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Supplemental Digital Content is available in the text., Objectives: There has been controversy about the timing and indications for intubation and mechanical ventilation in novel coronavirus disease 2019. This study assessed the effect of early intubation and mechanical ventilation on all-cause, inhospital mortality for coronavirus disease 2019 patients. Design: Multicenter retrospective cohort study. Setting: Eleven municipal hospitals in New York City from March 1, 2020, to December 1, 2020. Patients: Adult patients who tested positive for coronavirus disease 2019 in the emergency department were subsequently admitted. Patients with do-not-intubate orders at admission were excluded. Interventions: Intubation within 48 hours of triage and intubation at any point during hospital stay. Measurements and Main Results: Data from 7,597 coronavirus disease 2019 patients were included; of these, 1,628 (21%) were intubated overall and 807 (11%) were intubated within 48 hours of triage. After controlling for available confounders, intubation rates for coronavirus disease 2019 patients varied significantly across hospitals and decreased steadily as the pandemic progressed. After nearest neighbor propensity score matching, intubation within 48 hours of triage was associated with higher all-cause mortality (hazard ratio, 1.30 [1.15–1.48]; p < 0.0001), as was intubation at any time point (hazard ratio, 1.62 [1.45–1.80]; p < 0.0001). Among intubated patients, intubation within 48 hours of triage was not significantly associated with differences in mortality (hazard ratio, 1.09 [0.94–1.26]; p = 0.26). These results remained robust to multiple sensitivity analyses. CONCLUSIONS: Intubation within 48 hours of triage, as well as at any time point in the hospital course, was associated with increased mortality in coronavirus disease 2019 patients in this observational study.

We motivate a picture of social epistemology that sees forgetting as subject to epistemic evaluation. Using computer simulations of a simple agent-based model, we show that how agents forget can have as large an impact on group epistemic outcomes as how they share information. But, how we forget, unlike how we form beliefs, isn’t typically taken to be the sort of thing that can be epistemically rational or justified. We consider what we take to be the most promising argument for this claim and find it lacking. We conclude that understanding how agents forget should be as central to social epistemology as understanding how agents form beliefs and share information with others.

A number of formal models, including a highly influential model from Hong and Page, purport to show that functionally diverse groups often beat groups of individually high-performing agents in solving problems. Thompson argues that in Hong and Page’s model, that the diverse groups are created by a random process explains their success, not the diversity. Here, I defend the diversity interpretation of the Hong and Page result. The failure of Thompson’s argument shows that to understand the value of functional diversity, we should be clearer about how we conceive of and measure that diversity.

The Hong and Page ‘diversity trumps ability’ result has been used to argue for the more general claim that a diverse set of agents is epistemically superior to a comparable group of experts. Here we extend Hong and Page’s model to landscapes of different degrees of randomness and demonstrate the sensitivity of the ‘diversity trumps ability’ result. This analysis offers a more nuanced picture of how diversity, ability, and expertise may relate. Although models of this sort can indeed be suggestive for diversity policies, we advise against interpreting such results overly broadly.

Epistemic justifications for democracy have been offered in terms of two different forms of information aggregation and decision-making. The Condorcet Jury Theorem is appealed to as a justification in terms of votes, and the Hong–Page ‘diversity trumps ability’ result is appealed to as a justification in terms of deliberation in the form of collaborative search. Both results, however, are models of full and direct participation across a population. In this paper, we contrast how these results hold up within the familiar structure of a representative hierarchy. We first consider extant analytic work that shows that representation inevitably weakens the voting results of the Condorcet Jury Theorem. We then go on to show that collaborative search, as modeled by Hong and Page, holds its own within hierarchical representation. In a variation on the dynamics of group search, representation even shows a slight edge over direct participation. This contrast illustrates how models of information aggregation vary when put into a representative structure. While some of the epistemic merits of democracy are lost when voting is done hierarchically, modeling results show that representation can preserve and even slightly amplify the epistemic virtues of collaborative search.

Recent rejections of epistemic consequentialism, like those from Firth, Jenkins, Berker, and Greaves, have argued that consequentialism is committed to objectionable trade-offs and suggest that con...

Sympathetic Crashing Acute Pulmonary Edema (SCAPE) describes patients who present with acute hypertensive cardiogenic pulmonary edema. These patients present in respiratory distress, and requiring immediate medical and airway management. The treatment of SCAPE includes non-invasive positive pressure ventilation (NIPPV) to maintain oxygenation, and high dose nitrates to lower blood pressure and reduce afterload. We present a case report of a patient with refractory hypertension to high dose nitrates likely due to nitroglycerin resistance or an attenuated response. The addition of nicardipine led to marked clinical improvement, normalized blood pressure and spared the patient from endotracheal intubation and admission to the intensive care unit.

