Intensive Care Unit Management of Meningitis and Encephalitis.

Excessive nitrogen runoff from agricultural and urban sources poses a significant threat to coastal ecosystems. Elevated dissolved inorganic nitrogen (DIN) levels contribute to algal blooms, hypoxia, and coral degradation, undermining the health and resilience of the reef system. In addition to land-based management, bivalve aquaculture has been proposed as a potential solution for mitigating nitrogen loads in coastal environments. However, studies assessing the suitability, scale, and potential benefits of such production for reducing impacts of nitrogen runoff are often lacking. This study evaluated the potential of bivalve aquaculture (tropical black-lipped oyster, (Saccostrea echinata)) to mitigate DIN loads using a case study of the Great Barrier Reef (GBR). By combining spatial information on environmental, biophysical, and socio-economic constraints, we identified 818.9km2 of suitable bivalve aquaculture area along Queensland's coastline. Developing just 43% (352.9km2) of the suitable area could remove 77.9% (4145tonnes) of the GBR's total anthropogenic load, closing the critical nutrient management gap left by currently insufficient land-based mitigation measures. Economically, this could translate to a potential AUD $809.7 million in oyster market value and AUD $871.6 million in Reef Credits for nitrogen annually. These findings highlight the potential for bivalve aquaculture to contribute meaningfully to regional water quality targets by complementing land-based management measures. Our model and results can inform planning and investment decisions by policymakers, regulators, and industry, both within Australia and in other coastal regions facing similar challenges of nitrogen pollution and climate-resilient food production.

Nitrogen removal mechanisms in duckweed-based stabilization tanks with and without aerobic zones and intermediate feeding stream.

Recovery of glass fiber from retired wind turbine blades based on low-temperature plasma assisted flotation.

Incorporating benthic microbial thresholds into ecological carrying capacity to sustain ecosystem services of coastal oyster farming.

ImportanceKlebsiella pneumoniae invasive liver abscess syndrome (ILAS) is an emerging disease characterized by liver abscess without biliary disease, often with multiorgan metastatic infection. It can cause severe critical illness with significant morbidity and disability. There remains limited literature and understanding of this syndrome in the United States.ObjectivesThis article aims to describe the clinical characteristics of hospitalized and critically ill patients with ILAS and providing management considerations for critical care clinicians.Main Outcomes and MeasuresAdult patients admitted to Scripps Health from Janurary 1, 2018 to April 1, 2024 were reviewed. Inclusion criteria required radiographic evidence of a liver abscess and cultures (blood or abscess) positive for K.pneumoniae. Data collected included demographics, symptoms and signs, laboratory and radiologic data, metastatic infection characteristics, treatment, mortality, and morbidity. Patient cases were described, and a narrative review describing clinical, therapeutic, and prognostic characteristics was conducted.ResultsSix patients had ILAS. Mean age was 54.8 years, no immunosuppression (defined as underlying malignancy, drug‐induced, or chronic infection), 83% had diabetes, 50% were male, and 50% were of Asian ethnicity. Liver abscesses were multilocular (50%), and all had percutaneous catheter drainage. Fifty percent of patients developed distant metastatic infections: emphysematous cystitis, pulmonary septic emboli, complicated parapneumonic pleural effusions, meningitis, ventriculitis, cerebral septic emboli, and endophthalmitis. These patients were younger, male, and had a higher rate of intensive care unit (ICU) admission and mechanical ventilation. Two patients required ICU admission with septic shock, diabetic ketoacidosis, respiratory failure, severe thrombocytopenia, and altered mental status. K. pneumoniae isolates were pansensitive except to ampicillin. There was no in‐hospital mortality. The patient with meningitis and ventriculitis had full neurological recovery, and the patient with endophthalmitis had very poor residual visual acuity.Conclusions and RelevanceILAS is an emerging disease that can cause severe critical illness with multiorgan involvement. Early identification of the disease and metastatic infection is essential to provide appropriate treatment. Additionally, ILAS patients require screening for endophthalmitis.

ABSTRACT Management education remains deeply entrenched in colonial and neoliberal epistemic traditions, and privileges Eurocentric managerial paradigms while marginalising alternative knowledge systems. This paper outlines two levels of decolonisation: (a) surface-level interventions that introduce non-Western perspectives without challenging dominant frameworks and (b) deep-level transformations that fundamentally restructure curricula, pedagogy and institutional priorities. Drawing on decolonial and critical management studies, we identify three key mechanisms through which management education reproduces colonial and neoliberal hierarchies: (1) epistemic colonialism, (2) the exclusion of decolonial management models, and (3) the hegemony of Anglo-American institutional frameworks. We propose a decolonial approach which integrates Indigenous, feminist, and Southern epistemologies and challenges the neoliberal metrics governing management education. We adopt a multilevel perspective, as disrupting the reproduction of coloniality and neoliberalism demands coordinated epistemic, curricular, and institutional interventions. We highlight that decolonisation must go beyond tokenism to dismantle the ideological apparatuses sustaining racial capitalism and global economic asymmetries. In this sense, business schools can serve as sites of epistemic justice, which would foster alternative economic rationalities rooted in sustainability, relationality, and communal well-being.

