Climate tipping points — too risky to bet against

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordThe growing threat of abrupt and irreversible climate changes must compel political and economic action on emissions.Royal SocietyLeverhulme Trus

The emergence and evolution of Earth System Science

This is the author accepted manuscript. The final version is available from Nature Research via the DOI in this recordEarth System Science (ESS) is a rapidly emerging transdisciplinary endeavour aimed at understanding the structure and functioning of the Earth as a complex, adaptive system. Here, we discuss the emergence and evolution of ESS, outlining the importance of these developments in advancing our understanding of global change. Inspired by early work on biosphere–geosphere interactions and by novel perspectives such as the Gaia hypothesis, ESS emerged in the 1980s following demands for a new ‘science of the Earth’. The International Geosphere-Biosphere Programme soon followed, leading to an unprecedented level of international commitment and disciplinary integration. ESS has produced new concepts and frameworks central to the global-change discourse, including the Anthropocene, tipping elements and planetary boundaries. Moving forward, the grand challenge for ESS is to achieve a deep integration of biophysical processes and human dynamics to build a truly unified understanding of the Earth System

Influence of airway management strategy on "no-flow-time" during an "Advanced life support course" for intensive care nurses – A single rescuer resuscitation manikin study

<p>Abstract</p> <p>Background</p> <p>In 1999, the laryngeal tube (VBM Medizintechnik, Sulz, Germany) was introduced as a new supraglottic airway. It was designed to allow either spontaneous breathing or controlled ventilation during anaesthesia; additionally it may serve as an alternative to endotracheal intubation, or bag-mask ventilation during resuscitation. Several variations of this supraglottic airway exist. In our study, we compared ventilation with the laryngeal tube suction for single use (LTS-D) and a bag-mask device. One of the main points of the revised ERC 2005 guidelines is a low no-flow-time (NFT). The NFT is defined as the time during which no chest compression occurs. Traditionally during the first few minutes of resuscitation NFT is very high. We evaluated the hypothesis that utilization of the LTS-D could reduce the NFT compared to bag-mask ventilation (BMV) during simulated cardiac arrest in a single rescuer manikin study.</p> <p>Methods</p> <p>Participants were studied during a one day advanced life support (ALS) course. Two scenarios of arrhythmias requiring defibrillation were simulated in a manikin. One scenario required subjects to establish the airway with a LTS-D; alternatively, the second scenario required them to use BMV. The scenario duration was 430 seconds for the LTS-D scenario, and 420 seconds for the BMV scenario, respectively. Experienced ICU nurses were recruited as study subjects. Participants were randomly assigned to one of the two groups first (LTS-D and BMV) to establish the airway. Endpoints were the total NFT during the scenario, the successful airway management using the respective device, and participants' preference of one of the two strategies for airway management.</p> <p>Results</p> <p>Utilization of the LTS-D reduced NFT significantly (p < 0.01). Adherence to the time frame of ERC guidelines was 96% in the LTS-D group versus 30% in the BMV group. Two participants in the LTS-D group required more than one attempt to establish the LTS-D correctly. Once established, ventilation was effective in 100%. In a subjective evaluation all participants preferred the LTS-D over BMV to provide ventilation in a cardiac arrest scenario.</p> <p>Conclusion</p> <p>In our manikin study, NFT was reduced significantly when using LTS-D compared to BMV. During cardiac arrest, the LTS-D might be a good alternative to BMV for providing and maintaining a patent airway. For personnel not experienced in endotracheal intubation it seems to be a safe airway device in a manikin use.</p

Reply to Ruhl and Craig: Assessing and governing extreme climate risks needs to be legitimate and democratic

This is the final version. Available from the National Academy of Sciences via the DOI in this recor

Reply to Bhowmik et al.: Democratic climate action and studying extreme climate risks are not in tension

This is the final version. Available from the National Academy of Sciences via the DOI in this recor

Virtual rehabilitation for multiple sclerosis using a Kinect-based system: randomized controlled trial

