Changes In Output Research Articles

Physics-informed machine learning for moving load problems

Abstract This paper presents a new approach to simulate forward and inverse problems of moving loads using physics-informed machine learning (PIML). Physics-informed neural networks (PINNs) utilize the underlying physics of moving load problems and aim to predict the deflection of beams and the magnitude of the loads. The mathematical representation of the moving load considered involves a Dirac delta function, to capture the effect of the load moving across the structure. Approximating the Dirac delta function with PINNs is challenging because of its instantaneous change of output at a single point, causing difficulty in the convergence of the loss function. We propose to approximate the Dirac delta function with a Gaussian function. The incorporated Gaussian function physical equations are used in the physics-informed neural architecture to simulate beam deflections and to predict the magnitude of the load. Numerical results show that PIML is an effective method for simulating the forward and inverse problems for the considered model of a moving load.

Metabolic alterations and cellular responses to β-Hydroxybutyrate treatment in breast cancer cells

BackgroundThe ketogenic diet (KD), based on high fat (over 70% of daily calories), low carbohydrate, and adequate protein intake, has become popular due to its potential therapeutic benefits for several diseases including cancer. Under KD and starvation conditions, the lack of carbohydrates promotes the production of ketone bodies (KB) from fats by the liver as an alternative source of metabolic energy. KD and starvation may affect the metabolism in cancer cells, as well as tumor characteristics. The aim of this study is to evaluate the effect of KD conditions on a wide variety of aspects of breast cancer cells in vitro.MethodsUsing two cancer and one non-cancer breast cell line, we evaluate the effect of β-hydroxybutyrate (βHb) treatment on cell growth, survival, proliferation, colony formation, and migration. We also assess the effect of KB on metabolic profile of the cells. Using RNAseq analysis, we elucidate the effect of βHb on the gene expression profile.ResultsSignificant effects were observed following treatment by βHb which include effects on viability, proliferation, and colony formation of MCF7 cells, and different effects on colony formation of MDA-MB-231 cells, with no such effects on non-cancer HB2 cells. We found no changes in glucose intake or lactate output following βHb treatment as measured by LC-MS, but an increase in reactive oxygen species (ROS) level was detected. RNAseq analysis demonstrated significant changes in genes involved in lipid metabolism, cancer, and oxidative phosphorylation.ConclusionsBased on our results, we conclude that differential response of cancer cell lines to βHb treatment, as alternative energy source or signal to alter lipid metabolism and oncogenicity, supports the need for a personalized approach to breast cancer patient treatment.

Mechanism and clinical role of TIMP-2 and IGFBP-7 in cardiac surgery-associated acute kidney injury: A review.

Acute kidney injury (AKI) is a common postoperative complication, but there is still a lack of accurate biomarkers. Cardiac surgery-associated AKI is the most common cause of major-surgery-related AKI, and patients requiring renal replacement therapy have high mortality rates. Early diagnosis, intervention, and management are crucial for improving patient prognosis. However, diagnosing AKI based solely on changes in serum creatinine level and urine output is insufficient, as these changes often lag behind actual kidney damage, making early detection challenging. Biomarkers such as tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein-7 (IGFBP-7) have been found to be significant predictors of moderate-to-severe AKI when combined with urine content analysis. This article reviews the mechanism of biomarkers TIMP-2 and IGFBP-7 in AKI and provides a comprehensive overview of the clinical effects of TIMP-2 and IGFBP-7 in cardiac surgery-associated AKI, including prediction, diagnosis, and progression.

#2570 Non-invasive blood pressure monitoring in dialysis patients using pulse wave velocity

