Malgré les formations existantes, de nouvelles stratégies pédagogiques sont nécessaires afin d’améliorer les compétences des professionnels concernant la prescription et la dispensation des opiacés. ...La construction d’un jeu sérieux permet d’expérimenter dans un cadre sécurisant des habilités cliniques. Les modalités de conception du contenu théorique, des aspects interactionnels et ludiques développés sont présentés. Alors que la satisfaction des participants est élevée, les résultats concernant la participation des professionnels montrent les enjeux relatifs au déploiement.
Despite all educative efforts, medical caregivers continue to have only limited theoretical and practical knowledge of opioid therapy. New resources are necessary to help improve prescription and distribution of opioids. The development of a “serious game” may provide training in a secure environment. Here the development of the content and the possibilities of interprofessional interaction of such an e-learning are described. While satisfaction of participants was shown to be high, the rates of participation show the difficulties of implementing this type of training.
Why since 1945 have nuclear weapons not been used? Political scientists have cited five basic reasons: deterrence, practicality, precedent, reputation, and ethics. Scholars attempting to weight these ...factors face a dearth of empirical data. Declassified records of political-military wargames played by U.S. policymakers, however, open up new avenues for theory testing. An investigation of the willingness of U.S. “strategic elites”—experts with experience in diplomatic or military strategy—to use nuclear weapons in a sample of twenty-six political-military wargames reveals that elite players were reluctant to cross the nuclear threshold against both nuclear-armed and nonnuclear-armed adversaries. The only uses of nuclear weapons in the sample occurred in two wargames with nuclear adversaries. Players’ arguments for restraint in the wargames invoked reputational aversion: decisionmakers feared the opprobrium they would face if they used nuclear weapons. Wargame records also strongly support the power of deterrence and basic practicality—whether conventional weapons could accomplish the same goals—as reasons for widespread hesitation to use nuclear weapons. Precedent and ethical aversions to using nuclear weapons were less common. Finally, players also demonstrated some conformity to what they thought the president expected of them.
Conventional wisdom sees nuclear brinkmanship and Thomas Schelling's pathbreaking “threat that leaves something to chance” as a solution to the problem of agency in coercion. If leaders cannot ...credibly threaten to start a nuclear war, perhaps they can at least introduce uncertainty by signaling that the decision is out of their hands. It is not so easy to remove humans from crisis decision-making, however. Often in cases of nuclear brinkmanship, a human being retains a choice about whether to escalate. When two sides engage in rational decision-making, the chance of strategic nuclear exchange should be zero. Scholars have explained how risks associated with accidents, false warnings, and pre-delegation creep into nuclear crises. An investigation of how chance can still produce leverage while leaders retain a choice over whether and when to escalate adds to this scholarship. There remains an element of choice in chance. For a complete understanding of nuclear brinkmanship, psychology and emotion must be added to the analysis to explain how leaders make decisions under pressure. Human emotions can introduce chance into bargaining in ways that contradict the expectations of the rational cost-benefit assumptions that undergird deterrence theory. Three mechanisms of nuclear brinkmanship—accidents, self-control, and control of others—illustrate how a loss of control over the use of nuclear weapons is not a necessary element of the threat that leaves something to chance. Choice does not have to be eliminated for a risk of catastrophic destruction to remain.
Résumé
Une approche multiprofessionnelle est nécessaire à une bonne prise en charge de la douleur en milieu hospitalier. Cet article présente le rôle des infirmières dans cette multiprofessionnalité, ...à travers l’exemple d’un programme de soins institutionnel aux Hôpitaux universitaires de Genève. Il explicite le leadership infirmier dans le domaine de la gestion de la douleur aussi bien au chevet du patient qu’au niveau organisationnel ou relationnel. Il met en lumière une collaboration avec les professionnels des diverses disciplines et le développement d’un partenariat avec les personnes soignées.
Al-alloys with Si as the main alloying element constitute the vast majority of Al castings used commercially today. The eutectic Si microstructure in these alloys can be modified from plate-like to ...coral-like by the addition of a small amount of a third element to improve ductility and toughness. In this investigation the effects of Eu and Yb are studied and their influence on the microstructure is compared to further understand this modification. The two elements impact the alloy differently, where Eu modifies Si into a coral-like structure while Yb does not. Atom probe tomography shows that Eu is present within the Si phase in the form of ternary compound Al
Si
Eu clusters, while Yb is absent in the Si phase. This indicates that the presence of ternary compound clusters within Si is a necessary condition for the formation of a coral-like structure. A crystallographic orientation relationship between Si and the Al
Si
Eu phase was found, where the following plane normals are parallel: 011
//0001
, 111
//6Formula: see text10
and 011
//6Formula: see text10
. No crystallographic relationship was found between Si and Al
Si
Yb. The heterogeneous formation of coherent Al
Si
Eu clusters inside the Si-phase is suggested to trigger the modification of the microstructure.
