Trust, regulatory processes and NICE decision-making: Appraising cost-effectiveness models through appraising people and systems.

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience of trust for regulatory decisions, by which the appraisal of people becomes a proxy for appraising technologies themselves. Although such (dis)trust in manufacturers was one important influence, we describe a more intricate web of (dis)trust relations also involving various expert advisors, fellow committee members and committee Chairs. Within these complex chains of relations, we found examples of both more blind-acquiescent and more critical-investigative forms of trust as well as, at times, pronounced distrust. Difficulties in overcoming uncertainty through other means obliged trust in some contexts, although not in others. (Dis)trust was constructed through inferences involving abstract systems alongside actors’ oral and written presentations-of-self. Systemic features and ‘forced options’ to trust indicate potential insidious processes of regulatory capture

The Non-linear Dynamics of Meaning-Processing in Social Systems

Social order cannot be considered as a stable phenomenon because it contains an order of reproduced expectations. When the expectations operate upon one another, they generate a non-linear dynamics that processes meaning. Specific meaning can be stabilized, for example, in social institutions, but all meaning arises from a horizon of possible meanings. Using Luhmann's (1984) social systems theory and Rosen's (1985) theory of anticipatory systems, I submit equations for modeling the processing of meaning in inter-human communication. First, a self-referential system can use a model of itself for the anticipation. Under the condition of functional differentiation, the social system can be expected to entertain a set of models; each model can also contain a model of the other models. Two anticipatory mechanisms are then possible: one transversal between the models, and a longitudinal one providing the modeled systems with meaning from the perspective of hindsight. A system containing two anticipatory mechanisms can become hyper-incursive. Without making decisions, however, a hyper-incursive system would be overloaded with uncertainty. Under this pressure, informed decisions tend to replace the "natural preferences" of agents and an order of cultural expectations can increasingly be shaped

Diaphragmatic hernia following oesophagectomy for oesophageal cancer – Are we too radical?

Background: Diaphragmatic herniation (DH) of abdominal contents into the thorax after oesophageal resection is a recognised and serious complication of surgery. While differences in pressure between the abdominal and thoracic cavities are important, the size of the hiatal defect is something that can be influenced surgically. As with all oncological surgery, safe resection margins are essential without adversely affecting necessary anatomical structure and function. However very little has been published looking at the extent of the hiatal resection. We aim to present a case series of patients who developed DH herniation post operatively in order to raise discussion about the ideal extent of surgical resection required. Methods: We present a series of cases of two male and one female who had oesophagectomies for moderately and poorly differentiated adenocarcinomas of the lower oesophagus who developed post-operative DH. We then conducted a detailed literature review using Medline, Pubmed and Google Scholar to identify existing guidance to avoid this complication with particular emphasis on the extent of hiatal resection. Discussion: Extended incision and partial resection of the diaphragm are associated with an increased risk of postoperative DH formation. However, these more extensive excisions can ensure clear surgical margins. Post-operative herniation can be an early or late complication of surgery and despite the clear importance of hiatal resection only one paper has been published on this subject which recommends a more limited resection than was carried out in our cases. Conclusion: This case series investigated the recommended extent of hiatal dissection in oesophageal surgery. Currently there is no clear guidance available on this subject and further studies are needed to ascertain the optimum resection margin that results in the best balance of oncological parameters vs. post operative morbidity

A Comprehensive View of the 2006 December 13 CME: From the Sun to Interplanetary Space

The biggest halo coronal mass ejection (CME) since the Halloween storm in 2003, which occurred on 2006 December 13, is studied in terms of its solar source and heliospheric consequences. The CME is accompanied by an X3.4 flare, EUV dimmings and coronal waves. It generated significant space weather effects such as an interplanetary shock, radio bursts, major solar energetic particle (SEP) events, and a magnetic cloud (MC) detected by a fleet of spacecraft including STEREO, ACE, Wind and Ulysses. Reconstruction of the MC with the Grad-Shafranov (GS) method yields an axis orientation oblique to the flare ribbons. Observations of the SEP intensities and anisotropies show that the particles can be trapped, deflected and reaccelerated by the large-scale transient structures. The CME-driven shock is observed at both the Earth and Ulysses when they are separated by 74$^{\circ}$ in latitude and 117$^{\circ}$ in longitude, the largest shock extent ever detected. The ejecta seems missed at Ulysses. The shock arrival time at Ulysses is well predicted by an MHD model which can propagate the 1 AU data outward. The CME/shock is tracked remarkably well from the Sun all the way to Ulysses by coronagraph images, type II frequency drift, in situ measurements and the MHD model. These results reveal a technique which combines MHD propagation of the solar wind and type II emissions to predict the shock arrival time at the Earth, a significant advance for space weather forecasting especially when in situ data are available from the Solar Orbiter and Sentinels.Comment: 26 pages, 10 figures. 2008, ApJ, in pres

Sociological and Communication-Theoretical Perspectives on the Commercialization of the Sciences

Both self-organization and organization are important for the further development of the sciences: the two dynamics condition and enable each other. Commercial and public considerations can interact and "interpenetrate" in historical organization; different codes of communication are then "recombined." However, self-organization in the symbolically generalized codes of communication can be expected to operate at the global level. The Triple Helix model allows for both a neo-institutional appreciation in terms of historical networks of university-industry-government relations and a neo-evolutionary interpretation in terms of three functions: (i) novelty production, (i) wealth generation, and (iii) political control. Using this model, one can appreciate both subdynamics. The mutual information in three dimensions enables us to measure the trade-off between organization and self-organization as a possible synergy. The question of optimization between commercial and public interests in the different sciences can thus be made empirical.Comment: Science & Education (forthcoming

