Fantasy and Imagination: Discovering the Threshold of Meaning

This thesis addresses the ultimate question of western humanity; how does one find meaning in the present era? It offers the reader one powerful way for this to happen, and that is through the stories found in the pages of Fantasy literature. It begins with Frederick Nietzsche\u27s declaration that, God is dead. This describes the situation of men and women in his time and today. The statement has to do with the general disconnection of humanity in the western world from its foundations. All society had been based on the mythological literature of the past, but beginning in the Renaissance these tales had come under criticism. By the time of Nietzsche, they had fallen to the wayside. Humanity focused more on its ability to think than on the wisdom of former ages to govern society. Unfortunately, western humanity needed mythology to survive. Mythology reconnected it to a primal wisdom that truly guided how one should live. This thesis argues that Fantasy literature provides a way for humanity to once again have a relationship with the wisdom found in mythology. The evolution of consciousness has raised humanity\u27s ability to think critically and reflect. As it evolved, humanity outgrew the mythology of the past. Fantasy makes mythology relevant for the reader of today. Fantasy does this through the use of symbols. The old myths were made of symbols that universally spoke to the human condition. When the myths became dated and consciousness changed, the symbols lost their power because they could not be understood. Fantasy takes these symbols and places them in fresh settings. This allows today\u27s western mind the ability to once again access the wisdom found in mythology. A method based upon the Medieval Fourfold Reading is described to help draw wisdom out of Fantasy. It involves reading a text as a narrative, symbolically, morally, and creatively. Several examples are given from popular fantasy books, including Harry Potter. But the real hope of this thesis is that the readers of fantasy stories will become the creator of his their own tales. These stories will be embodied in their lives and actualize the wisdom found in the symbols of universal meaning discovered through the new myths of today

Research on the Human Dimensions of Climate Change in Nunavut, Nunavik, and Nunatsiavut: A Literature Review and Gap Analysis

Research on the human dimensions of climate change (HDCC) in the Canadian Arctic has expanded so rapidly over the past decade that we do not have a clear grasp of the current state of knowledge or research gaps. This lack of clarity has implications for duplication of climate policy and research, and it has been identified as a problem by communities, scientists, policy makers, and northern organizations. Our review of current knowledge about the HDCC in Nunavut, Nunavik, and Nunatsiavut indicates that the effects of climate change on subsistence harvesting and other land-based activities and the determinants of vulnerability and adaptation to such changes are well understood. However, the effects of climate change on health are less known. In the nascent research on this topic, studies on food security and personal safety dominate, and little peer-reviewed scholarship focuses on the business and economic sector. Published research shows a strong bias toward case studies in smaller communities, especially communities in Nunavut. Such studies have focused primarily on negative impacts of climate change, present-day vulnerabilities, and adaptive capacity, but studies proposing opportunities for adaptation intervention are beginning to emerge. While documenting the serious risks posed by climate change, they also highlight the adaptability of northern populations and the effects of economic-political stresses on vulnerability to changing climate. We note the absence of studies that examine how Northerners can benefit from new opportunities that may arise from climate change, or assess how the interaction of future climatic and socio-economic changes (specifically, resource development and enhanced shipping) will affect their experience of and response to climate change, or discuss the broader determinants of vulnerability and adaptation.L’étude des dimensions humaines du changement climatique (DHCC) dans l’Arctique canadien a pris de l’ampleur ces dix dernières années au point où nous n’avons pas une idée claire de l’état actuel des connaissances ou des lacunes en matière de recherche. Cette absence de précision a des incidences sur le plan du dédoublement des politiques et des études sur le climat, ce qui est considéré comme problématique par les collectivités, les scientifiques, les décisionnaires et les organi­sations se trouvant dans le Nord. Nous avons passé en revue les connaissances actuelles en matière de DHCC au Nunavut, au Nunavik et au Nunatsiavut, ce qui nous a permis de constater que les effets du changement climatique sur les récoltes de subsistance et sur d’autres activités rattachées aux ressources naturelles sont bien compris, tout comme le sont les déterminants de la vulnérabilité et de l’adaptation à ces changements. Cela dit, les effets du changement climatique sur la santé sont moins bien connus. Dans le cadre des recherches à l’état naissant à ce sujet, les études portant sur l’innocuité alimentaire et la sécurité personnelle dominent, et peu d’études évaluées par les pairs sont axées sur le secteur commercial et économique. Les travaux de recherche dont les résultats ont été publiés indiquent un fort penchant pour des études de cas visant de plus petites collectivités, surtout les collectivités du Nunavut. Ces études portent principalement sur les incidences négatives du changement climatique, sur les vulnérabilités actuelles et sur la capacité d’adaptation, quoi que des études proposant des possibilités d’intervention adaptative commencent à faire surface. Bien que des études se trouvent à documenter les risques sérieux que pose le changement climatique, elles font également ressortir l’adaptabilité des populations nordiques et les effets des stress politiques et économiques sur la vulnérabilité au climat changeant. Nous avons aussi remarqué l’absence d’études qui examinent comment les gens du Nord peuvent bénéficier des retombées du changement climatique, d’études qui évaluent comment l’interaction des changements climatiques et socioéconomiques futurs (plus précisément en ce qui a trait à la mise en valeur des ressources et à l’amélioration des voies d’expédition) toucheront leur expérience du changement climatique et leur réaction à celui-ci, ou d’études qui discutent des plus grands déterminants de la vulnérabilité et de l’adaptation

