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Search Results: 1 - 10 of 17248 matches for " Andrew Tillyard "
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Ethics review: 'Living wills' and intensive care – an overview of the American experience
Andrew RJ Tillyard
Critical Care , 2007, DOI: 10.1186/cc5945
Abstract: Autonomy, competence and capacity are limited by the nature of the critical illness, or by the effects of treatment. Withdrawing life-support in the intensive care unit (ICU) is common and is often made without the direct involvement of the patient, whose preferences regarding end-of-life treatment are usually unknown [1,2]. Physicians therefore frequently consult relatives regarding the appropriateness of treatment intervention, despite data suggesting that the consulted relatives find this emotionally stressful and do not consistently make decisions that accurately reflect their relative's wishes [3,4].Advance decisions (ADs), commonly known as 'living wills', have been proposed as a way of facilitating the maintenance of a patient's autonomy if they become incapacitated in the future. In October 2007 in England and Wales, ADs will become legally binding as part of the 2005 Mental Capacity Act. This has been the case in the USA for over 20 years [5].The 2005 Mental Capacity Act allows a competent person aged over 18 to make an AD that pre-emptively states their treatment preferences or to appoint a lasting power of attorney (LPA) to make decisions for them, if they become incapacitated. There is no set format for an AD (it can be written or verbal) unless it is specifically pertaining to refusing life-sustaining treatment, where it must be written and counter-signed. There is no obligation to seek advice from medical professionals when drawing up an AD, and it can be revoked verbally. If valid to the clinical scenario, an AD will override a LPA if one exists. The LPA must act in the patient's best interests, must be registered with the Office of Public Guardian, and the document must be structured in a statutory form that is counter-signed by an independent third party. The LPA can refuse life-sustaining treatment if it is explicitly stated in the patient's draft, is counter-signed and is deemed to be compatible with the patient's 'best interests'. Where disagreem
Critical care resource allocation: trying to PREEDICCT outcomes without a crystal ball
Michael D Christian, Robert Fowler, Matthew P Muller, Charles Gomersall, Charles L Sprung, Nathaniel Hupert, David Fisman, Andrew Tillyard, David Zygun, John C Marshal, PREEDICCT Study Group
Critical Care , 2013, DOI: 10.1186/cc11842
Abstract: The International Forum of Acute Care Trialists (InFACT) was formed in 2009 and provided a platform for international critical care research collaboration during the 2009/10 influenza A(H1N1) pandemic [12]. Over the past 2 years, a number of working groups have emerged from InFACT focused upon improving the investigation and care of patients with severe respiratory illness. Arising from these efforts, in June 2012 an inter-national group of clinicians convened the first meeting of the Providing Resources for Effective and Ethical Decisions In Critical Care Triage (PREEDICCT) Study Group. The study group's aim is to develop decision support tools appropriate for triaging critically ill adult patients during epidemics, mass-casualty scenarios or other resource-limited settings. This meeting identified a number of knowledge gaps and research priorities in this area, and suggested a revised framework for the requirements of an adequate triage decision support tool.While purpose-built triage protocols focus on specific events (for example, pandemics), resource allocation decisions are part of everyday practice for critical care physicians worldwide. Several PREEDICCT members work in settings where there are chronically insufficient critical care resources to meet the demand [13]. Critical care physicians also make resource allocation decisions every day in high-income countries, as they decide who might benefit from ICU care, when to accept outside transfers and when insufficient capacity dictates external transfer of patients. Yet intensivists lack objective tools to support these decision-making processes. Further, practices and specific decisions are likely to vary widely by country, by hospital and by individual provider.The first significant shift in direction advocated by our group is to move away from attempting to use a physiologic score alone to predict outcomes. The rationale for basing triage tools on a physiologic score is that all critically ill patients com
Can a Massive Graviton be a Stable Particle  [PDF]
Andrew Beckwith
Journal of Modern Physics (JMP) , 2011, DOI: 10.4236/jmp.2011.25043
Abstract: This document is based on a question asked in the Dark Side of the Universe 2010 conference in Leon, Mexico, when a researcher from India asked the author about how to obtain a stability analysis of massive gravitons. The answer to this question involves an extension of the usual Pauli_Fiertz Langrangian as written by Ortin, with non- zero graviton mass contributing to a relationship between the trace of a revised GR stress-energy tensor (assuming non- zero graviton mass), and the trace of a revised symmetric tensor times a tiny mass for a 4 dimensional graviton. The resulting analysis makes use of Visser’s treatment of a stress en-ergy tensor, with experimental applications discussed in the resulting analysis. If the square of frequency of a massive graviton is real valued and greater than zero, stability can be possibly confirmed experimentally.