The rapid expansion of lithium-ion battery (LIB) use has led to a critical waste management challenge, with end-of-life cells contributing to environmental degradation and resource depletion. Here, we report a low-temperature (100 °C) synthesis of high-entropy layered oxides, LixNa1-x(NiCoMnFe)O2, directly upcycled from spent LIB cathodes. These materials were designed and optimized as trifunctional electrocatalysts for overall water splitting (HER and OER) and 5-hydroxymethylfurfural (HMF) oxidation. Systematic compositional tuning revealed that the Ni-rich variant outperforms its counterparts, achieving overpotentials of 434 mV for the HER and 310 mV for the OER at 10 mA cm-2, with corresponding Tafel slopes of 113 and 81 mV dec-1, approaching the performance of Pt/C and RuO2 benchmarks, respectively. Simultaneously, this catalyst facilitates the selective electrooxidation of HMF to 2,5-furandicarboxylic acid (FDCA), achieving an FE of about 18% for FDCA and around 64% for hydrogen during co-electrolysis. The catalyst retains activity over 16 h during flow-cell operation. A cradle-to-gate life-cycle assessment shows that allocating environmental impacts to FDCA as a co-product reduces impacts relative to a hydrogen-only pathway. Moreover, as the electricity source is the dominant source of CO2 footprint, switching to renewable grids can lower the global warming potential (GWP, in Kg CO2-eq) by ≈80%. Our work offers a scalable, energy-efficient platform that integrates LIB waste remediation with renewable hydrogen generation and biomass upgrading.

Ecosystems carry memory through the material remains of organisms. Foundation species—trees, grasses, corals, and oysters—while alive are central to ecosystem structure, and the remains of these organisms continue to influence ecological processes after death. We conducted, to our knowldge, the first continental-scale exploration of how dead foundation species influence living conspecifics, leveraging long-term experiments and observations (2 to 32 years) from 10 ecosystems (five terrestrial and five marine) across the US Long Term Ecological Research Network. We found that material legacies commonly alter demographic processes, ranging from a 50% reduction to a 12-fold increase. The ubiquity of these postmortem effects reveals an underappreciated dimension of ecological memory that shapes pathways of ecosystem resilience, reorganization, and collapse, providing a critical management tool in an era of increasing disturbance- and climate-driven mortality events.

Existing research on critical chain buffer management has primarily focused on project and feeding buffers, while studies on resource buffer management remain relatively underexplored. To fully utilize resource buffers as early warning mechanisms, this paper proposes a novel resource early warning and control method for construction projects based on information coupling. First, the impacts of resource warnings and information coupling on critical chain project execution are analyzed. A Dependency Structure Matrix (DSM) is introduced to model the information coupling among activities, and the rework warning time window is quantified based on the degree of activity overlap. Next, a model for the sizing resource buffer warning window is developed by incorporating factors such as the probability of activity delay, resource transfer time, resource downtime cost and rework risk under information coupling. Furthermore, a dynamic trisection approach is adopted to define warning zones of varying intensities and corresponding action-triggering strategies based on the proximity of activity execution to resource switching points. Experimental results demonstrate that the proposed method outperforms the classic method in terms of project duration and cost, schedule overrun probability, time buffer consumption ratio, and project duration probability distribution, thereby enhancing critical chain execution efficiency and overall project performance.