How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals

BackgroundHospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown.AimsTo investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners.MethodsThe project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources.FindingsPatients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity.ConclusionsThis research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme (project number 10/1010/06). This research was supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula

Primary cilia signaling mediates intraocular pressure sensation

Lowe syndrome is a rare X-linked congenital disease that presents with congenital cataracts and glaucoma, as well as renal and cerebral dysfunction. OCRL, an inositol polyphosphate 5-phosphatase, is mutated in Lowe syndrome. We previously showed that OCRL is involved in vesicular trafficking to the primary cilium. Primary cilia are sensory organelles on the surface of eukaryotic cells that mediate mechanotransduction in the kidney, brain, and bone. However, their potential role in the trabecular meshwork (TM) in the eye, which regulates intraocular pressure, is unknown. Here, we show that TM cells, which are defective in glaucoma, have primary cilia that are critical for response to pressure changes. Primary cilia in TM cells shorten in response to fluid flow and elevated hydrostatic pressure, and promote increased transcription of TNF-α, TGF-β, and GLI1 genes. Furthermore, OCRL is found to be required for primary cilia to respond to pressure stimulation. The interaction of OCRL with transient receptor potential vanilloid 4 (TRPV4), a ciliary mechanosensory channel, suggests that OCRL may act through regulation of this channel. A novel disease-causing OCRL allele prevents TRPV4-mediated calcium signaling. In addition, TRPV4 agonist GSK 1016790A treatment reduced intraocular pressure in mice; TRPV4 knockout animals exhibited elevated intraocular pressure and shortened cilia. Thus, mechanotransduction by primary cilia in TM cells is implicated in how the eye senses pressure changes and highlights OCRL and TRPV4 as attractive therapeutic targets for the treatment of glaucoma. Implications of OCRL and TRPV4 in primary cilia function may also shed light on mechanosensation in other organ systems

Long-term nitrofurantoin:an analysis of complication awareness, monitoring, and pulmonary injury cases

BACKGROUND: Long-term nitrofurantoin (NF) treatment can result in pulmonary and hepatic injury. Current guidelines do not outline the type or frequency of monitoring required for detection of these injuries. AIM: To assess 1) awareness of NF complications among prescribers; 2) monitoring practice; and 3) to describe the pulmonary sequelae of NF-related complications. DESIGN & SETTING: Evaluation of prescribing habits by questionnaires and review of GP databases, and case-note review in secondary care. METHOD: The following study procedures were undertaken: 1) an electronic questionnaire was distributed to prescribers, interrogating prescribing and monitoring practices, and awareness of complications; 2) an analysis was undertaken (June–July 2020) of NF monitoring among GPs in the local clinical commissioning group (CCG); and 3) a case review was carried out of patients diagnosed with NF-induced interstitial lung disease (NFILD) at the interstitial lung disease (ILD) centre (2014–2020). RESULTS: A total of 125 prescribers of long-term NF responded to the questionnaire (82.4% GPs; 12.0% urologists). Many were unaware of the potential for liver (42.4%) and lung (28.0%) complications; 40.8% and 52.8% never monitored for these, respectively. Only 53.3% of urologists believed themselves responsible for arranging monitoring, while nearly all GPs believed this to be the prescriber’s responsibility (94.2%). One-third of all responders considered current British National Formulary (BNF) guidelines 'not at all sufficient/clear', with mean clarity scoring of 2.2/5. Among patients with NFILD (n = 46), NF had been prescribed most often (69.6%) for treatment of recurrent UTI and 58.6% (n = 27) were prescribed for >6 months. On withdrawal of the medication 61.4% displayed resolution (completely or minimal fibrosis), while 15.9% of patients had progressive lung fibrosis. CONCLUSION: NF can cause marked or irreversible lung complications and there is currently a shortfall in awareness and monitoring. Existing monitoring guidelines should be augmented

