The odds that patients in the ED with sepsis who do not require life support therapies will be admitted to the ICU are reduced when those ICUs experience high occupancy but not high levels of other previously explored measures of capacity strain. Patients with sepsis admitted to the wards during times of high ICU occupancy had increased odds of hospital mortality.

Rotations about its three carbon-nitrogen bonds give triethylamine a complex, 3-dimensional potential energy landscape of conformeric structures. Electronic excitation to Rydberg states prepares the molecule in a high-energy, nonequilibrium distribution of such conformers, initiating ultrafast transitions between them. Time-resolved Rydberg electron binding energy spectra, observed using photoionization-photoelectron spectroscopy with ultrashort laser pulses, reveal these time-evolving structures. The time-dependent structural fingerprint spectra are assigned with the aid of a computational analysis of the potential energy landscape. Upon 209 nm electronic excitation to the 3p Rydberg state, triethylamine decays to 3s with a 200 fs time constant. The initially prepared conformer reacts to a mixture of structures with a time constant of 232 fs and settles into a final geometry distribution on a further subpicosecond time scale. The binding energy of the Rydberg electron is found to be an important determinant of the conformeric energy landscape.

IMPORTANCE There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care. OBJECTIVE To examine whether default options in ADs influence care choices and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 515 patients who met criteria for having serious illness and agreed to participate. Patients were enrolled at 20

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