Endovascular Perfusion Augmentation for Critical Care (EPACC) is a method of dynamic aortic balloon catheter titration for precision hemodynamic support. EPACC has the potential to augment hemodynamics in conjunction with conventional resuscitation strategies. We previously described how even short periods of EPACC, along with an automated fluid and drug delivery system termed Precision Automated Critical Care Management (PACC-MAN) can reduce resuscitation requirements over the first few hours after severe ischemia-reperfusion injury (IRI). We sought to understand if an initial 180 minutes of EPACC+PACC-MAN can offset vasopressor requirements over 24 hours of critical care compared with PACC-MAN alone in an established IRI model. Twelve swine underwent 30% hemorrhage, then 45 minutes of complete zone 1 aortic occlusion, inducing IRI and vasoplegia. Animals were then transfused to euvolemia and randomized to EPACC+PACC-MAN (180min of dynamic partial aortic balloon pressure augmentation that autonomously adjusted based on the animal's physiology) or PACC-MAN automated critical care alone. Critical care lasted for 24 hours in both groups. Primary outcomes included duration of hypotension (mean arterial pressure <60mmHg), hypertension (mean arterial pressure >70mmHg), total crystalloid, and norepinephrine volumes. Secondary outcomes included lactate load, creatinine, urine output, biomarkers, and histopathology. Percent time spent in hypotension for EPACC+PACC-MAN versus PACC-MAN (3.10% vs. 3.75%, p=0.47) and hypertension (8.90% vs 5.58%, p=0.13) was not significantly different. Total crystalloid volume for EPACC+PACC-MAN versus PACC-MAN was not significant (198.3mL/kg vs. 308.2mL/kg, P=0.38). EPACC+PACC-MAN required significantly less norepinephrine during the study period (210.77mcg/kg vs. 1102.0mcg/kg, p=0.045). Supporting hemodynamics with EPACC to mitigate severe vasoplegia of initial resuscitation has a sustained effect on limiting vasopressor requirements in this 24-hour study, without compromising physiologic endpoints. Automation of endovascular devices may play an adjunctive role in managing severe shock states and augmenting autonomous resuscitation, particularly in resource-constrained care environments. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level IV.

Constructed stormwater pond and wetland for agricultural runoff treatment

With the global rise in cancer incidence, the number of critically ill oncology patients with potential need for intensive care unit (ICU) admission is also increasing. This trend is not solely attributable to disease progression, but also to the aging of the cancer population, often accompanied by significant comorbidities, and to complications arising from modern oncologic therapies. In particular, adverse effects related to chemotherapy, hematopoietic stem cell transplantation, and immunotherapies increasingly require intensive medical intervention. Although the marked heterogeneity of this patient population makes generalizations difficult, studies have shown that critically ill patients with hematologic malignancies can demonstrate favorable survival and recovery rates despite the severity of their illness. Acute respiratory failure (ARF) is among the most frequent indications for ICU admission in cancer patients. Therapeutic management is often complex and not standardized, especially in the context of treatment limitations. Non-invasive respiratory support strategies, such as high-flow oxygen therapy or non-invasive ventilation (NIV), may offer clinical benefit in carefully selected patients, provided that close monitoring and readiness to escalate therapy are ensured. Innovative immuno-oncologic treatment strategies have substantially broadened the therapeutic spectrum in oncology and often provide severely ill patients with curative options. However, these therapies are associated with specific and sometimes life-threatening adverse effects. Among the most significant are the cytokine release syndrome (CRS), triggered for example by CAR-T cells or T-cell engagers, and the immune effector cell-associated neurotoxicity syndrome (ICANS). In addition, other immune-related adverse events (irAEs) may occur in association with checkpoint inhibitor (ICI) therapies. These potentially life-threatening complications require structured diagnostic approaches, close interdisciplinary management, and early initiation of immunomodulatory therapy.

This paper presents a hybrid artificial intelligence framework designed to improve the diagnosis of error and subsequent optimization of operational efficiency in complex energy systems. By integrating knowledge-based systems with evolutionary algorithms, we address the critical need for fast and accurate fault identification as a prerequisite for maintaining the reliability of the network. Knowledge-based components use expert rules to precisely determine the locations and types of errors, and then dynamically limit genetic algorithms (GAs) to optimize restoration strategies such as load reduction and network reconfiguration. Performance metrics reported in this study were obtained from multiple independent simulation trials conducted under varying fault locations and noise conditions. The proposed framework achieved higher fault-diagnosis accuracy with an average detection latency of less than 55.65ms by performing comprehensive simulations of the IEEE 30-bus and 118-bus systems, across different test conditions. By intelligently reducing the search space, the hybrid approach reduces the total system recovery time to less than 1.0s, a significant improvement over the independent evolutionary methods that require more than 5.0s. In addition, the optimization module successfully limited load loss to less than 5%, surpassing traditional methods by more than 50% in terms of service continuity. Robustness analysis confirmed diagnostic accuracy of more than 98% even below the signal-to-noise ratio of 20dB, and IEEE 118 bus scale-up test showed a 38% to 47% increase in computational efficiency compared to standalone particle swarm optimization (PSO). These results highlight the performance of the framework and the practical application of critical energy infrastructure management with real-time, resilient management.

