Lean-Based Redesign of Multidisciplinary Rounds on General Medicine Service.

BACKGROUND: Multidisciplinary rounds (MDR) facilitate timely communication amongst the care team and with patients. We used Lean techniques to redesign MDR on the teaching general medicine service. OBJECTIVE: To examine if our Lean-based new model of MDR was associated with change in the primary outcome of length of stay (LOS) and secondary outcomes of discharges before noon, documentation of estimated discharge date (EDD), and patient satisfaction. DESIGN, SETTING, PATIENTS: This is a pre-post study. The preperiod (in which the old model of MDR was followed) comprised 4000 patients discharged between September 1, 2013, and October 22, 2014. The postperiod (in which the new model of MDR was followed) comprised 2085 patients between October 23, 2014, and April 30, 2015. INTERVENTION: Lean-based redesign of MDR. MEASUREMENTS: LOS, discharges before noon, EDD, and patient satisfaction. RESULTS: There was no change in the mean LOS. Discharges before noon increased from 6.9% to 10.7% (P < .001). Recording of EDD increased from 31.4% to 41.3% (P < .001). There was no change in patient satisfaction. CONCLUSIONS: Lean-based redesign of MDR was associated with an increase in discharges before noon and in recording of EDD.

Spurious valleys in the error surface of recurrent networks--analysis and avoidance.

This paper gives a detailed analysis of the error surfaces of certain recurrent networks and explains some difficulties encountered in training recurrent networks. We show that these error surfaces contain many spurious valleys, and we analyze the mechanisms that cause the valleys to appear. We demonstrate that the principle mechanism can be understood through the analysis of the roots of random polynomials. This paper also provides suggestions for improvements in batch training procedures that can help avoid the difficulties caused by spurious valleys, thereby improving training speed and reliability.

Aeroecology: probing and modeling the aerosphere.

Aeroecology is a discipline that embraces and integrates the domains of atmospheric science, ecology, earth science, geography, computer science, computational biology, and engineering. The unifying concept that underlies this emerging discipline is its focus on the planetary boundary layer, or aerosphere, and the myriad of organisms that, in large part, depend upon this environment for their existence. The aerosphere influences both daily and seasonal movements of organisms, and its effects have both short- and long-term consequences for species that use this environment. The biotic interactions and physical conditions in the aerosphere represent important selection pressures that influence traits such as size and shape of organisms, which in turn facilitate both passive and active displacements. The aerosphere also influences the evolution of behavioral, sensory, metabolic, and respiratory functions of organisms in a myriad of ways. In contrast to organisms that depend strictly on terrestrial or aquatic existence, those that routinely use the aerosphere are almost immediately influenced by changing atmospheric conditions (e.g., winds, air density, precipitation, air temperature), sunlight, polarized light, moon light, and geomagnetic and gravitational forces. The aerosphere has direct and indirect effects on organisms, which often are more strongly influenced than those that spend significant amounts of time on land or in water. Future advances in aeroecology will be made when research conducted by biologists is more fully integrated across temporal and spatial scales in concert with advances made by atmospheric scientists and mathematical modelers. Ultimately, understanding how organisms such as arthropods, birds, and bats aloft are influenced by a dynamic aerosphere will be of importance for assessing, and maintaining ecosystem health, human health, and biodiversity.

Analyzing NEXRAD doppler radar images to assess nightly dispersal patterns and population trends in Brazilian free-tailed bats (Tadarida brasiliensis).

Operators of early weather-surveillance radars often observed echoes on their displays that did not behave like weather pattern, including expanding ring-like shapes they called angels. These echoes were caused by high-flying insects, migrating birds, and large colonies of bats emerging from roosts to feed. Modern weather-surveillance radar stations in the United States (NEXt-generation RADar or NEXRAD) provide detailed images that clearly show evening bat emergences from large colonies. These images can be used to investigate the flight behavior of groups of bats and population trends in large colonies of Brazilian free-tailed bats (Tadarida brasiliensis) in south-central Texas which are clearly imaged by local NEXRAD radar stations. In this study, we used radar reflectivity data from the New Braunfels, Texas NEXRAD station to examine relative colony size, direction of movement, speed of dispersion, and altitude gradients of bats from these colonies following evening emergence. Base reflectivity clear-air-mode Level-II images were geo-referenced and compiled in a GIS along with locations of colonies and features on the landscape. Temporal sequences of images were filtered for the activity of bats, and from this, the relative size of bat colonies, and the speed and heading of bat emergences were calculated. Our results indicate cyclical changes in colony size from year to year and that initial headings taken by bats during emergence flights are highly directional. We found that NEXRAD data can be an effective tool for monitoring the nightly behavior and seasonal changes in these large colonies. Understanding the distribution of a large regional bat population on a landscape scale has important implications for agricultural pest management and conservation efforts.