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While the scientific community documents environmental degradation and develops scenarios to identify the operational margins of system Earth, less attention is given to how decisions are made that steer the system in one direction or the other. We propose to use strategy games for this purpose, increasing the representation of human agency in scenario development and creating spaces for deliberation between different worldviews. Played by the right people, strategy games could help break free from established norms and support more transparent democratic dialogues, responding to the human and social limitations of current decision-making. The question is, who gets to play?

Aims: There is limited published information regarding intensive care unit (ICU) led rapid response team (RRT) calls to obstetric patients. We examined the characteristics of RRT calls to obstetric patients at a tertiary teaching hospital. Method(s): Details of calls to pregnant and postpartum patients between October 2010 and June 2014 were obtained from the hospital RRT database. Each was retrospectively examined for data on patient demographics, call trigger, interventions and outcomes. Local obstetric-specific escalation practices (Code Pink/Green) for obstetrical concerns (not mandating maternal instability/involvement of the ICU team), were excluded. Result(s): There were 106 RRT calls logged during 43 months, and 97 had data available for analysis. Women currently pregnant accounted for 33% of calls and postpartum women 67%, with nearly half of these occurring more than 24 h post-delivery. The most common reason (29% of calls) for calling the RRT was hypotension, followed by 'concern about patient' (21%) and decreased Glasgow Coma Score (GCS) (17%). An escalation in the environment of care occurred after 32% of calls, with approximately 11% of calls necessitating direct ICU admission. Twenty-three percent of all calls were to women who had an ICU admission during their hospital stay. Among the cohort who received an RRT call, there was one maternal and three neonatal deaths. Conclusion(s): At our institution generic RRT calls are called to both pregnant and postpartum women, and frequently result in an escalation in the care environment. Further study is required to understand better the specific needs of this important population.Copyright © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Forests across the world stand at a crossroads where climate and land-use changes are shaping their future. Despite demonstrations of political will and global efforts, forest loss, fragmentation, and degradation continue unabated. No clear evidence exists to suggest that these initiatives are working. A key reason for this apparent ineffectiveness could lie in the failure to recognize the agency of all stakeholders involved. Landscapes do not happen. We shape them. Forest transitions are social and behavioral before they are ecological. Decision makers need to integrate better representations of people’s agency in their mental models. A possible pathway to overcome this barrier involves eliciting mental models behind policy decisions to allow better representation of human agency, changing perspectives to better understand divergent points of view, and refining strategies through explicit theories of change. Games can help decision makers in all of these tasks.

Short pauses or "transition-periods" at the end of expiration and prior to subsequent inspiration are commonly observed during sleep in humans. However, the role of transition periods in regulating ventilation during physiological challenges such as partial airway obstruction (PAO) has not been investigated. Twenty-nine obstructive sleep apnea patients and eight controls underwent overnight polysomnography with an epiglottic catheter. Sustained-PAO segments (increased epiglottic pressure over >=5 breaths without increased peak inspiratory flow) and unobstructed reference segments were manually scored during apnea-free non-REM sleep. Nasal pressure data was computationally segmented into inspiratory (TI, shortest period achieving 95% inspiratory volume), expiratory (TE, shortest period achieving 95% expiratory volume), and inter-breath transition period (TTrans, period between TE and subsequent TI). Compared with reference segments, sustained-PAO segments had a mean relative reduction in TTrans (-24.7 +/- 17.6%, P < 0.001), elevated TI (11.8 +/- 10.5%, P < 0.001), and a small reduction in TE (-3.9 +/- 8.0, P <= 0.05). Compensatory increases in inspiratory period during PAO are primarily explained by reduced transition period and not by reduced expiratory period.Copyright © 2017 Elsevier B.V.

This article documents the longer-term medical and psychosocial outcomes of patients referred for endovascular coiling. There is limited research investigating outcome following endovascular coiling for posterior compared to anterior circulation aneurysms, and minimal understanding of how medical outcomes relate to patient experiences of treatment and quality of life. We studied a consecutive cohort of 80 patients referred Australia wide for endovascular coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age 51.5 years). We used a mixed methods approach, assessing medical outcome with the Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of life and psychosocial functioning using the EuroQol questionnaire and a qualitative semistructured interview in 49 patients (61%). Despite the high proportion of posterior aneurysms, the majority of patients (80%) showed good medical outcomes as indicated by regained independence of activities of daily living (MRS score <=3). Patients with unruptured aneurysms were significantly more likely to show good outcomes (P < 0.04), whereas aneurysm location (posterior, anterior, or mixed) showed no significant effect. In patients with good medical outcomes, greater functional disability was associated with neurological complications surrounding treatment (P < 0.05). Good outcomes correlated with higher EuroQol ratings (P < 0.001) and the experience of less change after treatment (P< 0.001), although psychosocial adjustment issues were reported by most of the patients, including those with no medical symptoms. These results support the long-term efficacy of endovascular coiling, particularly for posterior circulation aneurysms. They have implications for guiding clinicians and patients in their choice of treatment, as well as the provision of psychological counseling for patient adjustment issues posttreatment.Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

