Fuzzy Logic in Health Care Settings: Moral Math for Value-Laden Choices

This essay is intended as an example of “moral math”, i.e., ideas culled from mathematics which can positively impact social behavior. Specifically, it combines fuzzy logic with the ethical decisions which hospital staff and others are sometimes forced to make about health care (e.g., euthanasia issues following Hurricane Katrina). The assumption is that such decisions involve value-laden choices which lend themselves to “fuzzy” or “smart” protocols. The article discusses the history of fuzzy logic – what it is, how it is used, and how it might be even better-used as a support basis for making difficult choices in the health care setting

A Workshop to Introduce Concepts of Moral Math

Moral Math refers to the study of ideas drawn from mathematics which can positively impact moral decision-making and social behavior. This essay describes a workshop designed to introduce these ideas to interested individuals of varying degrees of mathematical and theological sophistication. Created by a retired minister and former math professor, the workshop details five sets of interactive exercises culled from game theory, theoretical complexity, fuzzy logic, basic algebra, and simple arithmetic. Exercises are user-friendly, interactive, and easily related by analogy to various social issues

Cluster randomised comparison of the effectiveness of 100% oxygen versus titrated oxygen in patients with a sustained return of spontaneous circulation following out of hospital cardiac arrest : a feasibility study. PROXY: post ROSC OXYgenation study

Background Hyperoxia following out of hospital cardiac arrest (OHCA) is associated with a poor outcome. Animal data suggest the first hour post resuscitation may be the most important. In the UK the first hour usually occurs in the prehospital environment. Methods A prospective controlled trial, cluster randomised by paramedic, comparing titrated oxygen with 100% oxygen for the first hour after return of spontaneous circulation (ROSC) following OHCA. The trial was done in a single emergency medical services (EMS) system in the United Kingdom (UK) admitting patients to three emergency departments. This was a feasibility trial to determine whether EMS staff (UK paramedics) can be successfully recruited and deliver the intervention. Results One hundred and fifty seven paramedics were approached and 46 (29%) were consented, randomised and trained. During the study period 624 patients received a resuscitation attempt. A study paramedic was in attendance at 73 (12%) of these active resuscitations. Thirty-five patients were recruited to the trial, 32 (91%) were transported to hospital and 13 (37%) survived to 90 days. The intervention was initiated in 27/35 (77%) of enrolled patients. A reliable oxygen saturation trace was obtained in 22/35 (69%) of patients. Data collection was complete in 33/35 (94%) of patients. Conclusions It may be feasible to complete a randomised trial of titrated versus unrestricted oxygen in the first hour after ROSC following OHCA in the UK. However, the relatively few eligible patients and incomplete initiation of the allocated intervention are challenges to future research

Spirit-Wise Math: Two Examples from a Collection of Mathaphors

This article consists of two examples of loosely spiritual insights drawn from mathematics, both of which are from a work-in-progress -- a collection of mathematical metaphors

Quik Church, Route 3.141592

The following set of poems are from one of ten sections in a collection of poetry called Quik Church: Short Poems that Travel Far. Each section illustrates one of many “streets” which individuals often take on their spiritual journey through life, e.g., the Old Gods Path, Nature Trail, Memory Skyway, Mystic Avenue, Pastoral Lane, and so on. This one, Route 3.141592, is the route of mathematics and the science that depends on mathematics

Mathaphor as a Literary Tool

Drawing from one of my recent sermons, I chart the path of mathaphor (metaphor drawn from mathematics) as a literary tool. Following a short history of the concept, I detail contemporary author Colum McCann’s significant use of a geometric term to unveil and encourage compassion

Simple Arithmetic: Heavy on Butter, Cream, Wine

The language of poetry is one way to offer perspective on ethical issues and social behavior. The language of mathematics is another. The piece herein combines both these ways

Insulin resistance is higher in prepubertal girls but switches to become higher in boys at age 16:A Cohort Study (EarlyBird 57)