Polarization is a topic of intense interest among social scientists, but there is significant disagreement regarding the character of the phenomenon and little understanding of underlying mechanics. A first problem, we argue, is that polarization appears in the literature as not one concept but many. In the first part of the article, we distinguish nine phenomena that may be considered polarization, with suggestions of appropriate measures for each. In the second part of the article, we apply this analysis to evaluate the types of polarization generated by the three major families of computational models proposing specific mechanisms of opinion polarization.

This article aims to describe the last 10 years of the collaborative scientific endeavors on polarization in particular and collective problem-solving in general by our multidisciplinary research team. We describe the team's disciplinary composition-social psychology, political science, social philosophy/epistemology, and complex systems science-highlighting the shared and unique skill sets of our group members and how each discipline contributes to studying polarization and collective problem-solving. With an eye to the literature on team dynamics, we describe team logistics and processes that we believe make our multidisciplinary team persistent and productive. We emphasize challenges and difficulties caused by disciplinary differences in terms of terminology, units/levels of analysis, methodology, and theoretical assumptions. We then explain how work disambiguating the concepts of polarization and developing an integrative theoretical and methodological framework with complex systems perspectives has helped us overcome these challenges. We summarize the major findings that our research has produced over the past decade, and describe our current research and future directions. Last, we discuss lessons we have learned, including difficulties in a "three models" project and how we addressed them, with suggestions for effective multidisciplinary team research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This article distinguishes nine senses of polarization and provides formal measures for each one to refine the methodology used to describe polarization in distributions of attitudes. Each distinct concept is explained through a definition, formal measures, examples, and references. We then apply these measures to GSS data regarding political views, opinions on abortion, and religiosity—topics described as revealing social polarization. Previous breakdowns of polarization include domain-specific assumptions and focus on a subset of the distribution’s features. This has conflated multiple, independent features of attitude distributions. The current work aims to extract the distinct senses of polarization and demonstrate that by becoming clearer on these distinctions we can better focus our efforts on substantive issues in social phenomena.

Background In a constantly increasing world of opioid addiction, naloxone has become a topic of great discussion and use. With seemingly minimal side effects, naloxone has become one of the most wellknown and widely used reversal agents for opioid intoxication. While more common effects of using naloxone include agitation, abdominal cramps, piloerection, diarrhea, nausea, and yawning, lesser known side effects involve muscle spasms, flushing, hyperreflexia in neonates, and seizures. This case study demonstrates a side effect of rigidity secondary to IV naloxone that has not previously been documented. Case A 56 year old man was brought in by EMS after being found unresponsive in a car with a bag of drugs beside him. He was given 0.5 mg naloxone IV by EMS and immediately brought to the hospital. On arrival, the pt was noted to have tight rigidity of his upper extremities, with severe flexion. This presentation was not noted before the delivery of naloxone by EMS. Conclusions While this case highlights a patient with a rare side effect of naloxone, it reminds physicians that all medications come with a cost. Of course, ABCs remain the highest priority of resuscitation, however when administering a medication to reverse a drug overdose, it is important to keep in mind all possible consequences of said agent. Recognizing that complete muscle rigidity may remain a result of naloxone administration allows physicians to perhaps save patients from further medical workup.

Understanding the dynamics of information is crucial to many areas of research, both inside and outside of philosophy. Using computer simulations of three kinds of information, germs, genes, and memes, we show that the mechanism of information transfer often swamps network structure in terms of its effects on both the dynamics and the fitness of the information. This insight has both obvious and subtle implications for a number of questions in philosophy, including questions about the nature of information, whether there is genetic information, and how to arrange scientific communities.

The traditional solutions to the Sleeping Beauty problem say that Beauty should have either a sharp 1/3 or sharp 1/2 credence that the coin flip was heads when she wakes. But Beauty’s evidence is incomplete so that it doesn’t warrant a precise credence, I claim. Instead, Beauty ought to have a properly imprecise credence when she wakes. In particular, her representor ought to assign \(R(H\!eads)=[0,1/2]\). I show, perhaps surprisingly, that this solution can account for the many of the intuitions that motivate the traditional solutions. I also offer a new objection to Elga’s restricted version of the principle of indifference, which an opponent may try to use to collapse the imprecision.