Imaging Polarimeter Arrays for Near-Millimeter Waves

An integrated-circuit antenna array has been developed that images both polarization and intensity. The array consists of a row of antennas that lean alternately left and right, creating two interlaced sub-arrays that respond to different polarizations. The arrays and the bismuth bolometer detectors are made by a photoresist shadowing technique that requires only one photolithographic mask. The array has measured polarization at a wavelength of 800 µm with an absolute accuracy of 0.8° and a relative precision of 7 arc min. and has demonstrated nearly diffraction-Iimited resolutiort of a 20° step in polarization

Maximum Coronal Mass Ejection Speed as an Indicator of Solar and Geomagnetic Activities

We investigate the relationship between the monthly averaged maximal speeds of coronal mass ejections (CMEs), international sunspot number (ISSN), and the geomagnetic Dst and Ap indices covering the 1996-2008 time interval (solar cycle 23). Our new findings are as follows. (1) There is a noteworthy relationship between monthly averaged maximum CME speeds and sunspot numbers, Ap and Dst indices. Various peculiarities in the monthly Dst index are correlated better with the fine structures in the CME speed profile than that in the ISSN data. (2) Unlike the sunspot numbers, the CME speed index does not exhibit a double peak maximum. Instead, the CME speed profile peaks during the declining phase of solar cycle 23. Similar to the Ap index, both CME speed and the Dst indices lag behind the sunspot numbers by several months. (3) The CME number shows a double peak similar to that seen in the sunspot numbers. The CME occurrence rate remained very high even near the minimum of the solar cycle 23, when both the sunspot number and the CME average maximum speed were reaching their minimum values. (4) A well-defined peak of the Ap index between 2002 May and 2004 August was co-temporal with the excess of the mid-latitude coronal holes during solar cycle 23. The above findings suggest that the CME speed index may be a useful indicator of both solar and geomagnetic activities. It may have advantages over the sunspot numbers, because it better reflects the intensity of Earth-directed solar eruptions

Signatures of Interchange Reconnection: STEREO, ACE and Hinode Observations Combined

Combining STEREO, ACE and Hinode observations has presented an opportunity to follow a filament eruption and coronal mass ejection (CME) on the 17th of October 2007 from an active region (AR) inside a coronal hole (CH) into the heliosphere. This particular combination of `open' and closed magnetic topologies provides an ideal scenario for interchange reconnection to take place. With Hinode and STEREO data we were able to identify the emergence time and type of structure seen in the in-situ data four days later. On the 21st, ACE observed in-situ the passage of an ICME with `open' magnetic topology. The magnetic field configuration of the source, a mature AR located inside an equatorial CH, has important implications for the solar and interplanetary signatures of the eruption. We interpret the formation of an `anemone' structure of the erupting AR and the passage in-situ of the ICME being disconnected at one leg, as manifested by uni-directional suprathermal electron flux in the ICME, to be a direct result of interchange reconnection between closed loops of the CME originating from the AR and `open' field lines of the surrounding CH.Comment: 13 pages, 13 figures, accepted Annales Geophysica

Anomalous cosmic rays in the heliosheath

We report on Voyager 1 and 2 observations of anomalous cosmic rays in the outer heliosphere. The energy spectrum of anomalous cosmic ray helium as each spacecraft crossed the solar wind termination shock into the heliosheath remained modulated. Assuming the intensity gradient between the two spacecraft is purely radial, we find that radial gradients in the heliosheath of He with 11.6–22.3 MeV/nuc and with ∼61–73MeV/nuc∼61–73 MeV/nuc are 4.9±1.2%/AU4.9±1.2%/AU and 0.0±0.5%/AU,0.0±0.5%/AU, respectively. Strong temporal variations of the 11.6–22.3 MeV/nuc He intensity at both spacecraft were observed in 2005 just after Voyager 1 crossed the termination shock and while Voyager 2 was upstream. After 2006.0, the intensity variations are more moderate and likely due to a combination of spatial and temporal variations. As of early 2008, the anomalous cosmic ray He energy spectrum has unfolded to what may be a source spectrum. The spectrum at Voyager 2 remains modulated. We examine three recent models of the origin of anomalous cosmic rays in light of these observations

Abundances and energy spectra of corotating interaction region heavy ions

We have surveyed He-Fe spectra for 41 Corotating Interaction Regions (CIRs) from 1998–2007 observed on ACE. The spectra are similar for all species, and have the form of broken power laws with the spectral break occurring at a few MeV/nucleon. Except for overabundances of He and Ne, the abundances are close to those of the solar wind. We find the rare isotope ^3He is enhanced in ~40% of the events. In individual CIRs the Fe/O ratio correlates strongly with the solar wind Fe/O ratio measured 2–4 days prior to the CIR passage. Taken together with previously reported observations of pick-up He^+ in CIRs, these observations provide evidence that CIRs are accelerated out of a suprathermal ion pool of heated solar wind ions, pick-up ions, and remnant suprathermal ions from impulsive solar energetic particle (SEP) events