The implausibility of ‘usual care’ in an open system: sedation and weaning practices in Paediatric Intensive Care Units (PICUs) in the United Kingdom (UK).

Background
The power of the randomised controlled trial depends upon its capacity to operate in a closed system whereby the intervention is the only causal force acting upon the experimental group and absent in the control group, permitting a valid assessment of intervention efficacy. Conversely, clinical arenas are open systems where factors relating to context, resources, interpretation and actions of individuals will affect implementation and effectiveness of interventions. Consequently, the comparator (usual care) can be difficult to define and variable in multi-centre trials. Hence outcomes cannot be understood without considering usual care and factors that may affect implementation and impact on the intervention.

Methods
Using a fieldwork approach, we describe PICU context, ‘usual’ practice in sedation and weaning from mechanical ventilation, and factors affecting implementation prior to designing a trial involving a sedation and ventilation weaning intervention. We collected data from 23 UK PICUs between June and November 2014 using observation, individual and multi-disciplinary group interviews with staff.

Results
Pain and sedation practices were broadly similar in terms of drug usage and assessment tools. Sedation protocols linking assessment to appropriate titration of sedatives and sedation holds were rarely used (9 % and 4 % of PICUs respectively). Ventilator weaning was primarily a medical-led process with 39 % of PICUs engaging senior nurses in the process: weaning protocols were rarely used (9 % of PICUs). Weaning methods were variably based on clinician preference. No formal criteria or use of spontaneous breathing trials were used to test weaning readiness. Seventeen PICUs (74 %) had prior engagement in multi-centre trials, but limited research nurse availability. Barriers to previous trial implementation were intervention complexity, lack of belief in the evidence and inadequate training. Facilitating factors were senior staff buy-in and dedicated research nurse provision.

Conclusions
We examined and identified contextual and organisational factors that may impact on the implementation of our intervention. We found usual practice relating to sedation, analgesia and ventilator weaning broadly similar, yet distinctively different from our proposed intervention, providing assurance in our ability to evaluate intervention effects. The data will enable us to develop an implementation plan; considering these factors we can more fully understand their impact on study outcomes.

Role of environmental correlations in the non-Markovian dynamics of a spin system

We study the dynamics of a chain of interacting quantum particles affected by an individual or collective environment(s), focusing on the role played by the environmental quantum correlations over the evolution of the chain. The presence of entanglement in the state of the environment magnifies the non-Markovian nature of the chain's dynamics, giving rise to structures in figures of merit such as spin entanglement and purity that are not observed under a separable environmental state. Our analysis can be relevant to problems tackling the open-system dynamics of biological complexes of strong current interest.

Generalized Langevin equation: An efficient approach to nonequilibrium molecular dynamics of open systems

The generalized Langevin equation (GLE) has been recently suggested to simulate the time evolution of classical solid and molecular systems when considering general nonequilibrium processes. In this approach, a part of the whole system (an open system), which interacts and exchanges energy with its dissipative environment, is studied. Because the GLE is derived by projecting out exactly the harmonic environment, the coupling to it is realistic, while the equations of motion are non-Markovian. Although the GLE formalism has already found promising applications, e. g., in nanotribology and as a powerful thermostat for equilibration in classical molecular dynamics simulations, efficient algorithms to solve the GLE for realistic memory kernels are highly nontrivial, especially if the memory kernels decay nonexponentially. This is due to the fact that one has to generate a colored noise and take account of the memory effects in a consistent manner. In this paper, we present a simple, yet efficient, algorithm for solving the GLE for practical memory kernels and we demonstrate its capability for the exactly solvable case of a harmonic oscillator coupled to a Debye bath.

Transitionless quantum driving in open quantum systems

We extend the concept of superadiabatic dynamics, or transitionless quantum driving, to quantum open systems whose evolution is governed by a master equation in the Lindblad form. We provide the general framework needed to determine the control strategy required to achieve superadiabaticity. We apply our formalism to two examples consisting of a two-level system coupled to environments with time-dependent bath operators. 

Correlated electron transport in molecular electronics

Theoretical and experimental values to date for the resistances of single molecules commonly disagree by orders of magnitude. By reformulating the transport problem using boundary conditions suitable for correlated many-electron systems, we approach electron transport across molecules from a new standpoint. Application of our correlated formalism to benzene-dithiol gives current-voltage characteristics close to experimental observations. The method can solve the open system quantum many-body problem accurately, treats spin exactly, and is valid beyond the linear response regime.

Comment on “Electron transport through correlated molecules computed using the time-independent Wigner function: Two critical tests”

The many-electron-correlated scattering (MECS) approach to quantum electronic transport was investigated in the linear-response regime [I. Bâldea and H. Köppel, Phys. Rev. B 78, 115315 (2008). The authors suggest, based on numerical calculations, that the manner in which the method imposes boundary conditions is unable to reproduce the well-known phenomena of conductance quantization. We introduce an analytical model and demonstrate that conductance quantization is correctly obtained using open system boundary conditions within the MECS approach.