Enhancing postpartum hemorrhage management in Sri Lanka: A pilot study to assess the impact and appropriateness, acceptability, and feasibility of a locally co-created quality improvement intervention.

Mycotic pseudoaneurysms in renal transplant patients are rare but serious complications associated with significant morbidity, graft loss, and mortality. They present a critical management challenge between endovascular salvage and definitive surgical explant. While contemporary reports suggest endovascular techniques can successfully treat this condition, their role as definitive treatment in fungal fields is controversial. We report a case where repeated endovascular stent treatment of a polymicrobial fungal and bacterial pseudoaneurysm perpetuated biofilm formation and polymicrobial colonization, enabling ongoing infection and ultimately requiring explant and femoral-femoral bypass for definitive source control and revascularization. This case highlights an important decision threshold: in the setting of angioinvasive molds, endovascular salvage is often futile, with recent series showing a high failure rate for allograft preservation. Recognition of persistent pain and recurrent fluid collections following endovascular therapy should trigger early surgical source control with infection-resistant conduits, such as autologous or cryopreserved allografts, rather than endovascular temporization.

Hantavirus infection: A narrative review focusing on epidemiology, diagnosis, infection control and treatment in the era of globalisation.

Magnetic resonance imaging (MRI) enables noninvasive interrogation of penile pathology and can address uncertainties in cases of penile trauma and tumors, helping form critical management decisions. Specifically, MRI can assess the integrity of the tunica albuginea following penile trauma, thereby directing the patient to surgery versus nonoperative care. MRI also serves an adjunctive role to physical examination in local staging of penile cancer, and is especially useful for evaluation of corporal invasion, while simultaneously allowing a preliminary assessment of pelvic nodal status. In this review, we detail the normal anatomy of the penis, protocol considerations for MRI of the penis, and interpretation of penile MRI for trauma and tumors.

Extreme summer droughts increasingly threaten freshwater biodiversity in monsoonal regions, yet community responses within heterogeneous small water bodies (SWBs) remain poorly understood. This study evaluated how drying events influence macroinvertebrate taxonomic and functional composition across different SWB types and explored the mechanisms driving post-drought recovery. We sampled isolated ponds (IPs), stream-fed ponds (SFPs), pond-linked streams (PLSs), and non-pond-linked streams (NPLSs) in Eastern China during an extreme summer drought (2022) and a subsequent recovery year (2023). Ponds exhibited high resistance, maintaining stable taxonomic and functional richness. PLSs suffered substantial summer biodiversity declines but showed rapid post-drought recovery, possibly facilitated by spatial dispersal from nearby pond refuges. In contrast, NPLSs experienced severe, lasting biodiversity loss. Drought conditions drove overall community homogenization, with spatial dispersal playing a more important role in structuring assemblages than environmental filtering. Furthermore, functional trait analysis indicated that post-drought recovery was more closely associated with resilience-linked traits rather than resistance traits. These findings demonstrate that lateral connectivity within SWB networks buffers drought impacts by providing refugial support and enabling rapid recolonization. Preserving diverse, interconnected SWBs is a critical management strategy for maintaining metacommunity resilience under growing climatic volatility.

Genetic disorders are major causes of morbidity and mortality in neonatal intensive care units (NICUs), yet traditional tests like karyotyping and chromosomal microarray (CMA) often fail to provide a diagnosis, resulting in a "diagnostic odyssey". Trio whole-genome sequencing (WGS) has emerged as a comprehensive tool capable of detecting a wide range of variants beyond protein-coding regions, potentially offering higher diagnostic yields and rapid, actionable results for critical care management. This prospective study evaluated 16 neonates with multiple congenital anomalies who had previously received negative results from conventional genetic investigations. Trio WGS was performed using the Illumina NovaSeq 6000 platform, targeting a mean coverage of 30x. A stringent bioinformatics pipeline and a three-step filtering process were applied to prioritize rare functional variants (MAF < 0.1%) and genes specifically curated for NICU-associated conditions. A molecular diagnosis was achieved in 37.5% (6/16) of the cases within the first 6 months of age. Pathogenic or likely pathogenic variants were identified in genes including SCN4A, DLL1, ACTA1, KLHL40, CHD7, and CNTNAP1, covering both autosomal recessive and autosomal dominant inheritance patterns. These findings provided definitive diagnoses for complex conditions such as arthrogryposis, congenital myopathy, and CHARGE syndrome. Trio WGS is a highly effective and feasible diagnostic tool for neonates with clinically heterogeneous anomalies, successfully identifying causes where standard-of-care testing fails. Its implementation in the NICU facilitates targeted medical management, informs prognosis, and provides essential data for family planning.