©Jose-Antonio Lozano-Quilis, Hermenegildo Gil-Gómez, Jose-Antonio Gil-Gómez, Sergio Albiol-Pérez, Guillermo Palacios-Navarro, Habib M Fardoun, Abdulfattah S Mashat. Originally published in JMIR Serious Games (http://games.jmir.org), 12.11.2014. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.Background: The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients motivation and adherence to treatment. Objective: We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient s progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods: A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results: Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions: The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed.This contribution was partially funded by the Generalitat Valenciana ("Ajudes per a la realitzacio de projectes d'I+D per a grups d'investigacion emergents", projecte GV/2012/069) and by the Fundacion Antonio Gargallo ("Ayudas financiadas por la Obra Social de Ibercaja de proyectos de investigacion 2013", proyecto 2013/B001).Lozano Quilis, JA.; Gil Gómez, H.; Gil-Gómez, J.; Albiol Pérez, S.; Palacios Navarro, G.; Fardoun, HM.; Mashat, AS. (2014). Virtual rehabilitation for multiple sclerosis using a Kinect-based system: randomized controlled trial. JMIR Serious Games. 2(2). https://doi.org/10.2196/games.2933Se1222Adamovich, S. V., Fluet, G. G., Tunik, E., & Merians, A. S. (2009). Sensorimotor training in virtual reality: A review. Neurorehabilitation, 25(1), 29-44. doi:10.3233/nre-2009-0497Lange, B., Flynn, S., Proffitt, R., Chang, C.-Y., & «Skip» Rizzo, A. (2010). Development of an Interactive Game-Based Rehabilitation Tool for Dynamic Balance Training. Topics in Stroke Rehabilitation, 17(5), 345-352. doi:10.1310/tsr1705-345Lozano, J. A., Montesa, J., Juan, M. C., Alcañiz, M., Rey, B., Gil, J., … Morganti, F. (2005). VR-Mirror: A Virtual Reality System for Mental Practice in Post-Stroke Rehabilitation. Lecture Notes in Computer Science, 241-251. doi:10.1007/11536482_23Lange, B. S., Requejo, P., Flynn, S. M., Rizzo, A. A., Valero-Cuevas, F. J., Baker, L., & Winstein, C. (2010). The Potential of Virtual Reality and Gaming to Assist Successful Aging with Disability. Physical Medicine and Rehabilitation Clinics of North America, 21(2), 339-356. doi:10.1016/j.pmr.2009.12.007Wuang, Y.-P., Chiang, C.-S., Su, C.-Y., & Wang, C.-C. (2011). Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Research in Developmental Disabilities, 32(1), 312-321. doi:10.1016/j.ridd.2010.10.002Chang, Y.-J., Chen, S.-F., & Huang, J.-D. (2011). A Kinect-based system for physical rehabilitation: A pilot study for young adults with motor disabilities. Research in Developmental Disabilities, 32(6), 2566-2570. doi:10.1016/j.ridd.2011.07.002Da GamaAChavezTFigueiredoLTeichriebVPoster: improving motor rehabilitation process through a natural interaction based system using kinect sensor, IEEE Symposium on 3D User Interfaces 2012: 145-1462012IEEE Symposium on 3D User InterfacesMar 4-5Costa Mesa, CABaram, Y., & Miller, A. (2006). Virtual reality cues for improvement of gait in patients with multiple sclerosis. Neurology, 66(2), 178-181. doi:10.1212/01.wnl.0000194255.82542.6bFulk, G. D. (2005). Locomotor Training and Virtual Reality-based Balance Training for an Individual with Multiple Sclerosis. Journal of Neurologic Physical Therapy, 29(1), 34-42. doi:10.1097/01.npt.0000282260.59078.e4Lozano-QuilisJAAlbiol-PerezSGil-GomezHPalaciosGFardoumHMGil-GomezJAMashatASVirtual reality system for multiple sclerosis rehabilitation using KINECT2013International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth)May 5-8Venice, Italy366369Van Hedel, H. J., Wirz, M., & Dietz, V. (2005). Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests. Archives of Physical Medicine and Rehabilitation, 86(2), 190-196. doi:10.1016/j.apmr.2004.02.010Podsiadlo, D., & Richardson, S. (1991). The Timed «Up & Go»: A Test of Basic Functional Mobility for Frail Elderly Persons. Journal of the American Geriatrics Society, 39(2), 142-148. doi:10.1111/j.1532-5415.1991.tb01616.xSteffen, T. M., Hacker, T. A., & Mollinger, L. (2002). Age- and Gender-Related Test Performance in Community-Dwelling Elderly People: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and Gait Speeds. Physical Therapy, 82(2), 128-137. doi:10.1093/ptj/82.2.128Gil-GomezJASEQ: Suitability Evaluation Questionnaire for Virtual Rehabilitation systems2013International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth)2013Venice, Italy33533