Background: The risk of type 2 diabetes is increasing in teenage girls, and is associated with their greater insulin resistance (IR).Hypothesis: We hypothesized that the adverse metabolic profile of girls (compared with boys) would persist from childhood through adolescence.Patients and Methods: Community-based longitudinal cohort of 292 children (147 boys) studied annually from 9 to 16 years.Measures: IR (homeostasis-model-assessment-2), high-density lipoprotein-cholesterol (HDL-C), triglycerides, % body-fat (dual-energy x-ray absorptiometry), pubertal stage (age at peak height velocity), physical activity (accelerometry). Multi-level modelling established the age-related trends in IR and lipids and the influence of covariates.Results: Each year from 9 to 15 years, girls had 21% to 63% higher IR than boys (girls mean IR 0.73-1.33, boys 0.51-0.89, P &lt; .005). At 16 years the gender difference was not significant (girls IR 0.60, boys 0.56, P = .45). Girls had lower HDL-C from 9 to 12 years, higher triglycerides from 9 to 14 years, greater adiposity throughout, and earlier puberty, but boys were more active than girls (all P &lt; .05). After adjustment for %-fat, puberty and activity, the gender difference in IR between girls and boys aged 9 to 15 years became non-significant (IR girls 0.66-1.01, boys 0.65-1.04, P &gt; .07). However, after adjustment at 16 years, girls' IR was 25% lower than boys' (girls 0.44, boys 0.63, P = .001), and they had 22% higher HDL-C (P &lt; .001) and 20% lower triglycerides (P = .003).Conclusions: The higher IR of prepubertal and early pubertal girls diminishes during late puberty, and boys begin to exhibit greater metabolic risk. Despite being leaner and more active, boys at 16 years have higher IR than girls, suggesting future higher risk for diabetes, thus we reject our hypothesis.</p

School Counselors Treating Anxiety in Public School Settings: A Group Manual

As anxiety becomes more prevalent in children and adolescents, the demand for mental health resources has also increased. School counselors are highly trained mental health professionals who could be one of the answers to help close the gap of the demand for mental health resources. This review aims to analyze the benefits and effectiveness of school counselors treating anxiety in public school settings by utilizing small group interventions. Most public school settings have school counselors available for students, which is an opportunity for school counselors to provide mental health services. Several research studies have been conducted on this topic, showing benefits of school counselors treating anxiety. This review will analyze different therapies and strategies used to treat anxiety in public school settings such as cognitive behavioral therapy and small group interventions. It is important to note that depending on the school district in which the school counselor is employed, the administration may require tasks that interfere with the amount of time in the day to implement mental health treatments. Keywords: Anxiety, School Counselors, Cognitive Behavioral Therap

Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome

Importance The optimal approach to airway management during out-of-hospital cardiac arrest is unknown. Objective To determine whether a supraglottic airway device (SGA) is superior to tracheal intubation (TI) as the initial advanced airway management strategy in adults with nontraumatic out-of-hospital cardiac arrest. Design, Setting, and Participants Multicenter, cluster randomized clinical trial of paramedics from 4 ambulance services in England responding to emergencies for approximately 21 million people. Patients aged 18 years or older who had a nontraumatic out-of-hospital cardiac arrest and were treated by a participating paramedic were enrolled automatically under a waiver of consent between June 2015 and August 2017; follow-up ended in February 2018. Interventions Paramedics were randomized 1:1 to use TI (764 paramedics) or SGA (759 paramedics) as their initial advanced airway management strategy. Main Outcomes and Measures The primary outcome was modified Rankin Scale score at hospital discharge or 30 days after out-of-hospital cardiac arrest, whichever occurred sooner. Modified Rankin Scale score was divided into 2 ranges: 0-3 (good outcome) or 4-6 (poor outcome; 6 = death). Secondary outcomes included ventilation success, regurgitation, and aspiration. Results A total of 9296 patients (4886 in the SGA group and 4410 in the TI group) were enrolled (median age, 73 years; 3373 were women [36.3%]), and the modified Rankin Scale score was known for 9289 patients. In the SGA group, 311 of 4882 patients (6.4%) had a good outcome (modified Rankin Scale score range, 0-3) vs 300 of 4407 patients (6.8%) in the TI group (adjusted risk difference [RD], −0.6% [95% CI, −1.6% to 0.4%]). Initial ventilation was successful in 4255 of 4868 patients (87.4%) in the SGA group compared with 3473 of 4397 patients (79.0%) in the TI group (adjusted RD, 8.3% [95% CI, 6.3% to 10.2%]). However, patients randomized to receive TI were less likely to receive advanced airway management (3419 of 4404 patients [77.6%] vs 4161 of 4883 patients [85.2%] in the SGA group). Two of the secondary outcomes (regurgitation and aspiration) were not significantly different between groups (regurgitation: 1268 of 4865 patients [26.1%] in the SGA group vs 1072 of 4372 patients [24.5%] in the TI group; adjusted RD, 1.4% [95% CI, −0.6% to 3.4%]; aspiration: 729 of 4824 patients [15.1%] vs 647 of 4337 patients [14.9%], respectively; adjusted RD, 0.1% [95% CI, −1.5% to 1.8%]). Conclusions and Relevance Among patients with out-of-hospital cardiac arrest, randomization to a strategy of advanced airway management with a supraglottic airway device compared with tracheal intubation did not result in a favorable functional outcome at 30 days