Sudden Transition between Classical and Quantum Decoherence

We study the dynamics of quantum and classical correlations in the presence of nondissipative decoherence. We discover a class of initial states for which the quantum correlations, quantified by the quantum discord, are not destroyed by decoherence for times t < <(t)over bar>. In this initial time interval classical correlations decay. For t > (t) over bar, on the other hand, classical correlations do not change in time and only quantum correlations are lost due to the interaction with the environment. Therefore, at the transition time (t) over bar the open system dynamics exhibits a sudden transition from classical to quantum decoherence regime.

Non-Markovian qubit dynamics induced by Coulomb crystals

We investigate the backflow of information in a system with a second-order structural phase transition, namely, a quasi-one-dimensional Coulomb crystal. Using standard Ramsey interferometry which couples a target ion (the system) to the rest of the chain (a phononic environment), we study the non-Markovian character of the resulting open system dynamics. We study two different time scales and show that the backflow of information pinpoints both the phase transition and different dynamical features of the chain as it approaches criticality. We also establish an exact link between the backflow of information and the Ramsey fringe visibility.

Interaction-induced correlations and non-Markovianity of quantum dynamics

We investigate the conditions under which the trace distance between two different states of a given open system increases in time due to the interaction with an environment, therefore signaling non-Markovianity. We find that the finite-time difference in trace distance is bounded by two sharply defined quantities that are strictly linked to the occurrence of system-environment correlations created throughout their interaction and affecting the subsequent evolution of the system. This allows us to shed light on the origin of non-Markovian behaviors in quantum dynamics. We best illustrate our findings by tackling two physically relevant examples: a non-Markovian dephasing mechanism that has been the focus of a recent experimental endeavor and the open-system dynamics experienced by a spin connected to a finite-size quantum spin chain.

A geochronologic framework for the Ziegler Reservoir fossil site, Snowmass Village, Colorado

The Ziegler Reservoir fossil site near Snowmass Village, Colorado, provides a unique opportunity to reconstruct high-altitude paleoenvironmental conditions in the Rocky Mountains during the last interglacial period. We used four different techniques to establish a chronological framework for the site. Radiocarbon dating of lake organics, bone collagen, and shell carbonate, and in situ cosmogenic Be and Al ages on a boulder on the crest of a moraine that impounded the lake suggest that the ages of the sediments that hosted the fossils are between ~ 140 ka and > 45 ka. Uranium-series ages of vertebrate remains generally fall within these bounds, but extremely low uranium concentrations and evidence of open-system behavior limit their utility. Optically stimulated luminescence (OSL) ages (n = 18) obtained from fine-grained quartz maintain stratigraphic order, were replicable, and provide reliable ages for the lake sediments. Analysis of the equivalent dose (D) dispersion of the OSL samples showed that the sediments were fully bleached prior to deposition and low scatter suggests that eolian processes were likely the dominant transport mechanism for fine-grained sediments into the lake. The resulting ages show that the fossil-bearing sediments span the latest part of marine isotope stage (MIS) 6, all of MIS 5 and MIS 4, and the earliest part of MIS 3.

Squeezing of mechanical motion via qubit-assisted control

We propose a feedback control mechanism for the squeezing of the phononic mode of a mechanical oscillator. We show how, under appropriate working conditions, a simple adiabatic approach is able to induce mechanical squeezing. We then go beyond the limitations of such a working point and demonstrate the stationary squeezing induced by using repeated measurements and reinitialization of the state of a two-level system ancilla coupled to the oscillator. Our nonadaptive feedback loop offers interesting possibilities for quantum state engineering and steering in open-system scenarios.

Complete framework for efficient characterisation of non-Markovian processes

A non-Markovian process is one that retains `memory' of its past. A systematic understanding of these processes is necessary to fully describe and harness a vast range of complex phenomena; however, no such general characterisation currently exists. This long-standing problem has hindered advances in understanding physical, chemical and biological processes, where often dubious theoretical assumptions are made to render a dynamical description tractable. Moreover, the methods currently available to treat non-Markovian quantum dynamics are plagued with unphysical results, like non-positive dynamics. Here we develop an operational framework to characterise arbitrary non-Markovian quantum processes. We demonstrate the universality of our framework and how the characterisation can be rendered efficient, before formulating a necessary and sufficient condition for quantum Markov processes. Finally, we stress how our framework enables the actual systematic analysis of non-Markovian processes, the understanding of their typicality, and the development of new master equations for the effective description of memory-bearing open-system evolution.