducted utilizing scholarly articles and other online reliable resources. These findings are significant for any undergraduate student deciding on which role in healthcare they would like to pursue, for individuals who are not aware of the differences between physicians and physician assistants, and for potential future patients. The overall goal of this capstone thesis was to be informative and to help the community gain a better understanding of these professions in healthcare

Regimes of Wetting Transitions on Superhydrophobic Textures Conditioned by Energy of Receding Contact Lines

We discuss an evaporation-induced wetting transition on superhydrophobic stripes, and show that depending on the elastic energy of the deformed contact line, which determines the value of an instantaneous effective contact angle, two different scenarios occur. For relatively dilute stripes the receding angle is above 90$^\circ$, and the sudden impalement transition happens due to an increase of a curvature of an evaporating drop. For dense stripes the slow impregnation transition commences when the effective angle reaches 90$^\circ$ and represents the impregnation of the grooves from the triple contact line towards the drop center.Comment: 5 pages, 5 figure

Contact Angle Hysteresis on Superhydrophobic Stripes

We study experimentally and discuss quantitatively the contact angle hysteresis on striped superhydrophobic surfaces as a function of a solid fraction, $\phi_S$. It is shown that the receding regime is determined by a longitudinal sliding motion the deformed contact line. Despite an anisotropy of the texture the receding contact angle remains isotropic, i.e. is practically the same in the longitudinal and transverse directions. The cosine of the receding angle grows nonlinearly with $\phi_S$, in contrast to predictions of the Cassie equation. To interpret this we develop a simple theoretical model, which shows that the value of the receding angle depends both on weak defects at smooth solid areas and on the elastic energy of strong defects at the borders of stripes, which scales as $\phi_S^2 \ln \phi_S$. The advancing contact angle was found to be anisotropic, except as in a dilute regime, and its value is determined by the rolling motion of the drop. The cosine of the longitudinal advancing angle depends linearly on $\phi_S$, but a satisfactory fit to the data can only be provided if we generalize the Cassie equation to account for weak defects. The cosine of the transverse advancing angle is much smaller and is maximized at $\phi_S\simeq 0.5$. An explanation of its value can be obtained if we invoke an additional energy due to strong defects in this direction, which is shown to be proportional to $\phi_S^2$. Finally, the contact angle hysteresis is found to be quite large and generally anisotropic, but it becomes isotropic when $\phi_S\leq 0.2$.Comment: 17 pages, 8 figure

Direct femtosecond laser inscription in transparent dielectrics

Since 1996 direct femtosecond inscription in transparent dielectrics has become the subject of intensive research. This enabling technology significantly expands the technological boundaries for direct fabrication of 3D structures in a wide variety of materials. It allows modification of non-photosensitive materials, which opens the door to numerous practical applications. In this work we explored the direct femtosecond inscription of waveguides and demonstrated at least one order of magnitude enhancement in the most critical parameter - the induced contrast of the refractive index in a standard borosilicate optical glass. A record high induced refractive contrast of 2.5×10-2 is demonstrated. The waveguides fabricated possess one of the lowest losses, approaching level of Fresnel reflection losses at the glassair interface. High refractive index contrast allows the fabrication of curvilinear waveguides with low bend losses. We also demonstrated the optimisation of the inscription regimes in BK7 glass over a broad range of experimental parameters and observed a counter-intuitive increase of the induced refractive index contrast with increasing translation speed of a sample. Examples of inscription in a number of transparent dielectrics hosts using high repetition rate fs laser system (both glasses and crystals) are also presented. Sub-wavelength scale periodic inscription inside any material often demands supercritical propagation regimes, when pulse peak power is more than the critical power for selffocusing, sometimes several times higher than the critical power. For a sub-critical regime, when the pulse peak power is less than the critical power for self-focusing, we derive analytic expressions for Gaussian beam focusing in the presence of Kerr non-linearity as well as for a number of other beam shapes commonly used in experiments, including astigmatic and ring-shaped ones. In the part devoted to the fabrication of periodic structures, we report on recent development of our point-by-point method, demonstrating the shortest periodic perturbation created in the bulk of a pure fused silica sample, by using third harmonics (? =267 nm) of fundamental laser frequency (? =800 nm) and 1 kHz femtosecond laser system. To overcome the fundamental limitations of the point-by-point method we suggested and experimentally demonstrated the micro-holographic inscription method, which is based on using the combination of a diffractive optical element and standard micro-objectives. Sub-500 nm periodic structures with a much higher aspect ratio were demonstrated. From the applications point of view, we demonstrate examples of photonics devices by direct femtosecond fabrication method, including various vectorial bend-sensors fabricated in standard optical fibres, as well as a highly birefringent long-period gratings by direct modulation method. To address the intrinsic limitations of femtosecond inscription at very shallow depths we suggested the hybrid mask-less lithography method. The method is based on precision ablation of a thin metal layer deposited on the surface of the sample to create a mask. After that an ion-exchange process in the melt of Ag-containing salts allows quick and low-cost fabrication of shallow waveguides and other components of integrated optics. This approach covers the gap in direct fs inscription of shallow waveguide. Perspectives and future developments of direct femtosecond micro-fabrication are also discussed