Uncertainty, error and risk in human clinical judgment: Introductory theoretical frameworks in paramedic practice

Paramedic judgment and decision-making, not unlike much of ambulance practice, have not been the subject of systematic, sustained research. There exists a paucity of research or inquiry that examines the mechanics of human error in paramedic practice, ambulance or pre-hospital settings. Little is known of how paramedics make judgments and decisions, and how paramedics deal with risk and uncertainty they commonly face in their tasks and the environment in which they work in. The literature and theories on judgment and decisionmaking are as extensive as they are controversial and the scientific community is yet to obtain a comprehensive understanding of the risk and uncertainty in judgment and decisionmaking. The following paper provides an introduction to the concepts of error, risk, and uncertainty in the context of paramedic judgment and decision-making, discussion of two analytic frameworks that examine such error, risk, and uncertainty, and commentary on their application to the paramedic setting

Planetesimal collisions in binary systems

We study the collisional evolution of km-sized planetesimals in tight binary star systems to investigate whether accretion towards protoplanets can proceed despite the strong gravitational perturbations from the secondary star. The orbits of planetesimals are numerically integrated in two dimensions under the influence of the two stars and gas drag. The masses and orbits of the planetesimals are allowed to evolve due to collisions with other planetesimals and accretion of collisional debris. In addition, the mass in debris can evolve due to planetesimal-planetesimal collisions and the creation of new planetesimals. We show that it is possible in principle for km-sized planetesimals to grow by two orders of magnitude in size if the efficiency of planetesimal formation is relatively low. We discuss the limitations of our two-dimensional approach.Comment: 5 pages, 5 figures, accepted for publication in MNRA

Global stability of spacetimes with supersymmetric compactifications

This paper proves the stability, with respect to the evolution determined by the vacuum Einstein equations, of the Cartesian product of high-dimensional Minkowski space with a compact, Ricci-flat Riemannian manifold that admits a spin structure and a nonzero parallel spinor. Such a product includes the example of Calabi-Yau and other special holonomy compactifications, which play a central role in supergravity and string theory. The stability proved in this paper provides a counter example to an instability argument by Penrose

Beyond capitalism and liberal democracy: on the relevance of GDH Cole’s sociological critique and alternative

This article argues for a return to the social thought of the often ignored early 20th-century English thinker GDH Cole. The authors contend that Cole combined a sociological critique of capitalism and liberal democracy with a well-developed alternative in his work on guild socialism bearing particular relevance to advanced capitalist societies. Both of these, with their focus on the limitations on ‘free communal service’ in associations and the inability of capitalism to yield emancipation in either production or consumption, are relevant to social theorists looking to understand, critique and contribute to the subversion of neoliberalism. Therefore, the authors suggest that Cole’s associational sociology, and the invitation it provides to think of formations beyond capitalism and liberal democracy, is a timely and valuable resource which should be returned to

Asymmetric dimethylarginine blocks nitric oxide-mediated alcohol-stimulated cilia beating.

The airway epithelium is exposed to alcohol during drinking through direct exhalation of volatized ethanol from the bronchial circulation. Alcohol exposure leads to a rapid increase in the cilia beat frequency (CBF) of bronchial epithelial cells followed by a chronic desensitization of cilia stimulatory responses. This effect is governed in part by the nitric oxide regulation of cyclic guanosine and adenosine monophosphate-dependent protein kinases (PKG and PKA) and is not fully understood. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is implicated in the pathogenesis of several pulmonary disorders. We hypothesized that the inhibition of nitric oxide synthase by ADMA blocks alcohol-stimulated increases in CBF. To test this hypothesis, ciliated primary bovine bronchial epithelial cells (BBEC) were preincubated with ADMA (100  µM) and stimulated with 100 mM ethanol. CBF was measured and PKA assayed. By 1 hr, ethanol activated PKA, resulting in elevated CBF. Both alcohol-induced PKA activation and CBF were inhibited in the presence of ADMA. ADMA alone had no effect on PKA activity or CBF. Using a mouse model overexpressing the ADMA-degrading enzyme, dimethylarginine dimethylaminohydrolase (DDAH), we examined PKA and CBF in precision-cut mouse lung slices. Alcohol-stimulated increases in lung slice PKA and CBF were temporally enhanced in the DDAH mice versus control mice

Twist and Degrade-Impact of Molecular Structure on the Photostability of Nonfullerene Acceptors and Their Photovoltaic Blends

Nonfullerene acceptors (NFAs) dominate organic photovoltaic (OPV) research due to their promising efficiencies and stabilities. However, there is very little investigation into the molecular processes of degradation, which is critical to guiding design of novel NFAs for long‐lived, commercially viable OPVs. Here, the important role of molecular structure and conformation in NFA photostability in air is investigated by comparing structurally similar but conformationally different promising NFAs: planar O‐IDTBR and nonplanar O‐IDFBR. A three‐phase degradation process is identified: i) initial photoinduced conformational change (i.e., torsion about the core–benzothiadiazole dihedral), induced by noncovalent interactions with environmental molecules, ii) followed by photo‐oxidation and fragmentation, leading to chromophore bleaching and degradation product formation, and iii) finally complete chromophore bleaching. Initial conformational change is a critical prerequisite for further degradation, providing fundamental understanding of the relative stability of IDTBR and IDFBR, where the already twisted IDFBR is more prone to degradation. When blended with the donor polymer poly(3‐hexylthiophene), both NFAs exhibit improved photostability while the photostability of the polymer itself is significantly reduced by the more miscible twisted NFA. The findings elucidate the important role of NFA molecular structure in photostability of OPV systems, and provide vital insights into molecular design rules for intrinsically photostable NFAs

Adiabatic Output Coupling of a Bose Gas at Finite Temperatures

We develop a general theory of adiabatic output coupling from trapped atomic Bose-Einstein Condensates at finite temperatures. For weak coupling, the output rate from the condensate, and the excited levels in the trap, settles in a time proportional to the inverse of the spectral width of the coupling to the output modes. We discuss the properties of the output atoms in the quasi-steady-state where the population in the trap is not appreciably depleted. We show how the composition of the output beam, containing condensate and thermal component, may be controlled by changing the frequency of the output coupler. This composition determines the first and second order coherence of the output beam. We discuss the changes in the composition of the bose gas left in the trap and show how nonresonant output coupling can stimulate either the evaporation of thermal excitations in the trap or the growth of non-thermal excitations, when pairs of correlated atoms leave the condensate.Comment: 22 pages, 6 Figs. To appear in Physical Review A All the typos from the previous submission have been fixe

Circumstellar discs: What will be next?

This prospective chapter gives our view on the evolution of the study of circumstellar discs within the next 20 years from both observational and theoretical sides. We first present the expected improvements in our knowledge of protoplanetary discs as for their masses, sizes, chemistry, the presence of planets as well as the evolutionary processes shaping these discs. We then explore the older debris disc stage and explain what will be learnt concerning their birth, the intrinsic links between these discs and planets, the hot dust and the gas detected around main sequence stars as well as discs around white dwarfs.Comment: invited review; comments welcome (32 pages