Sepsis and Presidential Initiatives.

Critical Care Medicine www.ccmjournal. org 1963 July 29, 2016 marked the one-year anniversary of the President’s signing of the Executive Order establishing the National Strategic Computing Initiative (NSCI) (1). The NSCI is a long-term effort seeking a whole-of-government approach to draw upon the breadth of federal investments in the high-performance computing (HPC) ecosystem of people, software, and hardware to address national priorities. HPC has typically used numerical techniques to simulate particularly complex natural and technological systems, such as galaxies, climate, molecular interactions, electric power grids, and aircraft in flight. HPC can be contrasted with more conventional computing in that the former pushes the limits in capturing competing phenomena from the most granular and rapid to the largest and most collective behaviors with attention on how much trust can be associated with the results. In the coming generation of machines, calculations at scale will be complemented with entirely new abilities to address, learn, and predict from large, noisy, and heterogeneous data. A familiar-to-all example illustrating the value of HPC versus conventional computing is contemporary weather prediction. In decades past, predictions relied on sparse data and “average” models running on conventional computers. The forecasts were relatively unreliable more than a few hours in advance and at resolutions finer than 100 miles. In contrast, contemporary HPC-enabled forecasts use massive data flows from satellites, aircraft, and surface observations fed into detailed models that enable forecasting hours to days in advance. The forecasts have sufficiently high resolution and sufficient reliability that personal decisions about work, recreation, navigation, and protection and can often be set days in advance. The NSCI recognizes that federal investments in HPC have, to date, been driven by the specific missions of individual federal agencies. As a consequence, there has been unevenness in the application of supercomputing and simulation tools to complex problems. The NSCI creates a means to take an active step to identify opportunities to move forward collaborative projects agnostic to individual agencies. NSCI in fact creates a means to bring together whole-of-government, academia, and private industry as a nation toward solutions of the most vexing problems. At the White House event marking the first year of NSCI— an event that paralleled the anniversary marking of the Precision Medicine Initiative (PMI) (2) earlier in 2016—specialists drawn from diverse medical disciplines were invited to dialog on the intersection of supercomputing and their respective clinical challenges. The sepsis community and the biopharmaceutical sector were well represented. To this end, attendees and their local colleagues continue to explore partnerships that intersect the NSCI, the PMI and, most currently, the Vice President’s Cancer Moonshot (3). As one of the lead agencies for the NSCI, the Department of Energy (DOE) has been exploring how to best address selected cross-disciplinary opportunities, especially those involving the safety and health of the nation. The DOE is especially suited to this task. DOE missions from energy and climate, to nuclear and national security, can only be informed today through increasingly sophisticated high-performance computing approaches coupled with exquisite experimental validation. The DOE’s mission responsibilities often have demonstrable complexities and uncertainties, are recalcitrant to direct measurement, and may not have experimental paradigms. Despite this, decisions need to be made. This has led to the development of a rich ecosystem of people, applications, and hardware that has developed computer models of complex national scale challenges. Solving for these complex priorities is achieved through a tight partnership between computer scientists and engineers with leaders in the disciplines all aligned with a common goal. Recall the DOE’s leadership in the most impactful Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.0000000000002146 Mitchell Cohen, MD Denver Health Medical Center and the University of Colorado School of Medicine Denver, CO