Accurate detection of sepsis at ED triage using machine learning with clinical natural language processing

Sepsis is a life-threatening condition with organ dysfunction and is a leading cause of death and critical illness worldwide. Accurate detection of sepsis during emergency department triage would allow early initiation of lab analysis, antibiotic administration, and other sepsis treatment protocols. The purpose of this study was to determine whether EHR data can be extracted and synthesized with the latest machine learning algorithms (KATE Sepsis) and clinical natural language processing to produce accurate sepsis models, and compare KATE Sepsis performance with existing sepsis screening protocols, such as SIRS and qSOFA. A machine learning model (KATE Sepsis) was developed using patient encounters with triage data from 16 participating hospitals. KATE Sepsis, SIRS, standard screening (SIRS with source of infection) and qSOFA were tested in three settings. Cohort-A was a retrospective analysis on medical records from a single Site 1. Cohort-B was a prospective analysis of Site 1. Cohort-C was a retrospective analysis on Site 1 with 15 additional sites. Across all cohorts, KATE Sepsis demonstrates an AUC of 0.94-0.963 with 73-74.87% TPR and 3.76-7.17% FPR. Standard screening demonstrates an AUC of 0.682-0.726 with 39.39-51.19% TPR and 2.9-6.02% FPR. The qSOFA protocol demonstrates an AUC of 0.544-0.56, with 10.52-13.18% TPR and 1.22-1.68% FPR. For severe sepsis, across all cohorts, KATE Sepsis demonstrates an AUC of 0.935-0.972 with 70-82.26% TPR and 4.64-8.62% FPR. For septic shock, across all cohorts, KATE Sepsis demonstrates an AUC of 0.96-0.981 with 85.71-89.66% TPR and 4.85-8.8% FPR. SIRS, standard screening, and qSOFA demonstrate low AUC and TPR for severe sepsis and septic shock detection. KATE Sepsis provided substantially better sepsis detection performance in triage than commonly used screening protocols.Comment: 35 pages, 1 figure, 6 tables, 7 supplementary table

Kunskapskrav, läromedel och bedömningsuppgifter : Ett ämnesdidaktiskt examensarbete om samstämmighet

Samstämmighet innebär att delarna i ett utbildningssystem dvs. ämnesplan, undervisning och bedömning, arbetar i samma riktning. Blooms reviderade taxonomi är ett verktyg som gör att målen i skolan kan bli mer begripliga, bedömningsbara och genomförbara. Syftet med detta examensarbete är att öka kunskapen om hur en lärares planerade undervisning är samstämmig med de bedömningsuppgifter och ämnesplan i kursen privatjuridik på gymnasieskolans ekonomiprogram. Vid samstämmighet täcker bedömningsuppgifterna in samma krav på kunskap och förmåga, som anges i kursplanen. Genom att använda Blooms reviderade taxonomitabell går det att analysera de syften som ett moment eller en kurs anger, och bland annat, få en indikation på den omfattning av mer komplexa typer av kunskap och kognitiva processer som momentet eller kursen medför. Resultatet visar en god samstämmighet mellan det centrala innehållet i ämnesplanen för privatjuridik och informantens planerade undervisning

“The Private Life of the Series Detective”

There is nothing one-dimensional about contemporary series detectives; they are seldom simply tough, or intellectual, or street smart. The former cardboard figure has over the last thirty years or so turned into a dynamic character, with a private life and personal problems. The detective series, moreover, has developed from a chronicle of murder cases to a life story in installments, the private life of the series detective. In, for example, Reginald Hill's series about Dalziel and Pascoe and Walter Mosley's about Easy Rawlins, the protagonist is followed from one adventure to the next, but also from one relationship to the next, and through stages of personal development. There is an emphasis on narrative order within the series; cause in one novel is followed by effect in the next. Furthermore, the modern series detective typically has to react to authentic events such as the miner's strike in Great Britain and the murder of JFK. This article suggests that the new emphasis on the personal and on the authentic reflects a general trend in popular culture, and in fact signals realism to contemporary readers. Detectives Pascoe and Rawlins and their many colleagues come across as more realistic because they, like their readers, have families and personal problems to consider and are affected by topical, and factual, events