Reimagining Heliophysics: A bold new vision for the next decade and beyond

The field of Heliophysics has a branding problem. We need an answer to the question: ``What is Heliophysics\?'', the answer to which should clearly and succinctly defines our science in a compelling way that simultaneously introduces a sense of wonder and exploration into our science and our missions. Unfortunately, recent over-reliance on space weather to define our field, as opposed to simply using it as a practical and relatable example of applied Heliophysics science, narrows the scope of what solar and space physics is and diminishes its fundamental importance. Moving forward, our community needs to be bold and unabashed in our definition of Heliophysics and its big questions. We should emphasize the general and fundamental importance and excitement of our science with a new mindset that generalizes and expands the definition of Heliophysics to include new ``frontiers'' of increasing interest to the community. Heliophysics should be unbound from its current confinement to the Sun-Earth connection and expanded to studies of the fundamental nature of space plasma physics across the solar system and greater cosmos. Finally, we need to come together as a community to advance our science by envisioning, prioritizing, and supporting -- with a unified voice -- a set of bold new missions that target compelling science questions - even if they do not explore the traditional Sun- and Earth-centric aspects of Heliophysics science. Such new, large missions to expand the frontiers and scope of Heliophysics science large missions can be the key to galvanizing the public and policymakers to support the overall Heliophysics program

Final LDRD report : science-based solutions to achieve high-performance deep-UV laser diodes.

We present the results of a three year LDRD project that has focused on overcoming major materials roadblocks to achieving AlGaN-based deep-UV laser diodes. We describe our growth approach to achieving AlGaN templates with greater than ten times reduction of threading dislocations which resulted in greater than seven times enhancement of AlGaN quantum well photoluminescence and 15 times increase in electroluminescence from LED test structures. We describe the application of deep-level optical spectroscopy to AlGaN epilayers to quantify deep level energies and densities and further correlate defect properties with AlGaN luminescence efficiency. We further review our development of p-type short period superlattice structures as an approach to mitigate the high acceptor activation energies in AlGaN alloys. Finally, we describe our laser diode fabrication process, highlighting the development of highly vertical and smooth etched laser facets, as well as characterization of resulting laser heterostructures

Progress report no. 1

Statement of responsibility on title-page reads: Editors: I.A. Forbes, M.J. Driscoll, D.D. Lanning, I. Kaplan, N.C. Rasmussen; Contributors: S.A. Ali, S.T. Brewer, D.K. Choi, F.M. Clikeman, W.R. Corcoran, M.J. Driscoll, I.A. Forbes, C.W. Forsberg, S.L. Ho, C.S. Kang, I. Kaplan, J.L. Klucar, D.D. Lanning, T.C. Leung, E.L. McFarland P.G. Mertens, N.R. Ortiz, A. Pant, N.A. Passman, N.C. Rasmussen, M.K. Sheaffer, D.A. Shupe, G.E. Sullivan, A.T. Supple, J.W. Synan, C.P. Tzanos, W.J. Westlake"MIT-4105-3."Includes bibliographical referencesProgress report; June 30, 1970U.S. Atomic Energy Commission contracts: AT(30-1)410

How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals

Background Hospital emergency admissions have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical units. These pressures have an adverse impact on patient experience and potentially lead to suboptimal clinical decision-making. In response, a variety of innovations have been developed, but whether or not these reduce inappropriate admissions or improve patient and clinician experience is largely unknown. Aims To investigate the interplay of service factors influencing decision-making about emergency admissions, and to understand how the medical assessment process is experienced by patients, carers and practitioners. Methods The project used a multiple case study design for a mixed-methods analysis of decision-making about admissions in four acute hospitals. The primary research comprised two parts: value stream mapping to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers and 282 practitioners of different specialties and levels. Additional data were collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources. Findings Patients’ experiences of emergency care were positive and they often did not raise concerns, whereas carers were more vocal. Staff’s focus on patient flow sometimes limited time for basic care, optimal communication and shared decision-making. Practitioners admitted or discharged few patients during the first hour, but decision-making increased rapidly towards the 4-hour target. Overall, patients’ journey times were similar, although waiting before being seen, for tests or after admission decisions, varied considerably. The meaning of what constituted an ‘admission’ varied across sites and sometimes within a site. Medical and social complexity, targets and ‘bed pressure’, patient safety and risk, each influenced admission/discharge decision-making. Each site responded to these pressures with different initiatives designed to expedite appropriate decision-making. New ways of using hospital ‘space’ were identified. Clinical decision units and observation wards allow potentially dischargeable patients with medical and/or social complexity to be ‘off the clock’, allowing time for tests, observation or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams linked with community services; specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing ED activity. Conclusions This research shows how hospitals under pressure manage complexity, safety and risk in emergency care by developing ‘ground-up’ initiatives that facilitate timely, appropriate and safe decision-making, and alternative care pathways for lower-risk, ambulatory patients. New teams and ‘off the clock’ spaces contribute to safely reducing avoidable admissions; frontline expertise brings value not only by placing senior experienced practitioners at the front door of EDs, but also by using seniors in advisory roles. Although the principal limitation of this research is its observational design, so that causation cannot be inferred, its strength is hypothesis generation. Further research should test whether or not the service and care innovations identified here can improve patient experience of acute care and safely reduce avoidable admissions