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Stress and fear have biological functions that, when neuromodulated, make adaptive otherwise maladaptive responses. While the concept of a defensive cascade supports cognitive understanding and hypothesis testing, approaching this domain by function using an ecological approach brings the pragmatic stance with methods for prevention and intervention. Stress, fear, and threat have distinct functions to, respectively, constrain cognition, induce cognitive focus, and reflexively respond when in danger. We differentiate reference frames between a fixed-point reference frame that distinguishes the event (stimulus) from the person (responder and response) and an experiential reference frame within cascading events. Unrecognized, the characteristics and actions of an HRO bring modulation to the defense cascade, check the effects of stress, interrupt cascading fear reactions, and abridge threat reflexes.

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One person's error is another person's information. Until we experience something, we don't know exactly how we would act or what to expect. Acts are not mistakes; they become mistaken late in their development (Paget 1998, 45). " standardization along with outside 2005) makes medical error capable of error."

Attempts to climb Mount Everest failed for thirty years until a mountain climbing physiologist joined the efforts. This story demonstrates the value of context, inductive processes, and pragmatism to generate local knowledge and solutions in austere, hazardous environments. In these environments, imperfect information and inaccurate models can kill. This story, viewed from the climbers' experience rather than scientists or leaders, underscores the vitality of engaged individuals overcoming physical, social, and mental adversity to "gain altitude." At the individual level, what high altitude climbers learned can support the neonatologist's efforts for the neonate to "gain life." Three times men had climbed to more than 28,000 feet, unaided by oxygen apparatus, and failed to reach the summit.