Presumed vs confirmed full code

Background Many problems exist regarding inpatient code status: advance directives are rarely completed in outpatient and inpatient settings; patients preferences regarding code status are often not elicited; physicians do not provide adequate information to allow patients to make informed decisions about code status; code status discussions are often delayed during an admission until it is too late for the patients to participate; and providers inappropriately extrapolate DNR orders to limit other treatments (such as artificial nutrition, ICU admission, etc.) Most hospitals default to \u27Full Code\u27 as the status for patients admitted, particularly in patients with whom a code status discussion cannot or has not taken place. In many cases, confirmation of \u27Full Code\u27 does not occur later when these discussions become possible. These problems can result in patients receiving care they would not wish or choose. Purpose At the University of New Mexico (UNM), an academic safety net hospital, a multidisciplinary Advance Directives Task Force formed to address these issues. An initial survey found that \u3c2% of inpatients had advance directives. The goals of the task force were to improve the above issues around code status and increase advance directive completion, in an effort to improve patient care at end of life. Description A multi-disciplinary team at the University of New Mexico met regularly for 2 years to address these concerns. Quality improvement measures included: 1) A revision of the hospital Code Status Policy including the following: a) All adult admissions will have a code status discussion, identification of a surrogate decision maker, and a code status note written b) Code status orders are written for all adult inpatients and include the options of Presumed Full Code (for patients with whom a discussion cannot take place on admission), Confirmed Full Code (after discussion takes place with patient or surrogate), or DNR (eliminating \u27partial code\u27 status orders) 2) Process Improvements included: a) Modification of existing orders and order sets in EMR b) Development of standardized templates for code status discussion and surrogate decision maker identification notes c) Revision of patient handouts about Advance Directives in literacy appropriate language d) Education for physicians about \u27how to have a code status discussion\u27 e) Hospital-wide education to all staff about these changes Conclusions As a specialty, hospital medicine needs to take a more proactive role in ensuring that patients make informed decisions and receive all and only the care they desire. To make this cultural change in our nationwide practice, we submit these standards we hope to be adopted by other institutions including the use of \u27presumed\u27 and \u27confirmed\u27 code statuses, the expectation to have code status discussions on all admissions with identification of surrogate decision maker, and to support increased education to hospitalist in engaging in these discussions.\u2

Dynamic Multi-Objective Optimization With jMetal and Spark: a Case Study

Technologies for Big Data and Data Science are receiving increasing research interest nowadays. This paper introduces the prototyping architecture of a tool aimed to solve Big Data Optimization problems. Our tool combines the jMetal framework for multi-objective optimization with Apache Spark, a technology that is gaining momentum. In particular, we make use of the streaming facilities of Spark to feed an optimization problem with data from different sources. We demonstrate the use of our tool by solving a dynamic bi-objective instance of the Traveling Salesman Problem (TSP) based on near real-time traffic data from New York City, which is updated several times per minute. Our experiment shows that both jMetal and Spark can be integrated providing a software platform to deal with dynamic multi-optimization problems.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Hidden Cues in Random Line Stereograms

Successful fusion of random-line stereograms with breaks in the vernier acuity range has been interpreted to suggest that the interpolation process underlying hyperacuity is parallel and preliminary to stereomatching. In this paper (a) we demonstrate with computer experiments that vernier cues are not needed to solve the stereomatching problem posed by these stereograms and (b) we provide psychophysical evidence that human stereopsis probably does not use vernier cues alone to achieve fusion of these random-line stereograms.MIT Artificial Intelligence Laborator

Erythromycin-induced resistance to clindamycin in Staphylococcus aureus.

PURPOSE: To describe the incidence of erythromycin-induced resistance to clindamycin in a sample of Staphylococcus aureus isolates. METHODS: 100 erythromycin-resistant and clindamycin-sensitive S. aureus were collected as a convenience sample from February to August 2003. Inducible clindamycin resistance was identified using the D-zone disc method. RESULTS: Of the 100 Staphylococcus aureus isolates, 64 were methicillin sensitive (MSSA) and 36 were methicillin resistant (MRSA). Of the 64 MSSA isolates, 22 (34%) had inducible resistance. Of the 36 MRSA isolates, 4 (11%) had inducible resistance. Overall, 26% of these clindamycin sensitive S. aureus isolates, exhibited inducible resistance to clindamycin. CONCLUSIONS: In this sample, MSSA isolates were almost three times more likely to have inducible MLS resistance compared to MRSA isolates. Inducible resistance may compromise the efficacy of clindamycin. The frequency of inducible resistance in this series of "clindamycin sensitive" S. aureus isolates is 26%. It is likely that the true percentage of clindamycin resistance is being underestimated since testing for inducible resistance is not routinely performed

Model-based Cognitive Neuroscience: Multifield Mechanistic Integration in Practice

Autonomist accounts of cognitive science suggest that cognitive model building and theory construction (can or should) proceed independently of findings in neuroscience. Common functionalist justifications of autonomy rely on there being relatively few constraints between neural structure and cognitive function (e.g., Weiskopf, 2011). In contrast, an integrative mechanistic perspective stresses the mutual constraining of structure and function (e.g., Piccinini & Craver, 2011; Povich, 2015). In this paper, I show how model-based cognitive neuroscience (MBCN) epitomizes the integrative mechanistic perspective and concentrates the most revolutionary elements of the cognitive neuroscience revolution (Boone & Piccinini, 2016). I also show how the prominent subset account of functional realization supports the integrative mechanistic perspective I take on MBCN and use it to clarify the intralevel and interlevel components of integration

Enhancing Fashion Sustainability Through a Data Systemic Approach

Today everyday life is characterized by the interaction with an ever-increasing flow of digital data. The research aims to analyze the fashion industry as a data-driven enterprise in which the correlation of data characterized by greater information power and higher quality gives the chance to make a more informed decision making that lead to undertaking better and more sustainable actions in all the value chain. Data, in this focus, could have the power of increasing the efficiency of the system and reducing its impact at the same time, creating a new model that is not only able to improve environmental, economic and social sustainability but also communicative, enabling a more human-centered products and services designing. This research highlights the importance of giving an integrated and holistic perspective through a data systemic approach to deal with a complex and fragmented sustainable problem, proposing an information flow strategy that makes accessible information improving transparency and traceability. This paper presents several case studies that show how data-oriented projects can contribute some benefits to a fashion system that has environmental sustainability as its priority, but also that the lack of correlation of all these strategies is not yet able to generate and lead to a systemic change

Direct calculation of the hard-sphere crystal/melt interfacial free energy

We present a direct calculation by molecular-dynamics computer simulation of the crystal/melt interfacial free energy, $\gamma$, for a system of hard spheres of diameter $\sigma$. The calculation is performed by thermodynamic integration along a reversible path defined by cleaving, using specially constructed movable hard-sphere walls, separate bulk crystal and fluid systems, which are then merged to form an interface. We find the interfacial free energy to be slightly anisotropic with $\gamma$ = 0.62$\pm 0.01$, 0.64$\pm 0.01$ and 0.58$\pm 0.01 k_BT/\sigma^2$ for the (100), (110) and (111) fcc crystal/fluid interfaces, respectively. These values are consistent with earlier density functional calculations and recent experiments measuring the crystal nucleation rates from colloidal fluids of polystyrene spheres that have been interpreted [Marr and Gast, Langmuir {\bf 10}, 1348 (1994)] to give an estimate of $\gamma$ for the hard-sphere system of $0.55 \pm 0.02 k_BT/\sigma^2$, slightly lower than the directly determined value reported here.Comment: 4 pages, 4 figures, submitted to Physical Review Letter