Octonionic Gravity Formation, Its Connections to Micro Physics  [PDF]
Andrew Beckwith
Open Journal of Microphysics (OJM) , 2011, DOI: 10.4236/ojm.2011.11002
Abstract: We ask if Octonionic quantum gravity is a relevant consideration near the Planck scale. Furthermore, we examine whether gravitational waves would be generated during the initial phase, , of the universe when triggered by changes in spacetime geometry; i.e. what role would an increase in degrees of freedom have in setting the conditions during , so that the result of these conditions can be observed and analyzed by a gravitational detector. The micro physics interaction is due to the formation of a pre Planckian to Planckian space time transition in spatial dimensions at and near the Planck dimensional values, i.e. 10–33 centimeters in spatial dimensions. This transition would be abrupt and arising in micro physics regimes of space time.
Detailing Coherent, Minimum Uncertainty States of Gravitons, as Semi Classical Components of Gravity Waves, and How Squeezed States Affect Upper Limits To Graviton Mass  [PDF]
Andrew Beckwith
Journal of Modern Physics (JMP) , 2011, DOI: 10.4236/jmp.2011.27086
Abstract: We present what is relevant to squeezed states of initial space time and how that affects both the composition of relic GW, and also gravitons. A side issue to consider is if gravitons can be configured as semi classical "particles", which is akin to the Pilot model of Quantum Mechanics as embedded in a larger non linear "deterministic" background.
What the Null Energy Condition (and When It May Be Violated) Tells Us about Gravitational Wave Frequencies in/for Relic Cosmology?  [PDF]
Andrew Beckwith
Journal of Modern Physics (JMP) , 2011, DOI: 10.4236/jmp.2011.29118
Abstract: We introduce a criterion as to the range of HFGW generated by early universe conditions. The 1 to 10 Giga Hertz range is constructed initially starting with what Grupen writes as far as what to expect of GW frequencies which can be detected assuming a sensitivity of 7×h~10-27 . From there we examine the implications of an earlier Hubble parameter at the start of inflation, and a phase transition treatment of pre to post Planckian inflation physics via use of inflatons. We close with an analysis of how gravitational constant G may vary with time, the tie in with the NEC condition and how to select a range of relic GW frequencies. The gravitational frequencies in turn may enable resolving a mis match between the datum that the entropy of the center of the galaxy black hole is greater than the entropy of the present four dimensional universe as we can infer and measure.
Result-Based Management in the Public Sector: A Decade of Experience for the Tanzanian Executive Agencies  [PDF]
Andrew Sulle
Journal of Service Science and Management (JSSM) , 2011, DOI: 10.4236/jssm.2011.44057
Abstract: One element of the NPM-inspired reforms is the adoption of result-based management in the Tanzanian public sector. This paper examines the implementation of this type of reform by focusing on executive agencies. Executive agencies were especially created to be result-oriented public organizations. Our empirical question is whether or not and to what extent the management of executive agencies has shifted to result-based approach as promised by NPM-reform doctrine. Our findings indicate that result-based approach has only been partially implemented in the Tanzanian public sector. There is less emphasis on managing for results and management processes have continued to be predominantly based on inputs and processes.
