Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility

OBJECTIVES: Satellite inpatient facilities of larger children's hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children's hospital. Herein, we compare this model with our in-person model at our main campus. DESIGN: Cross-sectional. SETTING: A tertiary pediatric center and its satellite facility. PATIENTS: Patients admitted to the satellite facility. INTERVENTIONS: Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support. MEASUREMENTS AND MAIN RESULTS: We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model. MAIN RESULTS: Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45-55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation. CONCLUSIONS: Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities

Colloidal diffusion and hydrodynamic screening near boundaries

The hydrodynamic interactions between colloidal particles in small ensembles are measured at varying distances from a no-slip surface over a range of inter-particle separations. The diffusion tensor for motion parallel to the wall of each ensemble is calculated by analyzing thousands of particle trajectories generated by blinking holographic optical tweezers and by dynamic simulation. The Stokesian Dynamics simulations predict similar particle dynamics. By separating the dynamics into three classes of modes: self, relative and collective diffusion, we observe qualitatively different behavior depending on the relative magnitudes of the distance of the ensemble from the wall and the inter-particle separation. A simple picture of the pair-hydrodynamic interactions is developed, while many-body-hydrodynamic interactions give rise to more complicated behavior. The results demonstrate that the effect of many-body hydrodynamic interactions in the presence of a wall is much richer than the single particle behavior and that the multiple-particle behavior cannot be simply predicted by a superposition of pair interactions

Spacetime structure of static solutions in Gauss-Bonnet gravity: neutral case

We study the spacetime structures of the static solutions in the $n$-dimensional Einstein-Gauss-Bonnet-$\Lambda$ system systematically. We assume the Gauss-Bonnet coefficient $\alpha$ is non-negative. The solutions have the $(n-2)$-dimensional Euclidean sub-manifold, which is the Einstein manifold with the curvature $k=1,~0$ and -1. We also assume $4{\tilde \alpha}/\ell^2\leq 1$, where $\ell$ is the curvature radius, in order for the sourceless solution (M=0) to be defined. The general solutions are classified into plus and minus branches. The structures of the center, horizons, infinity and the singular point depend on the parameters $\alpha$, $\ell^2$, $k$, $M$ and branches complicatedly so that a variety of global structures for the solutions are found. In the plus branch, all the solutions have the same asymptotic structure at infinity as that in general relativity with a negative cosmological constant. For the negative mass parameter, a new type of singularity called the branch singularity appears at non-zero finite radius $r=r_b>0$. The divergent behavior around the singularity in Gauss-Bonnet gravity is milder than that around the central singularity in general relativity. In the $k=1,~0$ cases the plus-branch solutions do not have any horizon. In the $k=-1$ case, the radius of the horizon is restricted as $r_h\sqrt{2\tilde{\alpha}}$) in the plus (minus) branch. There is also the extreme black hole solution with positive mass in spite of the lack of electromagnetic charge. We briefly discuss the effect of the Gauss-Bonnet corrections on black hole formation in a collider and the possibility of the violation of third law of the black hole thermodynamics.Comment: 19 pages, 11 figure

Conductance Fluctuations of Generic Billiards: Fractal or Isolated?

We study the signatures of a classical mixed phase space for open quantum systems. We find the scaling of the break time up to which quantum mechanics mimics the classical staying probability and derive the distribution of resonance widths. Based on these results we explain why for mixed systems two types of conductance fluctuat ions were found: quantum mechanics divides the hierarchically structured chaotic component of phase space into two parts - one yields fractal conductance fluctuations while the other causes isolated resonances. In general, both types appear together, but on different energy scales.Comment: restructured and new figure

Do naked singularities generically occur in generalized theories of gravity?

A new mechanism for causing naked singularities is found in an effective superstring theory. We investigate the gravitational collapse in a spherically symmetric Einstein-Maxwell-dilaton system in the presence of a pure cosmological constant "potential", where the system has no static black hole solution. We show that once gravitational collapse occurs in the system, naked singularities necessarily appear in the sense that the field equations break down in the domain of outer communications. This suggests that in generalized theories of gravity, the non-minimally coupled fields generically cause naked singularities in the process of gravitational collapse if the system has no static or stationary black hole solution.Comment: 4 pages including 2 eps figures, to be published in Physical Review Letter

Swim Pressure: Stress Generation in Active Matter

We discover a new contribution to the pressure (or stress) exerted by a suspension of self-propelled bodies. Through their self-motion, all active matter systems generate a unique swim pressure that is entirely athermal in origin. The origin of the swim pressure is based upon the notion that an active body would swim away in space unless confined by boundaries—this confinement pressure is precisely the swim pressure. Here we give the micromechanical basis for the swim stress and use this new perspective to study self-assembly and phase separation in active soft matter. The swim pressure gives rise to a nonequilibrium equation of state for active matter with pressure-volume phase diagrams that resemble a van der Waals loop from equilibrium gas-liquid coexistence. Theoretical predictions are corroborated by Brownian dynamics simulations. Our new swim stress perspective can help analyze and exploit a wide class of active soft matter, from swimming bacteria to catalytic nanobots to molecular motors that activate the cellular cytoskeleton

LISA data analysis: The monochromatic binary detection and initial guess problems

We consider the detection and initial guess problems for the LISA gravitational wave detector. The detection problem is the problem of how to determine if there is a signal present in instrumental data and how to identify it. Because of the Doppler and plane-precession spreading of the spectral power of the LISA signal, the usual power spectrum approach to detection will have difficulty identifying sources. A better method must be found. The initial guess problem involves how to generate {\it a priori} values for the parameters of a parameter-estimation problem that are close enough to the final values for a linear least-squares estimator to converge to the correct result. A useful approach to simultaneously solving the detection and initial guess problems for LISA is to divide the sky into many pixels and to demodulate the Doppler spreading for each set of pixel coordinates. The demodulated power spectra may then be searched for spectral features. We demonstrate that the procedure works well as a first step in the search for gravitational waves from monochromatic binaries.Comment: 8 pages, 8 figure

LISA data analysis I: Doppler demodulation

The orbital motion of the Laser Interferometer Space Antenna (LISA) produces amplitude, phase and frequency modulation of a gravitational wave signal. The modulations have the effect of spreading a monochromatic gravitational wave signal across a range of frequencies. The modulations encode useful information about the source location and orientation, but they also have the deleterious affect of spreading a signal across a wide bandwidth, thereby reducing the strength of the signal relative to the instrument noise. We describe a simple method for removing the dominant, Doppler, component of the signal modulation. The demodulation reassembles the power from a monochromatic source into a narrow spike, and provides a quick way to determine the sky locations and frequencies of the brightest gravitational wave sources.Comment: 5 pages, 7 figures. References and new comments adde