International consensus on quality standards for multiple sclerosis care: results from a modified Delphi process

Background and aims: The importance of prompt intervention in multiple sclerosis (MS) was described in the widely endorsed report, Brain health: time matters in multiple sclerosis.1 The present study aimed to define standards for the timing of key steps in the care pathway. Methods: An international group of 29 MS neurologists was recruited to participate in a Delphi process. Across five rounds, they defined ‘core’, ‘achievable’ and ‘aspirational’ standards (to reflect a minimum, good and high standard of MS care, respectively). A Reviewing Group of 31 MS nurses, experts with MS and allied healthcare professionals reviewed the results and provided feedback. Results: Consensus was reached (≥75% agreement; n=21) on core, achievable and aspirational standards for 21 steps in the MS care pathway, covering symptom onset, referral, diagnosis, treatment decisions, lifestyle, monitoring, and managing new symptoms. For example, the panel agreed that MS teams should complete a diagnostic workup for MS within 2 months of referral to a neurologist as a core standard, and that completion within 4 weeks of referral should be achievable for most MS teams, with completion within 7 days as an aspirational standard. Here, we will present core, achievable and aspirational standards for key steps in the MS care pathway. Conclusion: These standards will inform tools for clinics and people with MS and act as a future benchmark for established and developing MS clinics across the globe aiming to deliver the highest quality care. Reference 1. Giovannoni G et al. Mult Scler Relat Disord 2016;9 Suppl 1:S5–S48

Nonlinear stability of oscillatory wave fronts in chains of coupled oscillators

We present a stability theory for kink propagation in chains of coupled oscillators and a new algorithm for the numerical study of kink dynamics. The numerical solutions are computed using an equivalent integral equation instead of a system of differential equations. This avoids uncertainty about the impact of artificial boundary conditions and discretization in time. Stability results also follow from the integral version. Stable kinks have a monotone leading edge and move with a velocity larger than a critical value which depends on the damping strength.Comment: 11 figure

Oscillatory wave fronts in chains of coupled nonlinear oscillators

Wave front pinning and propagation in damped chains of coupled oscillators are studied. There are two important thresholds for an applied constant stress $F$: for $|F|<F_{cd}$ (dynamic Peierls stress), wave fronts fail to propagate, for $F_{cd} < |F| < F_{cs}$ stable static and moving wave fronts coexist, and for $|F| > F_{cs}$ (static Peierls stress) there are only stable moving wave fronts. For piecewise linear models, extending an exact method of Atkinson and Cabrera's to chains with damped dynamics corroborates this description. For smooth nonlinearities, an approximate analytical description is found by means of the active point theory. Generically for small or zero damping, stable wave front profiles are non-monotone and become wavy (oscillatory) in one of their tails.Comment: 18 pages, 21 figures, 2 column revtex. To appear in Phys. Rev.

Temporary Bonding with Polydimethylglutarimide Based Lift Off Resist as a Layer Transfer Platform

Bonding of lift off resist (LOR) was performed to realize temporary wafer bonding without residue. Bonding process conditions such as spin speed, pre-bake temperature, and bonding temperature were optimized to obtain a large bonded area with high bond strength. Under optimized process conditions, a bonded area covering over 98% of the wafer surface, with a room temperature bond strength of nearly 5 J/m2 is achieved. During razor blade testing, fracture often occurs at the Si wafer. Moreover, debonding using an N-Methyl-2-pyrrolidone (NMP)-based solvent left the wafer surface extremely small amount of residue. Thus, the optimized bonding processed developed in this research is suitable for a clean temporary bonding process

Static solitons with non-zero Hopf number

We investigate a generalized non-linear O(3) $\sigma$-model in three space dimensions where the fields are maps $S^3 \mapsto S^2$. Such maps are classified by a homotopy invariant called the Hopf number which takes integer values. The model exhibits soliton solutions of closed vortex type which have a lower topological bound on their energies. We explicitly compute the fields for topological charge 1 and 2 and discuss their shapes and binding energies. The effect of an additional potential term is considered and an approximation is given for the spectrum of slowly rotating solitons.Comment: 13 pages, RevTeX, 7 Postscript figures, minor changes have been made, a reference has been corrected and a figure replace

The Ontology of Intentional Agency in Light of Neurobiological Determinism: Philosophy Meets Folk Psychology

The moot point of the Western philosophical rhetoric about free will consists in examining whether the claim of authorship to intentional, deliberative actions fits into or is undermined by a one-way causal framework of determinism. Philosophers who think that reconciliation between the two is possible are known as metaphysical compatibilists. However, there are philosophers populating the other end of the spectrum, known as the metaphysical libertarians, who maintain that claim to intentional agency cannot be sustained unless it is assumed that indeterministic causal processes pervade the action-implementation apparatus employed by the agent. The metaphysical libertarians differ among themselves on the question of whether the indeterministic causal relation exists between the series of intentional states and processes, both conscious and unconscious, and the action, making claim for what has come to be known as the event-causal view, or between the agent and the action, arguing that a sort of agent causation is at work. In this paper, I have tried to propose that certain features of both event-causal and agent-causal libertarian views need to be combined in order to provide a more defendable compatibilist account accommodating deliberative actions with deterministic causation. The ‘‘agent-executed-eventcausal libertarianism’’, the account of agency I have tried to develop here, integrates certain plausible features of the two competing accounts of libertarianism turning them into a consistent whole. I hope to show in the process that the integration of these two variants of libertarianism does not challenge what some accounts of metaphysical compatibilism propose—that there exists a broader deterministic relation between the web of mental and extra-mental components constituting the agent’s dispositional system—the agent’s beliefs, desires, short-term and long-term goals based on them, the acquired social, cultural and religious beliefs, the general and immediate and situational environment in which the agent is placed, etc. on the one hand and the decisions she makes over her lifetime on the basis of these factors. While in the ‘‘Introduction’’ the philosophically assumed anomaly between deterministic causation and the intentional act of deciding has been briefly surveyed, the second section is devoted to the task of bridging the gap between compatibilism and libertarianism. The next section of the paper turns to an analysis of folk-psychological concepts and intuitions about the effects of neurochemical processes and prior mental events on the freedom of making choices. How philosophical insights can be beneficially informed by taking into consideration folk-psychological intuitions has also been discussed, thus setting up the background for such analysis. It has been suggested in the end that support for the proposed theory of intentional agency can be found in the folk-psychological intuitions, when they are taken in the right perspective