Decision making in childhood asthma exacerbation – a clinical judgement analysis

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors on the basis of their knowledge and experience. These include administration of systemic corticosteroids (CS), oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 â??paperâ?? patients. Results:When compared by specialty, paediatriciansâ?? models for decision 1 were more likely to include as a cue level of alertness (54% v. 16%); for decision 2 presence of crepitations (49% v. 16%), and less likely to include inhaled CS (8% v. 40%), respiratory rate (0% v. 24%), and air entry (70% v. 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% v. 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

A low-energy core-collapse supernova without a hydrogen envelope

The final fate of massive stars depends on many factors. Theory suggests that some with initial masses greater than 25 to 30 solar masses end up as Wolf-Rayet stars, which are deficient in hydrogen in their outer layers because of mass loss through strong stellar winds. The most massive of these stars have cores which may form a black hole and theory predicts that the resulting explosion of some of them produces ejecta of low kinetic energy, a faint optical luminosity and a small mass fraction of radioactive nickel. An alternative origin for low-energy supernovae is the collapse of the oxygen-neon core of a star of 7-9 solar masses. No weak, hydrogen-deficient, core-collapse supernovae have hitherto been seen. Here we report that SN 2008ha is a faint hydrogen-poor supernova. We propose that other similar events have been observed but have been misclassified as peculiar thermonuclear supernovae (sometimes labelled SN 2002cx-like events). This discovery could link these faint supernovae to some long-duration gamma-ray bursts, because extremely faint, hydrogen-stripped core-collapse supernovae have been proposed to produce such long gamma-ray bursts, the afterglows of which do not show evidence of associated supernovae.

A Sheep in Wolf’s Clothing: Exploring Researcher Vulnerability

ABSTRACT Methodological concerns surrounding the research of vulnerable consumers tend to focus on respondents’ welfare, that they are not harmed or further disadvantaged by the research process (Reinharz 1992; Finch 1984). Consequentially, researcher vulnerability has been largely neglected within the consumer research literature. This paper aims to identify the ways that research with vulnerable consumers can impact on consumer researchers. Reflecting on our doctoral research experiences with vulnerable consumers, namely low income families and consumers confined to the home due to disability, we identify areas where the physical and psychological vulnerability of the researcher was exposed and the resulting strategies employed.

Detailed analytical investigation of magnetic field line random walk in turbulent plasmas: I. Two-component slab/two-dimensional turbulence

The random displacement of magnetic field lines in the presence of magnetic turbulence in plasmas is investigated from first principles. A two-component (slab/two-dimensional composite) model for the turbulence spectrum is employes. An analytical investigation of the asymptotic behavior of the field-line mean square displacement (FL-MSD) is carried out. It is shown that the magnetic field lines behave superdifusively for every large values of the position variable z, since the FL-MSD sigma varies as sigma similar to z(4/3). An intermediate diffusive regime may also possible exist for finite values of z under conditions which are explicitly determined in terms of the intrinsic turbulent plasma parameters. The superdiffusie asymptotic result is confirmed numerically via an iterative algorithm. The relevance to previous resuslts is discussed.