Can We Form Gravitinos by Something Other Than a Higgs Boson in the Electro-Weak Era?  [PDF]
Andrew Beckwith
Journal of Modern Physics (JMP) , 2012, DOI: 10.4236/jmp.2012.329162
Abstract: What is the physical nature of gravitinos? As asked before, this question was the template of how to introduce Machian Physics as a way to link gravitinos in the electro weak era and gravitons as of the present. What we wish to do now is to ask how a flaw in the Higgs equation as brought up by Comay shows a branch off from orthodox quantum physics, leading to, with the Machs principle application done earlier a way to embed the beginning of the universe as a semi classical superstructure of which Quantum Mechanics is a subset of. We argue that this will necessitate a review of the Higgs equation of state for reasons stated in the manuscript. We also finally review a proprosal for another form of mass formation mechanism as a replacement for the Higgs mass as introduced by Glinka and Beckwith, 2012, with commentary as to how suitable it may be to get a gravitino mass in fidelity to the Machian proposal introduced by Beckwith previously, to get linkage between electroweak era gravitinos and present day gravitons.
Variation of Vacuum Energy if Scale Factor Becomes Infinitely Small, with Fixed Entropy Due to a Non Pathological Big Bang Singularity Accessible to Modified Einstein Equations  [PDF]
Andrew Beckwith
Journal of Modern Physics (JMP) , 2012, DOI: 10.4236/jmp.2012.329171
Abstract: When initial radius Rinitial 0 if Stoica actually derived Einstein equations in a formalism which remove the big bang singularity pathology, then the reason for Planck length no longer holds. The implications of Rinitial 0 are the first part of this manuscript. Then the resolution is alluded to by work from Muller and Lousto, as to implications of entanglement entropy. We present entanglement entropy in the early universe with a steadily shrinking scale factor, due to work from Muller and Lousto, and show that there are consequences due to initial entanged Sentropy=0.3rH2/a2 for a time dependent horizon radius rH in cosmology, with for flat space conditions rH= for conformal time. In the case of a curved, but not flat space version of entropy, we look at vacuum energy as proportional to the inverse of scale factor squared times the inverse of initial entropy, effectively when there is no initial time in line with ~H2/G H≈a-1. The consequences for this initial entropy being entangled are elaborated in this manuscript. No matter how small the length gets, Sentropy if it is entanglement entropy, will not go to zero. The requirement is that the smallest length of time, t, re scaled does not go to zero. Even if the length goes to zero. This preserves a minimum non zero vacuum energy, and in doing so keep the bits, for computational bits cosmological evolution even if Rinitial 0.
Looking at Graviton Properties, as Either Classical or QM, in Nature, via Alicki-Van Ryn Experimental Realization  [PDF]
Andrew Beckwith
Open Journal of Microphysics (OJM) , 2012, DOI: 10.4236/ojm.2012.24007
Abstract: Recently, the author read the Alicki-Van Ryn test as to behavior of photons in a test of violations of classicality. The same thing is propoosed via use of a spin two graviton, using typical spin 2 matrices. While the technology currently does not exist to perform such an analysis yet, the same sort of thought experiment is proposed in a way to allow for a first principle test of the either classical or quantum foundations of gravity. The reason for the present manuscript topic is due to a specific argument presented in a prior document as to how h is formed from semiclassical reasoning. We referred to a procedure as to how to use Maxwell’s equations involving a closed boundary regime, in the boundary re- gime between Octonionic Geometry and quantum flat space. Conceivably, a similar argument could be made forgravi- tons, pending further investigations. Also the anlysis of if gravitons are constructed by a similar semiclassical argument is pending if gravitons as by the Alicki-Van Ryn test result in semiclassical and matrix observable eigenvalue behavior. This paper also indirectly raises the question of if Baysian statistics would be the optimal way to differentiate between and matrix observable eigenvalue behavior for reasons brought up in the conclusion.
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