Katz R.I.,SUNY at Stony Brook
Anesthesia and analgesia | Year: 2011
Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction. The medical records of 1000 consecutive patients scheduled for surgery at our institution were examined for testing outside of our approved guidelines. Subsequently, 4 scenarios were constructed to solicit physician views of appropriate testing: a 45-year-old woman for a laparoscopic ovarian cystectomy, a 23-year-old woman for right inguinal herniorrhaphy, a 50-year-old man for a hemithyroidectomy, and a 50-year-old man for a total hip replacement. One or more of these scenarios were sent to directors of preoperative clinics (all), United States anesthesiologists (all), gynecologists (cystectomy), general surgeons (herniorrhaphy), otolaryngologists (thyroidectomy), and orthopedists (hip replacement). Potential predictors of ordering and demographic information were collected. More than half of our patients had at least 1 unnecessary test based on our testing guidelines (95% lower confidence limit = 52%). The 17 responding preoperative directors were unanimous for 36 of the 72 combinations of test or consult (henceforth "test") and scenario as being unnecessary. Among the 175 anesthesiologists responding to the survey, 46% ordered 1 or more of the tests unanimously considered unnecessary by the preoperative directors for the given scenario. Among 17 potential predictors of anesthesiologists' unnecessary ordering, only training completed before 1980 significantly increased the risk of ordering at least 1 unnecessary test (by 48%, 95% confidence limits >29%). Anesthesiologists were 53% less likely to order at least 1 unnecessary test relative to gynecologists for the cystectomy scenario, 64% less likely than general surgeons for the herniorrhaphy scenario, 66% less likely than otolaryngologists for the thyroidectomy scenario, and 67% less likely than orthopedists for the hip replacement scenario. The 95% lower confidence limits were all >40%. The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training. Source
Parker R.I.,SUNY at Stony Brook
Critical Care Medicine | Year: 2010
Whereas thrombotic events in critically ill children do not occur as commonly as in adults, they are being recognized with increasing frequency in the pediatric intensive care unit. The reasons for this are not clear but likely include an increased awareness of the problem and the ability to make a diagnosis using relatively noninvasive tests. In this section, I attempt to define the extent of the problem, summarize and discuss the relevant literature (pointing out where published experience in the pediatric population differs from that in adult patients), and suggest some guidelines regarding thrombophilia treatment and the management of thrombotic events. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source
Albins M.A.,Oregon State University |
Lyons P.J.,SUNY at Stony Brook
Marine Ecology Progress Series | Year: 2012
Field and laboratory observations of feeding by invasive Pacific red lionfish Pterois volitans were conducted during June through August of 2008, 2009 and 2010 near Lee Stocking Island, Bahamas. Observations of this invasive marine predator revealed a previously undocumented piscivorous behavior. While slowly approaching prey fish, lionfish produce jets of water directed toward their prey. These jets may confuse or distract prey, and often result in prey fish facing the attacking lionfish, increasing the probability of head-first capture and swallowing. While a variety of fishes are re - ported to create directed water jets, to our knowledge, this is the first report of a fish that does so during the capture of fish prey. This behavior may confer a high degree of predatory efficiency, and thus contribute to the dramatic success of this Pacific invader of tropical Western Atlantic and Caribbean coral reefs. © Inter-Research 2012. Source
Palmer L.B.,SUNY at Stony Brook
Current Opinion in Pulmonary Medicine | Year: 2015
Purpose of review Despite multiple protocols for the prevention of ventilator-associated pneumonia (VAP), respiratory infections have not been eliminated in the ICU. The profound disruption in both airway integrity and mucociliary clearance caused by the endotracheal tube makes it unlikely there will ever be a zero rate of respiratory infection in critically ill ventilated patients or a 100% cure rate when infection is present. In fact, options for treatment are diminishing as bacteria resistant to most, or in some hospitals all, systemic antibiotics increase in prevalence from our liberal use of systemic antibiotics. Inhaled therapy with proper delivery will result in the high concentrations of antibiotics needed in the treatment of increasingly resistant organisms. Recent findings Data from many recent investigations have focused on inhaled antibiotics as: adjunctive therapy to systemic antibiotic for VAP, monotherapy for VAP, and as monotherapy for ventilator-associated tracheobronchitis. The clinical outcomes of these studies will be reviewed as well as their effect on multidrug-resistant organisms. Summary The present review will focus on the rationale for inhaled therapy, the current studies examining the delivery and clinical efficacy of inhaled antibiotics, and the potential role for this mode of delivery actually decreasing antibiotic resistance in the respiratory tract. © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source
Agency: NSF | Branch: Continuing grant | Program: | Phase: ALGORITHMIC FOUNDATIONS | Award Amount: 185.10K | Year: 2016
This project expands the theory of mechanisms to settings with unstructured beliefs. More specifically, computer science studies optimization problems when the data is at hand, and mechanism design studies optimization problems when the data is in the hands of rational players, who may strategically lie about the data in their possession if this is in their interest. The need for mechanism design arises in many contexts in both computer science and economics, such as distributed computation, auctions, social networks, healthcare, and multiagent systems at large. A players belief about other players in a mechanism is the information he has about them: its called belief rather than knowledge to reflect that the information may not always be correct or consistent. Players beliefs form the basis of their reasoning, and largely affect the mechanisms structure and performance. Beliefs can be null, purely possibilistic, or purely probabilistic; but, very often, they are unstructured: a players belief can be anywhere between a set of possibilities and a fully-fledged probability distribution. Despite the tremendous progress made in mechanism design, the vast space where players have unstructured beliefs remains highly unexplored. This project studies fundamental questions about such settings and aims at developing a theory of mechanisms for analyzing and leveraging unstructured beliefs. If successful, it will make profound contributions to both computer science and economics, and is expected to have a long-lasting impact on logic, multiagent systems, and game theory.
The technical part of this project consists of two key components. On the one hand, it will establish the logical foundation for different information structures and characterize corresponding notions of rationality. On the other hand, it will develop new tools and criteria for mechanism design, and provide new mechanisms for strategic settings such as auctions. This project will establish a solid scientific foundation for mechanisms with unstructured beliefs, bring mechanism design closer to logic and epistemic game theory, and further strengthen the connections between computer science and economics. Results from this project will be broadly disseminated in computer science, economics, and operations research. The PI will encourage the participation of women and members of underrepresented minority groups in this project. Moreover, new graduate and undergraduate curriculums will be developed based on this project.