"And in that moment I leapt upon his shoulder." : Non-human Intradiegetic Narrators in The Wind on The Moon

Non-human narrators, by definition anthropomorphized, fill different functions in literature, and have different effects, not always positive for the species that is utilized, for example to voice a human political concern. However, many animal studies scholars agree that anthropomorphism, while inadequate, may be the best way we have to get to know another species. Animal characters who tell their own, autobiographical, stories are particularly interesting in this regard. Eric Linklater’s children’s novel The Wind on the Moon (1944), raises posthumanist questions about human–animal differences, similarities and language, especially through its engagement of several non-human intradiegetic narrators. In a novel with surprisingly few other forms of characterization of the non-human characters, their own detailed narratives become a highly significant means of access to their species characteristics, their consciousness, and their needs. In an analysis of these embedded narratives using Genette’s theory of narrative levels and functions, as well as intersections of speech act theory and cognitive narratology, this article exposes an otherwise inaccessible dimension of characterization in Linklater’s novel. It argues that the embedded narratives, in contrast to crude anthropomorphism, are in fact what enables both a verbalization of the character narrators’ otherness, and a connection and comprehension between species. In other words, these non-human narratives constitute what might be called (with Garrard) examples of critical anthropomorphism

Ecology, Capability and Companion Species : Conflicting Ethics in Nevada Barr’s Blood Lure

The primary concern of this essay is the way Nevada Barr’s Blood Lure (2002), set in Glacier National Park, handles the animal as murderer motif and the ethics that are signalled and developed in the text. Textual ethics are signalled by the park setting, the representation of grizzly bears and human–non-human relations, as well as by several intertexts. The essay argues that the novel’s ethical stance is compromised by an incompatibility of its affiliations with, on the one hand, the conventions of the detective genre and of the Anna Pigeon series, and, on the other, three different and incompatible ethical schemas: ecological ethics, as defined and discussed by Donaldson and Kymlicka, capability ethics, described by Nussbaum, and Haraway’s companion species ethics. The novel’s unwillingness to engage in a discussion regarding wild animals in captivity, and grizzly bear welfare, is found to be especially problematic

Kunskapskrav, läromedel och bedömningsuppgifter : Ett ämnesdidaktiskt examensarbete om samstämmighet

Samstämmighet innebär att delarna i ett utbildningssystem dvs. ämnesplan, undervisning och bedömning, arbetar i samma riktning. Blooms reviderade taxonomi är ett verktyg som gör att målen i skolan kan bli mer begripliga, bedömningsbara och genomförbara. Syftet med detta examensarbete är att öka kunskapen om hur en lärares planerade undervisning är samstämmig med de bedömningsuppgifter och ämnesplan i kursen privatjuridik på gymnasieskolans ekonomiprogram. Vid samstämmighet täcker bedömningsuppgifterna in samma krav på kunskap och förmåga, som anges i kursplanen. Genom att använda Blooms reviderade taxonomitabell går det att analysera de syften som ett moment eller en kurs anger, och bland annat, få en indikation på den omfattning av mer komplexa typer av kunskap och kognitiva processer som momentet eller kursen medför. Resultatet visar en god samstämmighet mellan det centrala innehållet i ämnesplanen för privatjuridik och informantens planerade undervisning

“The Private Life of the Series Detective”

There is nothing one-dimensional about contemporary series detectives; they are seldom simply tough, or intellectual, or street smart. The former cardboard figure has over the last thirty years or so turned into a dynamic character, with a private life and personal problems. The detective series, moreover, has developed from a chronicle of murder cases to a life story in installments, the private life of the series detective. In, for example, Reginald Hill's series about Dalziel and Pascoe and Walter Mosley's about Easy Rawlins, the protagonist is followed from one adventure to the next, but also from one relationship to the next, and through stages of personal development. There is an emphasis on narrative order within the series; cause in one novel is followed by effect in the next. Furthermore, the modern series detective typically has to react to authentic events such as the miner's strike in Great Britain and the murder of JFK. This article suggests that the new emphasis on the personal and on the authentic reflects a general trend in popular culture, and in fact signals realism to contemporary readers. Detectives Pascoe and Rawlins and their many colleagues come across as more realistic because they, like their readers, have families and personal problems to consider and are affected by topical, and factual, events