Reducing Sepsis Mortality: A Cloud-Based Alert Approach

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed with sepsis within the year leading up to the alert intervention consisted of 1,551 unique inpatient visits, and the three-year post-implementation sample size was 9,711 visits, for a total cohort of 11,262 visits. Logistic regression and multiple linear regression were used to test the hypotheses. Study results showed that sepsis-related mortality was slightly higher after the implementation of SIRS alerts, but the presence of sepsis alerts did not have a significant relationship to mortality. The average length of stay and the total number of recorded sepsis diagnoses were higher after the implementation of both SIRS and sepsis alerts, while ordering of the Sepsis Initial Resuscitation PowerPlan was lower. There is preliminary evidence from this study that more sepsis diagnoses are made as a result of alert adoption, suggesting that clinicians can consider the implementation of these alerts in order to capture a higher number of sepsis diagnoses

The End of the Triad:Morality, Reality, and the Ideal Deterrent

Since the closing days of the World War II, we have witnessed an evolution of the national nuclear deterrence strategy. From the early days of Massive Retaliation, born of our nuclear monopoly, we have seen the strategy pass through stages of Mutual Assured Destruction, Flexible Response, and a graduated scale of destruction sufficiency. But today’s radically altered geopolitical environment calls for a radically altered deterrent strategy

Nasa desalting kit development, phase ii first progress report

NASA desalting kit development - container and processor desig

Grothendieck-Messing deformation theory for varieties of K3-type

This is the final version. Available from Tunisian Mathematical Society / MSP via the DOI in this record.Let R be an artinian local ring with perfect residue class eld k. We associate to certain 2-displays over the small ring of Witt vectors ^W (R) a crystal on SpecR. Let X be a scheme of K3-type over SpecR. We de ne a perfect bilinear form on the second crystalline cohomology group X which generalizes the Beauville-Bogomolov form for hyper-K ahler varieties over C. We use this form to prove a lifting criterion of Grothendieck- Messing type for schemes of K3-type. The crystalline cohomology H2 crys(X= ^W (R)) is endowed with the structure of a 2-display such that the Beauville-Bogomolov form becomes a bilinear form in the sense of displays. If X is ordinary the in nitesimal deformations of X correspond bijectively to in nitesimal deformations of the 2-display of X with its Beauville-Bogomolov form. For ordinary K3-surfaces X=R we prove that the slope spectral sequence of the de Rham-Witt complex degenerates and that H2 crys(X=W(R)) has a canonical Hodge- Witt decomposition

Pluripotent stem cells for uncovering the role of mitochondria in human brain function and dysfunction

Mitochondrial dysfunctions are a known pathogenetic mechanism of a number of neurological and psychiatric disorders. At the same time, mutations in genes encoding for components of the mitochondrial respiratory chain cause mitochondrial diseases, which commonly exhibit neurological symptoms. Mitochondria are therefore critical for the functionality of the human nervous system. The importance of mitochondria stems from their key roles in cellular metabolism, calcium handling, redox and protein homeostasis, and overall cellular homeostasis through their dynamic network. Here, we describe how the use of pluripotent stem cells (PSCs) may help addressing the physiological and pathological relevance of mitochondria for the human nervous system. PSCs allow the generation of patient-derived neurons and glia and the identification of gene-specific and mutation-specific cellular phenotypes via genome engineering approaches. We discuss the recent advances in PSC-based modeling of brain diseases and the current challenges of the field. We anticipate that the careful use of PSCs will improve our understanding of the impact of mitochondria in neurological and psychiatric disorders and the search for effective therapeutic avenues

Cauchy-perturbative matching revisited: tests in spherical symmetry

During the last few years progress has been made on several fronts making it possible to revisit Cauchy-perturbative matching (CPM) in numerical relativity in a more robust and accurate way. This paper is the first in a series where we plan to analyze CPM in the light of these new results. Here we start by testing high-order summation-by-parts operators, penalty boundaries and contraint-preserving boundary conditions applied to CPM in a setting that is simple enough to study all the ingredients in great detail: Einstein's equations in spherical symmetry, describing a black hole coupled to a massless scalar field. We show that with the techniques described above, the errors introduced by Cauchy-perturbative matching are very small, and that very long term and accurate CPM evolutions can be achieved. Our tests include the accretion and ring-down phase of a Schwarzschild black hole with CPM, where we find that the discrete evolution introduces, with a low spatial resolution of \Delta r = M/10, an error of 0.3% after an evolution time of 1,000,000 M. For a black hole of solar mass, this corresponds to approximately 5 s, and is therefore at the lower end of timescales discussed e.g. in the collapsar model of gamma-ray burst engines. (abridged)Comment: 14 pages, 20 figure

TARGET: A Digitizing And Trigger ASIC For The Cherenkov Telescope Array

The future ground-based gamma-ray observatory Cherenkov Telescope Array (CTA) will feature multiple types of imaging atmospheric Cherenkov telescopes, each with thousands of pixels. To be affordable, camera concepts for these telescopes have to feature low cost per channel and at the same time meet the requirements for CTA in order to achieve the desired scientific goals. We present the concept of the TeV Array Readout Electronics with GSa/s sampling and Event Trigger (TARGET) Application Specific Circuit (ASIC), envisaged to be used in the cameras of various CTA telescopes, e.g. the Gamma-ray Cherenkov Telescope (GCT), a proposed 2-Mirror Small-Sized Telescope, and the Schwarzschild-Couder Telescope (SCT), a proposed Medium-Sized Telescope. In the latest version of this readout concept the sampling and trigger parts are split into dedicated ASICs, TARGET C and T5TEA, both providing 16 parallel input channels. TARGET C features a tunable sampling rate (usually 1 GSa/s), a 16k sample deep buffer for each channel and on-demand digitization and transmission of waveforms with typical spans of ~100 ns. The trigger ASIC, T5TEA, provides 4 low voltage differential signal (LVDS) trigger outputs and can generate a pedestal voltage independently for each channel. Trigger signals are generated by T5TEA based on the analog sum of the input in four independent groups of four adjacent channels and compared to a threshold set by the user. Thus, T5TEA generates four LVDS trigger outputs, as well as 16 pedestal voltages fed to TARGET C independently for each channel. We show preliminary results of the characterization and testing of TARGET C and T5TEA.Comment: 6 pages, 8 figures, Proceedings of the 6th International Symposium on High-Energy Gamma-Ray Astronomy (Gamma2016