Identifying the science and technology dimensions of emerging public policy issues through horizon scanning

Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security.Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security

The association between timed up and go test and history of falls: The Tromsø study

BACKGROUND: Fall-related injuries in older adults are a major health problem. Although the aetiology of falls is multifactorial, physical factors are assumed to contribute significantly. The "Timed up and go test" (TUG) is designed to measure basic mobility function. This report evaluates the association between TUG times and history of falls. METHODS: A retrospective, observational, population-based study was conducted on 414 men and 560 women with mean age 77.5 (SD 2.3). TUG time and falls during the previous 12 months were recorded. Covariates were age, sex, medical history and health-related mobility problems. Means, confidence intervals and test characteristics for TUG were calculated. Odds ratios and influence of covariates were examined by logistic regression. RESULTS: The mean TUG time was 11.1s (SD 2.5) among male non-fallers and 13.0s (SD 7.8) among fallers. The difference was 1.9s (95%CI 0.9–3.0). The odds ratio for fallers being in the upper quartile was 2.1 (95%CI 1.4–3.3). Adjusted for covariates, the odds ratio was (OR = 1.8, 95%CI 1.1–2.9). The corresponding mean was 13.0s (SD 5.74) among female non-fallers and 13.9s (SD 8.5) among fallers. The difference was 0.9 (95%CI -0.3–2.1). The odds ratio for fallers being in upper quartile was 1.0 (95%CI 0.7–1.4). The area under the ROC curve was 0.50 (95%CI 0.45–0.55) in women and 0.56 (95%CI 0.50–0.62) in men. CONCLUSION: TUG is statistically associated with a history of falls in men but not in women. The ability to classify fallers is poor, and the clinical value of the association is therefore limited

Robust Signal Processing in Living Cells

Cellular signaling networks have evolved an astonishing ability to function reliably and with high fidelity in uncertain environments. A crucial prerequisite for the high precision exhibited by many signaling circuits is their ability to keep the concentrations of active signaling compounds within tightly defined bounds, despite strong stochastic fluctuations in copy numbers and other detrimental influences. Based on a simple mathematical formalism, we identify topological organizing principles that facilitate such robust control of intracellular concentrations in the face of multifarious perturbations. Our framework allows us to judge whether a multiple-input-multiple-output reaction network is robust against large perturbations of network parameters and enables the predictive design of perfectly robust synthetic network architectures. Utilizing the Escherichia coli chemotaxis pathway as a hallmark example, we provide experimental evidence that our framework indeed allows us to unravel the topological organization of robust signaling. We demonstrate that the specific organization of the pathway allows the system to maintain global concentration robustness of the diffusible response regulator CheY with respect to several dominant perturbations. Our framework provides a counterpoint to the hypothesis that cellular function relies on an extensive machinery to fine-tune or control intracellular parameters. Rather, we suggest that for a large class of perturbations, there exists an appropriate topology that renders the network output invariant to the respective perturbations

Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop

Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding the environmental effects and health risks associated with nanomaterials is limited and sometimes contradictory. This article summarizes the conclusions of a 2008 NATO workshop designed to evaluate the wide-scale implications (e.g., benefits, risks, and costs) of the use of nanomaterials on human health and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower pace of human health and environmental risk science, along with strategies to reduce the uncertainties associated with calculating these risks