The global polarization of Λ hyperons along the total orbital angular momentum of a relativistic heavy-ion collision is presented based on the high statistics data samples collected in Au+Au ...collisions at sNN=2.4 GeV and Ag+Ag at 2.55 GeV with the High-Acceptance Di-Electron Spectrometer (HADES) at GSI, Darmstadt. This is the first measurement below the strangeness production threshold in nucleon-nucleon collisions. Results are reported as a function of the collision centrality as well as a function of the hyperon's transverse momentum (pT) and rapidity (yCM) for the range of centrality 0–40%. We observe a strong centrality dependence of the polarization with an increasing signal towards peripheral collisions. For mid-central (20 – 40%) collisions the polarization magnitudes are 〈PΛ〉(%)=6.8±1.3(stat.)±2.1(syst.) for Au+Au and 〈PΛ〉(%)=6.2±0.4(stat.)±0.6(syst.) for Ag+Ag, which are the largest values observed so far. This observation thus provides a continuation of the increasing trend previously observed by STAR and contrasts expectations from recent theoretical calculations predicting a maximum in the region of collision energies about 3 GeV. The observed polarization is of a similar magnitude as predicted by 3D-fluid-dynamics and the UrQMD plus thermal vorticity model and significantly above results from the AMPT model.
We report on an exclusive and kinematically complete high-statistics measurement of the basic double-pionic fusion reaction pn→dπ(0)π(0) over the full energy region of the ABC effect, a pronounced ...low-mass enhancement in the ππ-invariant mass spectrum. The measurements, which cover also the transition region to the conventional t-channel ΔΔ process, were performed with the upgraded WASA detector setup at COSY. The data reveal the Abashian-Booth-Crowe effect to be uniquely correlated with a Lorentzian energy dependence in the integral cross section. The observables are consistent with a narrow resonance with m=2.37 GeV, Γ≈70 MeV and I(J(P))=0(3(+)) in both pn and ΔΔ systems. Necessary further tests of the resonance interpretation are discussed.
Using low-temperature scanning tunneling spectroscopy, we map the local density of states of graphene quantum dots supported on Ir(111). Because of a band gap in the projected Ir band structure ...around the graphene K point, the electronic properties of the QDs are dominantly graphenelike. Indeed, we compare the results favorably with tight binding calculations on the honeycomb lattice based on parameters derived from density functional theory. We find that the interaction with the substrate near the edge of the island gradually opens a gap in the Dirac cone, which implies soft-wall confinement. Interestingly, this confinement results in highly symmetric wave functions. Further influences of the substrate are given by the known moiré potential and a 10% penetration of an Ir surface resonance into the graphene layer.
Prion diseases result from conformational alteration of PrP C , a cell surface glycoprotein expressed in brain, spinal cord, and several peripheral tissues, into PrP Sc , a protease-resistant isoform ...that is the principal component of infectious prion particles. Although a great deal is known
about the pathogenic role of PrP Sc , the physiological function of PrP C has remained a mystery. Several lines of evidence have recently suggested the possibility that PrP C may play a role in the metabolism of copper. To further investigate the interaction of PrP C and copper, we have analyzed the effect of this metal ion on the endocytic trafficking of PrP C in cultured neuroblastoma cells. We report here that copper rapidly and reversibly stimulates endocytosis of PrP C from the cell surface. This effect may be physiologically relevant and suggests the hypothesis that PrP C could serve as a recycling receptor for uptake of copper ions from the extracellular milieu.
Substituted polyphenylacetylenes featuring reactive pentafluorophenyl (PFP) ester moieties are synthesized. Parts of the reactive PFP groups are then converted with a mono ortho‐nitrobenzyl‐protected ...diamine in variable ratios. Thin films are prepared from these copolymers and irradiated with UV light (λ = 365 nm), resulting in crosslinking of the irradiated areas and hence enabling a photopatterning. We found that during the photocrosslinking process, the excess of PFP ester moieties is stable and remained intact, enabling a subsequent post‐polymerization modification step with amines. Noteworthy, this subsequent modification with amines results in a dramatically shift in the UV–vis absorption spectra, rendering these patterned conjugated polymer films ideal candidates for optical sensors.
Reactive substituted polyphenylacetylenes (PPAs), which can be used for patterned films for optical sensors, are synthesized. PPAs featuring reactive pentafluorophenyl (PFP) ester moieties are modified, enabling crosslinking upon irradiation. Photopatterned thin films still contain PFP ester moieties for a subsequent modification resulting in a color change of the films.
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