An uncertain future, deep uncertainty, scenarios, robustness and adaptation: How do they fit together?

A highly uncertain future due to changes in climate, technology and socio-economics has led to the realisation that identification of “best-guess” future conditions might no longer be appropriate. Instead, multiple plausible futures need to be considered, which requires (i) uncertainties to be described with the aid of scenarios that represent coherent future pathways based on different sets of assumptions, (ii) system performance to be represented by metrics that measure insensitivity (i.e. robustness) to changes in future conditions, and (iii) adaptive strategies to be considered alongside their more commonly used static counterparts. However, while these factors have been considered in isolation previously, there has been a lack of discussion of the way they are connected. In order to address this shortcoming, this paper presents a multidisciplinary perspective on how the above factors fit together to facilitate the devel- opment of strategies that are best suited to dealing with a deeply uncertain future

Quantification of In-Hospital Patient Mobilization after Cardiac Surgery using Accelerometers: There is More than Meets the Eye

Purpose Patients after cardiac surgery infrequently mobilize during their surgical ward stay. Patients are unaware why mobilization is important, and patients’ progress of mobilization activities is not available. The aim of this study was to use accelerometers with artificial intelligence algorithms for quantification of in-hospital mobilization after cardiac surgery. Methods Six static and dynamic patient activities were defined to measure patient mobilization. An accelerometer (AX3, Axivity) was postoperatively placed on both the upper arm and upper leg. An artificial neural network algorithm classified lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was each activity duration performed between 7 a.m. and 11 p.m. Secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis was performed for male and female patients. Results In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1–2) night and surgical ward stay of 5 (3–6) nights. Patients spent 41 (20–62) min less time in bed for each following hospital day (p<0.001). Standing (p=0.004), walking (p<0.001), and walking the stairs (p=0.001) increased during hospital stay. No differences between men (n=22) and women (n=7) were observed for all endpoints. Conclusion The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide tailored feedback to patients and healthcare professionals, to speed up recovery

A good beginning:study protocol for a group-randomized trial to investigate the effects of sit-to-stand desks on academic performance and sedentary time in primary education

Background Sedentary behavior is associated with health risks and academic under-achievement in children. Still, children spend a large part of their waking hours sitting at a desk at school. Recent short-term studies demonstrated the potential of sit-to-stand desks to reduce sitting time in primary education. The program of "A Good Beginning" was conceived to assess the long-term effects of sit-to-stand desks on sitting time in primary education, and to examine how sit-to-stand desks versus regular desks relate to academic performance, and measures of executive functioning, health and wellbeing. The present paper describes the design of this group-randomized trial, which started in 2017 and will be completed in 2019. Methods Children of two grade-three groups (age 8-9) following regular primary education in Leiden, The Netherlands, were recruited. A coin toss determined which group is the experimental group; the other group is the control group. All children in the experimental group received sit-to-stand desks. They are invited and motivated to reduce sedentary time at school, however, it is their own choice to sit or stand. Children in the control group use regular desks. Otherwise, both groups receive regular treatment. Outcomes are assessed at baseline (T0) and at five follow-up sessions (T1-T5) alternately in winter and summer seasons over three academic years. Primary outcome measures are academic performance, and the proportion of sitting time at school, measured with a 3D accelerometer. Secondary outcome measures are a number of measures related to executive functioning (e.g., N-back task for working memory), health (e.g., height and weight for BMI), and wellbeing (e.g., KIDSCREEN-52 for Quality of Life). Discussion A Good Beginning is a two-and-a-half-year research program, which aims to provide a better understanding of the long-term effects of sit-to-stand desks on sedentary time at school and the relation between sitting time reduction and academic performance, executive functioning, health and wellbeing. The findings may serve as useful information for policy making and practical decision making for school and classroom environments

Physicians' experiences with euthanasia: a cross-sectional survey amongst a random sample of Dutch physicians to explore their concerns, feelings and pressure

BACKGROUND: Physicians who receive a request for euthanasia or assisted suicide may experience a conflict of duties: the duty to preserve life on the one hand and the duty to relieve suffering on the other hand. Little is known about experiences of physicians with receiving and granting a request for euthanasia or assisted suicide. This study, therefore, aimed to explore the concerns, feelings and pressure experienced by physicians who receive requests for euthanasia or assisted suicide. METHODS: In 2016, a cross-sectional study was conducted. Questionnaires were sent to a random sample of 3000 Dutch physicians. Physicians who had been working in adult patient care in the Netherlands for the last year were included in the sample (n = 2657). Half of the physicians were asked about the most recent case in which they refused a request for euthanasia or assisted suicide, and half about the most recent case in which they granted a request for euthanasia or assisted suicide. RESULTS: Of the 2657 eligible physicians, 1374 (52%) responded. The most reported reason not to participate was lack of time. Of the respondents, 248 answered questions about a refused euthanasia or assisted suicide request and 245 about a granted EAS request. Concerns about specific aspects of the euthanasia and assisted suicide process, such as the emotional burden of preparing and performing euthanasia or assisted suicide were commonly reported by physicians who refused and who granted a request. Pressure to grant a request was mostly experienced by physicians who refused a request, especial

