An outreach programme for patients with an exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is a common clinical condition characterised by airflow obstruction. The clinical course of the disease is characterised by intermittent exacerbations. In Ireland exacerbations of chronic obstructive pulmonary disease are a common cause of admission to acute medical hospitals. The Beaumont Hospital COPD Outreach Programme was designed to provide care at home for patients with an exacerbation of COPD that would otherwise require hospitalisation. Patients recruited to the programme were discharged home within 72 hours of admission and reviewed by the Outreach Team over a two week period. In addition to monitoring clinical progress the Team provided education, smoking cessation and medication advice. Analysis of the outcome of the first 100 patients recruited to the study show that one third of patients admitted to Hospital with an exacerbation of COPD are eligible for this programme and the average length of Hospital stay was 2.6 days. During the fourteen day follow up there was one death (non-respiratory) and six patients were re-admitted to hospital. Forty percent of smokers had abstained from smoking at the end of three months. In summary, the COPD Outreach programme is a safe and effective alternative to acute hospital care for selected patients with exacerbations of COPD.

Self-deception in an evolutionary game.

From the perspective of philosophy, the idea of humans lying to themselves seems irrational and maladaptive, if even possible. However, the paradigm of cognitive modularity admits the possibility of self-deception. Trivers argues that self-deception can increase fitness by improving the effectiveness of inter-personal deception. Ramachandran criticizes Trivers' conjecture, arguing that the costs of self-deception outweigh its benefits. We first modify a well-known cognitive modularity model of Minsky to formalize a cognitive model of self-deception. We then use Byrne's multi-dimensional dynamic character meta-model to integrate the cognitive model into an evolutionary hawk-dove game in order to investigate Trivers' and Ramachandran's conjectures. By mapping the influence of game circumstances into cognitive states, and mapping the influence of multiple cognitive modules into player decisions, our cognitive definition of self-deception is extended to a behavioral definition of self-deception. Our cognitive modules, referred to as the hunger and fear daemons, assess the benefits and the cost of competition and generate player beliefs. Daemon-assessment of encounter benefits and costs may lead to inter-daemonic conflict, that is, ambivalence, about whether or not to fight. Player-types vary in the manner by which such inter-daemonic conflict is resolved, and varieties of self-deception are modeled as type-specific conflict-resolution mechanisms. In the display phase of the game, players signal to one another and update their beliefs before finally committing to a decision (hawk or dove). Self-deception can affect player beliefs, and hence player actions, before or after signaling. In support of Trivers' conjecture, the self-deceiving types do outperform the non-self-deceiving type. We analyse the sensitivity of this result to parameters of the cognitive model, specifically the cognitive resolution of the players and the influence of player signals on co-player beliefs.