Some risk exposures, including many medical and surgical procedures, typically carry hazards of death that are difficult to convey and appreciate in absolute terms. I propose presenting the death risk as a condensed life experience (i.e., the equivalent amount of life T that would carry the same cumulative mortality hazard for a person of the same age and sex based on life tables). For example, if the risk of death during an elective 1-hour procedure is 0.01%, and same-age and same-sex people have a 0.01% death risk over 1 month, one can inform the patient that “this procedure carries the same death risk as living 1 month of normal life.” Comparative standards from other risky activities or from a person with the same disease at the same stage and same predictive profile could also be used. A complementary metric that may be useful to consider is the death intensity. The death intensity λ is the hazard function that shows the fold-risk estimate of dying compared with the reference person. The death intensity can vary substantially for different phases of the event, operation, or procedure (e.g., intraoperative, early postoperative, late postoperative), and this variability may also be useful to convey. T will vary depending on the time window for which it is computed. I present examples for calculating T and λ using literature data on accidents, ascent to Mount Everest, and medical and surgical procedures.
Fifty-eight cases of bacteremia due to Moraxella catarrhalis, including seven that occurred in patients treated at our facilities, are analyzed. The host's medical history plays a major role in the presentation and outcome of M. catarrhalis bacteremia. Bacteremia is typically accompanied by pneumonia in adults with underlying respiratory disease. Many neutropenic patients do not manifest a focus of infection; in contrast, the source identified in healthy, immunocompetent patients is usually the upper airway or the ears. In the recent literature, it has been reported that a rash is typically absent in adults with bacteremic pneumonia and in immunocompetent hosts and that only some neutropenic patients have a rash. The prognosis is grave for patients with endocarditis and for patients with immunoglobulin deficiency or neutropenia not related to a hematologic malignancy. In addition, mortality is substantial among bacteremic patients with respiratory conditions or other chronic debilities, especially when respiratory copathogens are present. The prognosis is good for febrile neutropenic patients with underlying leukemia or lymphoma when the neutropenia resolves. When healthy, immunocompetent individuals are affected with M. catarrhalis bacteremia, their presentations range from self-limited febrile illness to life-threatening disease.
In this paper we investigate possible ways to improve the energy efficiency of a general purpose microprocessor. We show that the energy of a processor depends on its performance, so we chose the energy-delay product to compare different processors. To improve the energy-delay product we explore methods of reducing energy consumption that do not lead to performance loss (i.e. wasted energy), and explore methods to reduce delay by exploiting instruction level parallelism. We found that careful design reduced the energy dissipation by almost 25%. Pipelining can give approximately a 2/spl times/ improvement in energy-delay product. Superscalar issue, however, does not improve the energy-delay product any further since the overhead required offsets the gains in performance. Further improvements will be hard to come by since a large fraction of the energy (50-80%) is dissipated in the clock network and the on-chip memories. Thus, the efficiency of processors will depend more on the technology being used and the algorithm chosen by the programmer than the micro-architecture.
Cache memories have become common across a wide range of computer implementations. To date, most analyses of cache performance have concentrated on time independent metrics, such as miss rate and traffic ratio. This paper presents a series of simulations that explore the interactions between various organizational decisions and program execution time. We investigate the tradeoffs between cache size and CPU/Cache cycle time, set associativity and cycle time, and between block size and main memory speed. The results indicate that neither cycle time nor cache size dominates the other across the entire design space. For common implementation technologies, performance is maximized when the size is increased to the 32KB to 128KB range with modest penalties to the cycle time. If set associativity impacts the cycle time by more than a few nanoseconds, it increases overall execution time. Since the block size and memory transfer rate combine to affect the cache miss penalty, the optimum block size is substantially smaller than that which minimizes the miss rate. Finally, the interdependence between optimal cache configuration and the main memory speed necessitates multi-level cache hierarchies for high performance uniprocessors.
Abstract Evidence‐based medicine and molecular medicine have both been influential in biomedical research in the last 15 years. Despite following largely parallel routes to date, the goals and principles of evidence‐based and molecular medicine are complementary and they should be converging. I define molecular evidence‐based medicine as the study of medical information that makes sense of the advances of molecular biological disciplines and where errors and biases are properly appreciated and placed in context. Biomedical measurement capacity improves very rapidly. The exponentially growing mass of hypotheses being tested requires a new approach to both statistical and biological inference. Multidimensional biology requires careful exact replication of research findings, but indirect corroboration is often all that is achieved at best. Besides random error, bias remains a major threat. It is often difficult to separate bias from the spirit of scientific inquiry to force data into coherent and ‘significant’ biological stories. Transparency and public availability of protocols, data, analyses and results may be crucial to make sense of the complex biology of human disease and avoid being flooded by spurious research findings. Research efforts should be integrated across teams in an open, sharing environment. Most research in the future may be designed, performed, and integrated in the public cyberspace.
