Prevention, recognition, diagnosis and treatment of acute illness remain formidable challenges. The conventional view of illness, namely that disease states correspond to mechanistic failure and therefore can be reliably remedied with a specific appropriate intervention, persists in medical teaching and medical practice. SCAI offers a complementary perspective. A century and a half of physiology, including the clinical applications of physiology at the bedside of critically ill patients, have shown us that health is not a single state but rather a collection of states that can be robustly accessed as adaptive responses to an ever-changing environment.
SCAI and its members hold that acute and critical illness are better interpreted in the context of complex systems science in which both health and illness are emergent

phenomena and moreover that robustness derives as much from organization and dynamics as it does from engineered and purpose-specific corrective mechanisms.

The perspective is important to SCAI’s members and also to the public. For our members, SCAI is the leading global forum for complex systems science in the context of acute illness. It is the only forum that convenes mathematicians, modelers, complex systems scientists, bench researchers, bedside clinicians and industry partners to explore the latest advances and discuss future strategies.
It is a crucial vehicle for fostering collaborations across an especially broad spectrum of sciences and disciplines. For our biomedical colleagues and for the public, SCAI offers a fresh and important point of view.

Discovery and bedside application of complex systems principles should allow early recognition of deteriorating trajectories, rational interventions and timely and accurate predictions of outcomes for individual patients. That, in turn, should allow for better care, better outcomes and lower healthcare costs. Over the next five years, SCAI will take the complex systems perspective into the mainstreams of research and of the practice of medicine. My goal is to support the organization and its members in this effort.

The formative years of my science education were characterized by a paradox: my mentors were generalists at a time before “Systems Biology” existed as a term, yet they carried out reductionist, hypothesis-driven research on various aspects of inflammation, which we all know to be central to the pathology of acute illness. Seven years ago I embarked on a road to help unravel this complexity, as part of a collaborative team at the University of Pittsburgh and in other institutions. Our work led us to form the Society for Complexity in Acute Illness (SCAI), and I can say with much pride and joy that this process has resulted in a groundswell of enthusiasm, creative energy, and novel insights. As the first SCAI Secretary and ICCAI co-organizer, I helped move us along the first, necessary steps as scientific society.

However, I feel that SCAI is at a crossroads.

We have achieved sufficient success to stand on our own as a scientific society, but still require vigorous and energetic leadership in order to advance the goal of bringing complex systems methods to the field of acute illness. As Vice President of SCAI, I would advocate for a clear set of mandates to be pursued by the Society during the coming three years.

These goals would be solicited from the membership, since the priorities are different in the different countries in which we live.

My own priority is the goal of expanding the nascent work done on Translational Systems Biology in acute illness. Simply stated, Translational Systems Biology is a framework in which translational rather than basic insights are primary, mathematical models are designed to facilitate in silico clinical trials, simulations are appropriate for in vivo validation, and mechanistic simulations of whole-organism responses guide “-omics” studies. I would work with the President and SCAI Officers to expand the programmatic reach of SCAI, to increase the visibility of SCAI in the academic, commercial, and government arenas, and to increase our funding base in order to assure our long-term future.

I have been interested in the application of complex systems analysis to sepsis and inflammation since 1999, working primarily with using agent based modeling (ABM) to create mechanistic models of the acute inflammatory response.
Coming from a clinical viewpoint, without a formal research background, I was prompted by my frustrations in treating my septic patients to try and understand what issues were at the core of the challenge of translating basic science knowledge into effective clinical regimens.
Little did I know that there was a revolution occurring in the field of scientific inquiry, driven by the same realization that the behavior of the whole was more than the sum of its parts, that there was an essential quality of the "system" that was lost when the system was taken apart.

However, as a scientist, I could not accept the semi-mystical "throwing-up-of-the-hands" that so often accompanies discussion of "complex systems."

Complexity is not a dead end of understanding; it is an entrance ramp to new paths of discovery. We must use the tools that we have, often in new ways, to find our way, and if the tools do not yet exist, we must learn how to further their making.

I believe the Society for Complexity in Acute Illness is evidence of the potential of this new roadmap. The multidisciplinary approaches that meld the basic researcher, the mathematician, the computer scientist and the clinician are fostered in the SCAI environment. Discussion supersedes dogma, discovery over doctrine, development above dictates. We should lead by the quality of our ideas; justify that leadership by the strength of our accomplishments.
I am proud to have been one of the founding members of SCAI, and hope to now to continue to serve this organization and further its development as one of its officers.

The Society for Complexity in Acute Illness is at a critical juncture. SCAI plays a unique and important role that has not been picked up by any of the larger scientific societies regrouping critical care professionals namely, bring sophisticated quantitative science at the bedside. Yet, SCAI’s existence is fragile and would be greatly solidified if SCAI could count on a more robust income stream from interested constituents, individuals and corporations. I am proposing an improved financial structure, improved communication with SCAI members, and a systematic exploration of corporate sources of sponsorship fro SCAI. These measures would go a long way in assuring a healthier collaboration with our preferred scientific outlet, the Journal of Critical Care, our current and future

corporate members and importantly, in setting the financing of our yearly meeting, ICCAI, on more solid grounds.

Some of specific things I propose are meant to assure current membership, increase SCAI membership, and greatly increase investment of corporations directly in SCAI, Specifically, I believe SCAI should introduce credit card payments of dues, direct mailing to members of reminders on SCAI letterhead, direct representations to potential

corporate members, direct publicity via existing mailing lists of both quantitative and clinical communities.