Clinical negligence in the UK: Throwing the baby out with the bath water

As the total cost of clinical negligence claims has grown in the UK in recent years, calls for reform have resurfaced. The government now plans a White Paper on the subject next year. This paper assesses some of the economic arguments surrounding such reform. It suggests that the principle of negligence performs a useful economic function, that there is some uncertainty surrounding the precise costs of the UK's clinical negligence, and that costs of alternative systems may sometimes be larger than they first appear

NASA Perspective and Modeling of Thermal Runaway Propagation Mitigation in Aerospace Batteries

NASA has traditionally sought to reduce the likelihood of a single cell thermal runaway (TR) in their aerospace batteries to an absolute minimum by employing rigorous screening program of the cells. There was generally a belief that TR propagation resulting in catastrophic failure of the battery was a forgone conclusion for densely packed aerospace lithium-ion batteries. As it turns out, this may not be the case. An increasing number of purportedly TR propagation-resistant batteries are appearing among NASA partners in the commercial sector and the Department of Defense. In the recent update of the battery safety standard (JSC 20793) to address this paradigm shift, the NASA community included requirements for assessing TR severity and identifying simple, low-cost severity reduction measures. Unfortunately, there are no best-practice guidelines for this work in the Agency, so the first project team attempting to meet these requirements would have an undue burden placed upon them. A NASA engineering Safety Center (NESC) team set out to perform pathfinding activities for meeting those requirements. This presentation will provide contextual background to this effort, as well as initial results in attempting to model and simulate TR heat transfer and propagation within battery designs

Mesoscale theory of grains and cells: crystal plasticity and coarsening

Solids with spatial variations in the crystalline axes naturally evolve into cells or grains separated by sharp walls. Such variations are mathematically described using the Nye dislocation density tensor. At high temperatures, polycrystalline grains form from the melt and coarsen with time: the dislocations can both climb and glide. At low temperatures under shear the dislocations (which allow only glide) form into cell structures. While both the microscopic laws of dislocation motion and the macroscopic laws of coarsening and plastic deformation are well studied, we hitherto have had no simple, continuum explanation for the evolution of dislocations into sharp walls. We present here a mesoscale theory of dislocation motion. It provides a quantitative description of deformation and rotation, grounded in a microscopic order parameter field exhibiting the topologically conserved quantities. The topological current of the Nye dislocation density tensor is derived from a microscopic theory of glide driven by Peach-Koehler forces between dislocations using a simple closure approximation. The resulting theory is shown to form sharp dislocation walls in finite time, both with and without dislocation climb.Comment: 5 pages, 3 figure

Efficiency of free energy calculations of spin lattices by spectral quantum algorithms

Quantum algorithms are well-suited to calculate estimates of the energy spectra for spin lattice systems. These algorithms are based on the efficient calculation of the discrete Fourier components of the density of states. The efficiency of these algorithms in calculating the free energy per spin of general spin lattices to bounded error is examined. We find that the number of Fourier components required to bound the error in the free energy due to the broadening of the density of states scales polynomially with the number of spins in the lattice. However, the precision with which the Fourier components must be calculated is found to be an exponential function of the system size.Comment: 9 pages, 4 figures; corrected typographical and minor mathematical error

Same-day antiretroviral therapy initiation in people living with HIV who have tuberculosis symptoms: a systematic review

Objectives Tuberculosis symptoms are very common among people living with HIV (PLHIV) initiating antiretroviral therapy (ART), are not specific for tuberculosis disease and may result in delayed ART start. The risks and benefits of same-day ART initiation in PLHIV with tuberculosis symptoms are unknown. Methods We systematically reviewed nine databases on 12 March 2020 to identify studies that investigated same-day ART initiation among PLHIV with tuberculosis symptoms and reported both their approach to TB screening and clinical outcomes. We extracted and summarised data about TB screening, numbers of people starting same-day ART and outcomes. Results We included four studies. Two studies deferred ART for everyone with any tuberculosis symptoms (one or more of cough, fever, night sweats or weight loss) and substantial numbers of people had deferred ART start (28% and 39% did not start same-day ART). Two studies permitted some people with tuberculosis symptoms to start same-day ART, and fewer people deferred ART (2% and 16% did not start same-day). Two of the four studies were conducted sequentially; proven viral load suppression at eight months was 31% when everyone with tuberculosis symptoms had ART deferred, and 44% when algorithm was changed so that some people with tuberculosis symptoms could start same-day ART. Conclusions Although tuberculosissymptoms are very common in people starting ART, there is insufficient evidence about whether presence of tuberculosis symptoms should lead to ART start being deferred or not. Research to inform clear guidelines would help maximise benefits of sameday ART