BACKGROUND: The rapid response system (RRS) is a process of accessing help for health professionals when a patient under their care becomes severely ill. Recent studies and meta-analyses show a reduction in cardiac arrests by a one-third in hospitals that have introduced a rapid response team, although the effect on overall hospital mortality is less clear. It has been suggested that the difficulty in establishing the benefit of the RRS has been due to implementation difficulties and a reluctance of clinical staff to call for additional help. This assertion is supported by the observation that patients continue to have poor outcomes in our institution despite an established RRS being available. In many of these cases, the patient is often unstable for many hours or days without help being sought. These poor outcomes are often discovered in an ad hoc fashion, and the real numbers of patients who may benefit from the RRS is currently unknown. This study has been designed to answer three key questions to improve the RRS: estimate the scope of the problem in terms of numbers of patients requiring activation of the RRS; determine cognitive and socio-cultural barriers to calling the Rapid Response Team; and design and implement solutions to address the effectiveness of the RRS. METHOD(S): The extent of the problem will be addressed by establishing the incidence of patients who meet abnormal physiological criteria, as determined from a point prevalence investigation conducted across four hospitals. Follow-up review will determine if these patients subsequently require intensive care unit or critical care intervention. This study will be grounded in both cognitive and socio-cultural theoretical frameworks. The cognitive model of situation awareness will be used to determine psychological barriers to RRS activation, and socio-cultural models of interprofessional practice will be triangulated to inform further investigation. A multi-modal approach will be taken using reviews

The natural variability of pitch naming ability in the population (known as absolute pitch or AP) provides an ideal method for investigating individual differences in pitch processing and auditory knowledge formation and representation. We have demonstrated the involvement of different cognitive processes in AP ability that reflects varying skill expertise in the presence of similar early age of onset of music tuition. These processes were related to different regions of brain activity, including those involved in pitch working memory (right prefrontal cortex) and the long-term representation of pitch (superior temporal gyrus). They reflected expertise through the use of context dependent pitch cues and the level of automaticity of pitch naming. They impart functional significance to structural asymmetry differences in the planum temporale of musicians and establish a neurobiological basis for an AP template. More generally, they indicate variability of knowledge representation in the presence of environmental fostering of early cognitive development that translates to differences in cognitive ability. © 2008 The Authors.

1 februari 2010, Item does not contain fulltext, Little is known about the motor control of the lumbo-pelvic musculature in microgravity and its simulation (bed-rest). Analysis of spectral and temporal electromyographic variables can provide information on motor control relevant for normal function. This study examined the effect of 56-days of bed-rest with 1-year follow-up in 10 male subjects on the median frequency and the activation timing in surface electromyographic recordings from five superficial lumbo-pelvic muscles during a repetitive knee movement task. Trunk fat mass (from whole body-composition measurements) and movement accuracy as possible explanatory factors were included. Increased median frequency was observed in the lumbar erector spinae starting late in bed-rest, but this was not seen in its synergist, the thoracic erector spinae (p<.0001). These changes persisted up to 1-year after bed-rest and were independent of changes in body-composition or movement accuracy. Analysis suggested decreases of median frequency (p<.0001) in the abdominal and gluteal muscles to result from increased (p<.01) trunk fat levels during and after bed-rest. No changes in lumbo-pelvic muscle activation timing were seen. The results suggest that bed-rest particularly affects the shorter lumbar erector spinae and that the temporal sequencing of superficial lumbo-pelvic muscle activation is relatively robust.

We review the human literature examining the effects of neurological insult on human sexual behaviour. We provide a synthesis of the findings to date, and identify key brain regions associated with specific aspects of human sexual behaviour. These include subcortical and cortical regions, with the mesial temporal lobe and the amygdala in particular being a crucial structure in the mediation of human sexual drive.