Modelling future changes in social vulnerability and bushfire risk

Session G1. Modelling for action: Advancing climate resilience and adaptationA natural hazard becomes a natural disaster when individuals, communities and infrastructure are impacted. The impact of a natural disaster is a function of the type and magnitude of the hazard, and the vulnerability of the people and assets exposed to the hazard. Consequently, bushfire risk is not only a function of bushfire likelihood and intensity, but also the social vulnerability of affected communities. In this paper, a framework is presented that enables the spatial distribution of bushfire risk to be quantified by considering bushfire likelihood and social vulnerability. The framework also caters to the assessment of how this risk could change into the future in response to climate change and socio-economic development. The framework is applied to the case study of Greater Adelaide, South Australia. The current distribution of social vulnerability is calculated based on a number of indicators and the current distribution of bushfire likelihood determined using the Unified Natural Hazard Risk Mitigation Exploratory Decision Support System (UNHaRMED), enabling the spatial distribution of current bushfire risk to be determined based on social vulnerability. Plausible spatial distributions of future bushfire risk based on social vulnerability are obtained in response to a number of climate and socio-economic exploratory scenarios. The impact of climate change scenarios on bushfire likelihood is quantified with UNHaRMED. The impact of the socio-economic scenarios on social vulnerability is quantified using a combination of changes in the distribution of land use and population with the aid of UNHaRMED, as well as “clues” in the narrative scenario storylines about likely changes in factors affecting social vulnerability. The results indicate that future changes in social vulnerability are likely to affect long-term bushfire risk in greater Adelaide, with spatial distributions of social vulnerability and bushfire risk changing in different ways under different plausible future scenarios. This enables areas of emerging risk to be identified, opening the door to long-term risk-reduction strategies to be targeted to these high-risk regions.E. Moore, Y. Zhar, P. Radford, M. O, Callaghan, H.R. Maier, G. Riddell, H. van Delden, M. Wouter

Testing new concepts for crop cultivation in space : Effects of rooting volume and nitrogen availability

Long term human missions to the Moon and Mars, rely on life support systems for food production and regeneration of resources. In the EU H2020 TIME SCALE-project, an advanced life support system concept was developed to facilitate plant research and technology demonstration under different gravity conditions. Ground experiments assessed irrigation systems and effects of rooting- and nutrient solution volume. The maximal allowed volume for existing International Space Station research facilities (3.4 L) was able to support cultivation of two lettuce heads for at least 24 days. A smaller rooting volume (0.6 L) increased root biomass after 24 days, but induced a 5% reduction in total biomass at day 35. Regulating effects of nitrate supply on plant water fluxes in light and dark were also investigated. At low concentrations of nitrate in the nutrient solution, both transpiration and stomatal conductance increased rapidly with increasing nitrate concentration. During day-time this increase levelled off at high concentrations, while during nigh-time there was a distinct decline at supra optimal concentrations. Plants supplied with nitrate concentrations as low as 1.25 mM did not show visible signs of nutrient stress or growth reduction. These findings hold promise for both reducing the environmental impact of terrestrial horticulture and avoiding nutrient stress in small scale closed cultivation systems for space.</p

Ballistic nanofriction

Sliding parts in nanosystems such as Nano ElectroMechanical Systems (NEMS) and nanomotors, increasingly involve large speeds, and rotations as well as translations of the moving surfaces; yet, the physics of high speed nanoscale friction is so far unexplored. Here, by simulating the motion of drifting and of kicked Au clusters on graphite - a workhorse system of experimental relevance -- we demonstrate and characterize a novel "ballistic" friction regime at high speed, separate from drift at low speed. The temperature dependence of the cluster slip distance and time, measuring friction, is opposite in these two regimes, consistent with theory. Crucial to both regimes is the interplay of rotations and translations, shown to be correlated in slow drift but anticorrelated in fast sliding. Despite these differences, we find the velocity dependence of ballistic friction to be, like drift, viscous

Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis

Objective To determine whether the use of age adapted D-dimer cut-off values can be translated to primary care patients who are suspected of deep vein thrombosis