Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

Groups, organizations, families and movements: The sociology of social systems between interaction and society

Kühl S. Groups, organizations, families and movements: The sociology of social systems between interaction and society. Systems Research and Behavioral Science. 2020;37(3):496-515.In enhancing a proposal by Luhmann, this contribution shows that it is possible to locate different types of systems between ‘face‐to‐face‐interaction’ and ‘society’: groups, organizations, families and protest movements. The common ground of these is that they use membership to attribute persons to the system or not. However, they differ fundamentally in regard to how they understand membership. In contrast to Luhmann's differentiation between interaction, organization and society, it is not only possible to imagine different types of interlocking systems but also coequal combinations of and transitions between the different types of social systems

Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

Background: Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods: We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion: Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity

Millimeter-wave diode-grid phase shifters

Monolithic diode grids have been fabricated on 2-cm square gallium-arsenide wafers with 1600 Schottky-barrier varactor diodes. Shorted diodes are detected with a liquid-crystal technique, and the bad diodes are removed with an ultrasonic probe. A small-aperture reflectometer that uses wavefront division interference was developed to measure the reflection coefficient of the grids. A Phase shift of 70° with a 7-dB loss was obtained at 93 GHz when the bias on the diode grid was changed from -3 V to 1 V. A simple transmission-line grid model, together with the measured low-frequency parameters for the diodes, was shown to predict the measured performance over the entire capacitive bias range of the diodes, as well as over the complete reactive tuning range provided by a reflector behind the grid, and over a wide range of frequencies form 33 GHz to 141 GHz. This shows that the transmission-line model and the measured low-frequency diode parameters can be used to design an electronic beam-steering array and to predict its performance. An electronic beam-steering array made of a pair of grids using state-of-the-art diodes with 5-Ω series resistances would have a loss of 1.4 dB at 90 GHz

Millimeter-Wave Diode-Grid Frequency Doubler

Monolithic diode grid were fabricated on 2-cm^2 gallium-arsenide wafers in a proof-of-principle test of a quasi-optical varactor millimeter-wave frequency multiplier array concept. An equivalent circuit model based on a transmission-line analysis of plane wave illumination was applied to predict the array performance. The doubler experiments were performed under far-field illumination conditions. A second-harmonic conversion efficiency of 9.5% and output powers of 0.5 W were achieved at 66 GHz when the diode grid was pumped with a pulsed source at 33 GHz. This grid had 760 Schottky-barrier varactor diodes. The average series resistance was 27 Ω, the minimum capacitance was 18 fF at a reverse breakdown voltage of -3 V. The measurements indicate that the diode grid is a feasible device for generating watt-level powers at millimeter frequencies and that substantial improvement is possible by improving the diode breakdown voltage

The Non-linear Dynamics of Meaning-Processing in Social Systems

Social order cannot be considered as a stable phenomenon because it contains an order of reproduced expectations. When the expectations operate upon one another, they generate a non-linear dynamics that processes meaning. Specific meaning can be stabilized, for example, in social institutions, but all meaning arises from a horizon of possible meanings. Using Luhmann's (1984) social systems theory and Rosen's (1985) theory of anticipatory systems, I submit equations for modeling the processing of meaning in inter-human communication. First, a self-referential system can use a model of itself for the anticipation. Under the condition of functional differentiation, the social system can be expected to entertain a set of models; each model can also contain a model of the other models. Two anticipatory mechanisms are then possible: one transversal between the models, and a longitudinal one providing the modeled systems with meaning from the perspective of hindsight. A system containing two anticipatory mechanisms can become hyper-incursive. Without making decisions, however, a hyper-incursive system would be overloaded with uncertainty. Under this pressure, informed decisions tend to replace the "natural preferences" of agents and an order of cultural expectations can increasingly be shaped

Culture, Utility or Social Systems?:Explaining the Cross-National Ties of Emigrants from Borsa, Romania

Emigrants from Borşa, Romania, display two quite distinct patterns of ties with their community of origin: migration to Italy is discernibly transnational, with a strong reliance on migrant networks; while migration to the UK is more individualistic, with emigrants shunning interaction with compatriots and retaining only weak ties to Borşa. We argue that prevalent theories of cross-national ties fail adequately to explain this divergence. Instead, we draw on systems theory to explain the discrepancy in terms of divergent conditions for societal inclusion. In Italy, incorporation into parallel, unofficial structures of work, welfare and accommodation encouraged a reliance on cultural criteria for maintaining social ties. In the UK, migrants were obliged to integrate into state-sponsored systems, encouraging the relinquishing of ethnic ties in favour of more strategic networking to facilitate societal inclusion

Sociological and Communication-Theoretical Perspectives on the Commercialization of the Sciences

Both self-organization and organization are important for the further development of the sciences: the two dynamics condition and enable each other. Commercial and public considerations can interact and "interpenetrate" in historical organization; different codes of communication are then "recombined." However, self-organization in the symbolically generalized codes of communication can be expected to operate at the global level. The Triple Helix model allows for both a neo-institutional appreciation in terms of historical networks of university-industry-government relations and a neo-evolutionary interpretation in terms of three functions: (i) novelty production, (i) wealth generation, and (iii) political control. Using this model, one can appreciate both subdynamics. The mutual information in three dimensions enables us to measure the trade-off between organization and self-organization as a possible synergy. The question of optimization between commercial and public interests in the different sciences can thus be made empirical.Comment: Science & Education (forthcoming

A Comprehensive View of the 2006 December 13 CME: From the Sun to Interplanetary Space

The biggest halo coronal mass ejection (CME) since the Halloween storm in 2003, which occurred on 2006 December 13, is studied in terms of its solar source and heliospheric consequences. The CME is accompanied by an X3.4 flare, EUV dimmings and coronal waves. It generated significant space weather effects such as an interplanetary shock, radio bursts, major solar energetic particle (SEP) events, and a magnetic cloud (MC) detected by a fleet of spacecraft including STEREO, ACE, Wind and Ulysses. Reconstruction of the MC with the Grad-Shafranov (GS) method yields an axis orientation oblique to the flare ribbons. Observations of the SEP intensities and anisotropies show that the particles can be trapped, deflected and reaccelerated by the large-scale transient structures. The CME-driven shock is observed at both the Earth and Ulysses when they are separated by 74$^{\circ}$ in latitude and 117$^{\circ}$ in longitude, the largest shock extent ever detected. The ejecta seems missed at Ulysses. The shock arrival time at Ulysses is well predicted by an MHD model which can propagate the 1 AU data outward. The CME/shock is tracked remarkably well from the Sun all the way to Ulysses by coronagraph images, type II frequency drift, in situ measurements and the MHD model. These results reveal a technique which combines MHD propagation of the solar wind and type II emissions to predict the shock arrival time at the Earth, a significant advance for space weather forecasting especially when in situ data are available from the Solar Orbiter and Sentinels.Comment: 26 pages, 10 figures. 2008, ApJ, in pres

On the problem of the justification of river rights

This article aims to work out the social conditions that determine whether the communication of river rights finds success in society. Employing the context of hydropower development in the Mekong region, the article finds that an essentialist strategy which claims that river rights have unlimited ‘moral’ validity regardless of any of the decision consequences is unlikely to succeed. Instead, it is proposed that moral conflicts over river rights may ultimately only be resolvable ‘unmorally’, that is, by procedural legitimacy – and this is best captured by employing a methodological framework composed of thematic, social and temporal dimension