This paper introduces TIRAMISU, a polyhedral framework designed to generate high performance code for multiple platforms including multicores, GPUs, and distributed machines. TIRAMISU introduces a scheduling language with novel commands to explicitly manage the complexities that arise when targeting these systems. The framework is designed for the areas of image processing, stencils, linear algebra and deep learning. TIRAMISU has two main features: it relies on a flexible representation based on the polyhedral model and it has a rich scheduling language allowing fine-grained control of optimizations. TIRAMISU uses a four-level intermediate representation that allows full separation between the algorithms, loop transformations, data layouts, and communication. This separation simplifies targeting multiple hardware architectures with the same algorithm. We evaluate TIRAMISU by writing a set of image processing, deep learning, and linear algebra benchmarks and compare them with state-of-the-art compilers and hand-tuned libraries. We show that TIRAMISU matches or outperforms existing compilers and libraries on different hardware architectures, including multicore CPUs, GPUs, and distributed machines.

IMPORTANCE Individuals with behavioral disorders are increasingly presenting to the emergency department (ED), and associated episodes of agitation can cause significant safety threats to patients and the staff caring for them. Treatment includes the use of physical restraints, which may be associated with injuries and psychological trauma; to date, little is known regarding the perceptions of the use of physical restraint among individuals who experienced it in the ED. OBJECTIVE To characterize how individuals experience episodes of physical restraint during their ED visits. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured, 1-on-1, in-depth interviews were conducted with 25 adults (ie, aged 18 years or older) with a diverse range of chief concerns and socioeconomic backgrounds who had a physical restraint order associated with an ED visit. Eligible visits included those presenting to 2 EDs in an urban Northeast MAIN OUTCOMES AND MEASURES Basic participant demographic information, self-reported responses to the MacArthur Perceived Coercion Scale, and experiences of physical restraint in the ED. RESULTS Data saturation was reached with 25 interviews (17 [68%] men; 18 [72%] white; 19 [76%]non-Hispanic). The time between the patient's last restraint and the interview ranged from less than 2 weeks to more than 6 months. Of those interviewed, 22 (88%) reported a combination of mental illness and/or substance use as contributing to their restraint experience. Most patients (20 [80%]) said that they felt coerced to present to the ED. Three primary themes were identified from interviews, as follows: (1) harmful experiences of restraint use and care provision, (2) diverse and complex personal contexts affecting visits to the ED, and (3) challenges in resolving their restraint experiences, leading to negative consequences on well-being. CONCLUSIONS AND RELEVANCEIn this qualitative study, participants described a desire for compassion and therapeutic engagement, even after they experienced coercion and physical restraint during their visits that created lasting negative consequences. Future work may need to consider more patient-centered approaches that minimize harm. Findings This qualitative study of 25 patients who were physically restrained in the emergency department found the 3 following major themes: harmful experiences of restraint use and care provision, diverse and complex personal contexts affecting visits to the emergency department, and challenges in resolving their restraint experiences, leading to negative consequences on well-being. Meaning Results of this study suggest that the participants in this study desired compassion and therapeutic engagement during physical restraint, warranting further attention to patientcentered approaches and coercionreduction techniques that fit with the needs of emergency care.

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In-situ simulation can be used to improve reliability and safety especially in areas of high risk, and in high-stress environments. It is also a reasonable and attractive alternative for programs that want to conduct interdisciplinary simulations for their trainees and faculty, and for those who do not have access to a fully functional simulation center. Further research needs to be done in assessing effectiveness of training using this method and the effect of such training on clinical outcomes.

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