Proposed Changes to the Hospital-Medical Staff Relationship to Improve Quality of Care

Medical staff attorney Snelson answers the Colloquium\u27s charge, What exactly has to change in the hospital-medical staff relationship for health care quality to be improved? Her response emphasizes the logic of having clinicians vested with authority to establish policies concerning the clinical decision-making. The article discusses the cases defining the medical staff bylaws as contractual in nature, and the problem of hospital attorneys demanding unilateral amendments to bylaws. Bylaw clauses that would chill medical opinion and communication or denigrate clinical recommendations are discussed. Ms. Snelson advocates for the inclusion of the medical staff organization in exclusive contract and other clinical decision-making, and includes sample bylaw language enacting her recommendations

From Silent Film to YouTube™ : Tracing the Historical Roots of Motion Picture Technologies in Education

This article traces the historical roots of YouTube™ and online video to examine it within the context of educational motion picture history. The current state of online video is discussed first followed by a thematic analysis of the history of educational motion pictures from silent film to YouTube. The historical literature reveals recurring themes and issues, which include: (1) the intrinsic advantages of motion picture technologies, (2) differing opinions about the benefits of film and video, and (3) access and equipment issues. Previous historical accounts fall short of addressing how these themes connect to online video. The potential future of online video is discussed in the conclusion

Gaussian Approximation Potentials: the accuracy of quantum mechanics, without the electrons

We introduce a class of interatomic potential models that can be automatically generated from data consisting of the energies and forces experienced by atoms, derived from quantum mechanical calculations. The resulting model does not have a fixed functional form and hence is capable of modeling complex potential energy landscapes. It is systematically improvable with more data. We apply the method to bulk carbon, silicon and germanium and test it by calculating properties of the crystals at high temperatures. Using the interatomic potential to generate the long molecular dynamics trajectories required for such calculations saves orders of magnitude in computational cost.Comment: v3-4: added new material and reference

Neurocysticercosis as a first presentation of tonic-clonic seizures: a case report

We report the case of a 28 year-old immigrant Asian man from the Punjab region with a first presentation of seizures. This patient had no significant past medical history, but suffered several headaches in the preceding week and was pyrexial on presentation. A CT scan of his head showed a single area of subcortical low attenuation initially suggesting ischaemia. A lumbar puncture and CSF examination was unremarkable. Further investigation revealed discrete calcified gluteal lesions on pelvic X-ray, and serum immunology positive for cysticercosis. The diagnosis of neurocysticercosis was made, and the patient improved on dexamethasone and a short course of vermicide, to be discharged a week later. With increasing global migration, the prevalence of neurological parasitic infections seen in the UK is likely to rise. This case highlights the importance of careful interpretation of non-specific head CTs in the context of first presentation of seizures in a susceptible population

Probabilistic Inference for Fast Learning in Control

We provide a novel framework for very fast model-based reinforcement learning in continuous state and action spaces. The framework requires probabilistic models that explicitly characterize their levels of confidence. Within this framework, we use flexible, non-parametric models to describe the world based on previously collected experience. We demonstrate learning on the cart-pole problem in a setting where we provide very limited prior knowledge about the task. Learning progresses rapidly, and a good policy is found after only a hand-full of iterations

Knot selection in sparse Gaussian processes with a variational objective function

Sparse, knot‐based Gaussian processes have enjoyed considerable success as scalable approximations of full Gaussian processes. Certain sparse models can be derived through specific variational approximations to the true posterior, and knots can be selected to minimize the Kullback‐Leibler divergence between the approximate and true posterior. While this has been a successful approach, simultaneous optimization of knots can be slow due to the number of parameters being optimized. Furthermore, there have been few proposed methods for selecting the number of knots, and no experimental results exist in the literature. We propose using a one‐at‐a‐time knot selection algorithm based on Bayesian optimization to select the number and locations of knots. We showcase the competitive performance of this method relative to optimization of knots simultaneously on three benchmark datasets, but at a fraction of the computational cost

Loss of microbial diversity and pathogen domination of the gut microbiota in critically ill patients

Among long-stay critically ill patients in the adult intensive care unit (ICU), there are often marked changes in the complexity of the gut microbiota. However, it remains unclear whether such patients might benefit from enhanced surveillance or from interventions targeting the gut microbiota or the pathogens therein. We therefore undertook a prospective observational study of 24 ICU patients, in which serial faecal samples were subjected to shotgun metagenomic sequencing, phylogenetic profiling and microbial genome analyses. Two-thirds of the patients experienced a marked drop in gut microbial diversity (to an inverse Simpson's index of <4) at some stage during their stay in the ICU, often accompanied by the absence or loss of potentially beneficial bacteria. Intravenous administration of the broad-spectrum antimicrobial agent meropenem was significantly associated with loss of gut microbial diversity, but the administration of other antibiotics, including piperacillin/tazobactam, failed to trigger statistically detectable changes in microbial diversity. In three-quarters of ICU patients, we documented episodes of gut domination by pathogenic strains, with evidence of cryptic nosocomial transmission of Enterococcus faecium. In some patients, we also saw an increase in the relative abundance of apparent commensal organisms in the gut microbiome, including the archaeal species Methanobrevibacter smithii. In conclusion, we have documented a dramatic absence of microbial diversity and pathogen domination of the gut microbiota in a high proportion of critically ill patients using shotgun metagenomics