What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta-analysis

Background: HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We aimed to assess whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis. Methods: We did a systematic review by searching nine database for for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studied published from database inception to 12 March 2021. We compared ART within four weeks vs. ART more than four weeks after TB treatment, and ART within two weeks vs. ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS-defining events. We used random effects meta-analysis to pool effect estimates. Results: 2468 abstracts were screened, from which we identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤ 4 week) vs. later ART (> 4 week) (risk difference [RD] 0%; 95% confidence interval [CI] -2% to +1%). Among people with CD4 count ≤50 cells/mm3, earlier ART (≤4 weeks) reduced risk of death (RD -6%; -10% to -1%). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6%, 95% CI +2% to +10%) and reduced the incidence of AIDS defining events (RD -2%, 95% CI -4% to 0%). Results were similar when trials were restricted to the five trials which permitted comparison of ART within two weeks to ART between two and eight weeks. Discussion: Earlier ART did not alter risk of death overall among people living with HIV who had TB disease. Trials were conducted between 2004 and 2014, before recommendations to treat HIV at any CD4 count or to rapidly start ART in people without TB. No trials included children or pregnant women. No trials included integrase inhibitors in ART regimens. For logistical and patient preference reasons, earlier ART initiation for everyone with TB and HIV may be preferred to later ART

Epitaxial Growth Kinetics with Interacting Coherent Islands

The Stranski-Krastanov growth kinetics of undislocated (coherent) 3-dimensional islands is studied with a self-consistent mean field rate theory that takes account of elastic interactions between the islands. The latter are presumed to facilitate the detachment of atoms from the islands with a consequent decrease in their average size. Semi-quantitative agreement with experiment is found for the time evolution of the total island density and the mean island size. When combined with scaling ideas, these results provide a natural way to understand the often-observed initial increase and subsequent decrease in the width of the coherent island size distribution.Comment: 4 pages, 4 figure

Dislocation Free Island Formation in Heteroepitaxial Growth: An Equilibrium Study

We investigate the equilibrium properties of strained heteroepitaxial systems, incorporating the formation and the growth of a wetting film, dislocation free island formation, and ripening. The derived phase diagram provides a detailed characterization of the possible growth modes in terms of the island density, equilibrium island size, and wetting layer thickness. Comparing our predictions with experimental results we discuss the growth conditions that can lead to stable islands as well as ripening.Comment: 4 pages, LaTeX, 3 ps figure

Apparent non-canonical trans-splicing is generated by reverse transcriptase in vitro

Trans-splicing, the in vivo joining of two RNA molecules, is well characterized in several groups of simple organisms but was long thought absent from fungi, plants and mammals. However, recent bioinformatic analyses of expressed sequence tag (EST) databases suggested widespread trans-splicing in mammals^1-2^. Splicing, including the characterised trans-splicing systems, involves conserved sequences at the splice junctions. Our analysis of a yeast non-coding RNA revealed that around 30% of the products of reverse transcription lacked an internal region of 117 nt, suggesting that the RNA was spliced. The junction sequences lacked canonical splice-sites but were flanked by direct repeats, and further analyses indicated that the apparent splicing actually arose because reverse transcriptase can switch templates during transcription^3^. Many newly identified, apparently trans-spliced, RNAs lacked canonical splice sites but were flanked by short regions of homology, leading us to question their authenticity. Here we report that all reported categories of non-canonical splicing could be replicated using an in vitro reverse transcription system with highly purified RNA substrates. We observed the reproducible occurrence of ostensible trans-splicing, exon shuffling and sense-antisense fusions. The latter generate apparent antisense non-coding RNAs, which are also reported to be abundant in humans^4^. Different reverse transcriptases can generate different products of template switching, providing a simple diagnostic. Many reported examples of splicing in the absence of canonical splicing signals may be artefacts of cDNA preparation