Prior to 2001 there was no standard for early management of severe sepsis and septic shock in the emergency department. In the presence of standard or usual care, the prevailing mortality was over 40-50 %. In response, a systems-based approach, similar to that in acute myocardial infarction, stroke and trauma, called early goal-directed therapy was compared to standard care and this clinical trial resulted in a significant mortality reduction. Since the publication of that trial, similar outcome benefits have been reported in over 70 observational and randomized controlled studies comprising over 70,000 patients. As a result, early goal-directed therapy was largely incorporated into the first 6 hours of sepsis management (resuscitation bundle) adopted by the Surviving Sepsis Campaign and disseminated internationally as the standard of care for early sepsis management. Recently a trio of trials (ProCESS, ARISE, and ProMISe), while reporting an all-time low sepsis mortality, question the continued need for all of the elements of early goal-directed therapy or the need for protocolized care for patients with severe and septic shock. A review of the early hemodynamic pathogenesis, historical development, and definition of early goal-directed therapy, comparing trial conduction methodology and the changing landscape of sepsis mortality, are essential for an appropriate interpretation of these trials and their conclusions.

In the original publication of the article, the Acknowledgement section was inadvertently not included. The Acknowledgement is given in this Correction.

A scientific community can be modeled as a collection of epistemic agents attempting to answer questions, in part by communicating about their hypotheses and results. We can treat the pathways of scientific communication as a network. When we do, it becomes clear that the interaction between the structure of the network and the nature of the question under investigation affects epistemic desiderata, including accuracy and speed to community consensus. Here we build on previous work, both our own and others’, in order to get a firmer grasp on precisely which features of scientific communities interact with which features of scientific questions in order to influence epistemic outcomes.Here we introduce a measure on the landscape meant to capture some aspects of the difficulty of answering an empirical question. We then investigate both how different communication networks affect whether the community finds the best answer and the time it takes for the community to reach consensus on an answer. We measure these two epistemic desiderata on a continuum of networks sampled from the Watts–Strogatz spectrum. It turns out that finding the best answer and reaching consensus exhibit radically different patterns. The time it takes for a community to reach a consensus in these models roughly tracks mean path length in the network. Whether a scientific community finds the best answer, on the other hand, tracks neither mean path length nor clustering coefficient.

Public health care interventions-regarding vaccination, obesity, and HIV, for example-standardly take the form of information dissemination across a community. But information networks can vary importantly between different ethnic communities, as can levels of trust in information from different sources. We use data from the Greater Pittsburgh Random Household Health Survey to construct models of information networks for White and Black communities--models which reflect the degree of information contact between individuals, with degrees of trust in information from various sources correlated with positions in that social network. With simple assumptions regarding belief change and social reinforcement, we use those modeled networks to build dynamic agent-based models of how information can be expected to flow and how beliefs can be expected to change across each community. With contrasting information from governmental and religious sources, the results show importantly different dynamic patterns of belief polarization within the two communities.

Complement activation is increased in Alzheimer's disease (AD) and may contribute to the development and progression of this disorder. To compare early complement activation between normal and AD brain specimens, C4d and iC3b concentrations were measured in hippocampus, entorhinal cortex, temporal cortex, parietal cortex, and cerebellum from aged normal and AD subjects n=10-14 for both), and in hippocampus and entorhinal cortex from younger normal subjects (n=5-6). C4d and iC3b levels increased 2.3- to 4.6-fold in AD versus aged normal specimens (all P

Recently, scholars have been investigating the hidden moral and political valence of apparently non-political forms of communication, by looking at how certain prima facie harmless uses of language can spread prejudice and contribute to social injustice. In this chapter I argue that while analyses such as Langton’s convincingly explain how descriptive contents are transmitted and can contribute to belief formation and knowledge transmission, a different model is required to satisfactorily account for value judgments. I submit that while individuals can come to believe and, in the good cases, know certain descriptive facts about the world only based on what others tell them, testimony cannot transmit evaluative contents in the same way. Informative evaluative presupposition contributes to the creation of beliefs and knowledge, but it does not determine them in the way in which testimony typically works with descriptive contents: I argue for this claim by examining taste, moral and aesthetic value judgments. My point does not undermine the idea that presupposing certain value contents may affect one’s audience, but challenges the idea that testimony is the right notion to account for how value talk can spread and impose contents on the participants to a conversation.