Geometry of Time and Dimensionality of Space

One of the most distinguished features of our algebraic geometrical, pencil concept of space-time is the fact that spatial dimensions and time stand, as far as their intrinsic structure is concerned, on completely different footings: the former being represented by pencils of lines, the latter by a pencil of conics. As a consequence, we argue that even at the classical (macroscopic) level there exists a much more intricate and profound coupling between space and time than that dictated by (general) relativity theory. It is surmised that this coupling can be furnished by so-called Cremona (or birational) transformations between two projective spaces of three dimensions, being fully embodied in the structure of configurations of their fundamental elements. We review properties of some of the simplest Cremona transformations and show that the corresponding "fundamental" space-times exhibit an intimate connection between the extrinsic geometry of time dimension and the dimensionality of space. Moreover, these Cremonian space-times seem to provide us with a promising conceptual basis for the possible reconciliation between two extreme concepts of (space-)time, viz. physical and psychological. Some speculative remarks in this respect are made

Using experience-based co-design with older patients, their families and staff to improve palliative care experiences in the emergency department: a reflective critique on the process and outcomes

Background: Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of − and preferences for − palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting. Objectives: To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work. Setting: an Emergency Department in a large teaching hospital in the United Kingdom. Methods: Experience-based Co-design incorporating: 150 hours of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members. Findings: the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the ‘voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process. Conclusion: Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the ‘accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

<p>Abstract</p> <p>Background</p> <p>School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making.</p> <p>Methods</p> <p>We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members.</p> <p>Results</p> <p>There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance.</p> <p>Conclusions</p> <p>The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly.</p

Temporal structure of consciousness and minimal self in schizophrenia

International audienceThe concept of the minimal self refers to the consciousness of oneself as an immediate subject of experience. According to recent studies, disturbances of the minimal self may be a core feature of schizophrenia. They are emphasized in classical psychiatry literature and in phenomenological work. Impaired minimal self-experience may be defined as a distortion of one's first-person experiential perspective as, for example, an " altered presence " during which the sense of the experienced self (" mineness ") is subtly affected, or " altered sense of demarcation, " i.e., a difficulty discriminating the self from the non-self. Little is known, however, about the cognitive basis of these disturbances. In fact, recent work indicates that disorders of the self are not correlated with cognitive impairments commonly found in schizophrenia such as working-memory and attention disorders. In addition, a major difficulty with exploring the minimal self experimentally lies in its definition as being non-self-reflexive, and distinct from the verbalized, explicit awareness of an " I. " In this paper, we shall discuss the possibility that disturbances of the minimal self observed in patients with schizophrenia are related to alterations in time processing. We shall review the literature on schizophrenia and time processing that lends support to this possibility. In particular we shall discuss the involvement of temporal integration windows on different time scales (implicit time processing) as well as duration perception disturbances (explicit time processing) in disorders of the minimal self. We argue that a better understanding of the relationship between time and the minimal self as well of issues of embodiment require research that looks more specifically at implicit time processing. Some methodological issues will be discussed