Abstract Background and Aims Dialysis patients are at high risk of circulatory dysregulation and hypotension during treatment. Intradialytic hypotension (IDH) is a potentially life-threatening complication. The main causes are high ultrafiltration volumes and high ultrafiltration rates when patients tend to gain a lot of weight between dialysis treatments. A lack of patient compliance with regard to drinking volumes and a lack of residual diuresis are risk factors for this. Close circulatory monitoring and therapy settings to avoid absolute or relatively high UF rates to prevent IDH are frequently used. These are primarily the frequent non-invasive measurement of blood pressure using cuffs, the measurement of relative blood volume and the adjustment of ultrafiltration rates to these values. Prophylactically, the dialysis time can be extended, ultrafiltration profiles or ultrafiltration breaks can be planned, the dialysate temperature can be lowered and the composition of the dialysate can be adjusted. Despite all attempts, however, the incidence of IDH in everyday clinical practice is too high. The non-invasive measurements with cuffs are not carried out frequently enough, the measurement of the relative blood volume only covers a partial range, sudden changes in vascular tension or cardiac output are not recorded. Method The pulse wave velocity (PWV) is a well-known parameter for describing the propagation of the pressure wave after ejection of the heart beat volume in the arteries. The PWV is dependent on blood pressure, vessel wall tension and cardiac output. Changes in blood pressure can therefore be recognised by measuring the PWV. With the help of a measuring device (PESAS) for the ECG signal and peripheral pulse plethysmography, PWV can be measured non-invasively, continuously, for every heartbeat and, above all, hardly noticed by the patient. The PESAS allows the time-synchronised measurement of ECG and peripheral plethysmography curves and thus the determination of PWV. It is an experimental device. We would like to present a study showing the use of a measuring device (PESAS) in 15 prevalent dialysis patients for the detection of IDH. All study participants were examined during 3 dialysis treatments. Results The measurement of PWV in chronic dialysis patients during treatment is technically feasible. The measurement is tolerated by the patients. Changes in PWV could be detected in the patients during the course of dialysis; these were also dependent on the ultrafiltration rates. Individual patient reactions to volume withdrawal varied, with both increases and decreases in PWV being demonstrated. An acute change in PWV was usually associated with a drop in blood pressure. Continuous measurement allowed IDH events to be detected earlier than intermittent blood pressure measurement with cuffs. Sudden drops in blood pressure could be detected better and earlier with the PESAS system than by measuring the relative blood volume. Conclusion The PESAS system is suitable for monitoring dialysis patients to prevent IDH. Further adjustments and optimisation of the evaluation algorithms are necessary.

#1605 Development of an app for a science-based prescription of haemodialysis

Abstract Background and Aims The delivery of an adequate haemodialysis (HD) dose (i.e., a target single-pool Kt/V (spKt/V) of 1.4 per session) is often challenging, especially in patients with huge urea distribution volumes (V). On the other hand, patients with an extremely small V, such as children, are at higher risk of disequilibrium syndrome, which is caused by an excessive or overly rapid correction of urea levels, particularly during the first HD session. The treatment prescription often neglects many elements contributing to the final delivered HD dose, whereas a systematic and comprehensive evaluation of all adjustable parameters could improve the management of patients, not only facilitating the achievement of treatment goals, but also avoiding short- and long-term complications. We aimed at developing a web app capable of predicting the delivered HD dose, given a wide range of parameters, and using renowned kinetic equations relevant to urea clearance in HD. Method The platform used to develop our app is based on Angular, an open-source framework to develop web applications. Specifically, it can be used to realise single-page apps and it is only for frontend. This fits our case, since a backend is not required due to the absence of huge databases or complex operations. The application is grounded on a stepper component, a paradigm to guide the user step-by-step during the data entry process. It consists of three phases, namely (1) patient, (2) haemodialyser, (3) target spKt/V. The last section is also for output. A modification of any input triggers a real-time output change. Results We developed a free access user-friendly web app, through which HD professionals can simulate a treatment prescription and obtain an estimate of the delivered dose in terms of spKt/V. The app is structured in three sections and all calculations are based on validated formulas and kinetic equations applicable to HD: The output “expected spKt/V” changes in real time, after any modification of the input parameters. The result can thus be compared to the treatment goal (i.e., 1.4 for a standard HD session; 0.55 for a first treatment, aiming at reducing the risk of disequilibrium syndrome), as suggested by international guidelines and expert opinions. Conclusion We developed a user-friendly web app, which will be freely accessible online by HD professionals, aimed at predicting the delivered HD dose (spKt/V) considering a wide range of patient- and prescription-related parameters. The application of such a tool in everyday clinical practice, particularly in cases requiring a more accurate definition of the actual delivered dose, could improve the management of patients through a personalisation of the treatment. This could enhance prescription adjustments aimed at achieving an adequate spKt/V in patients receiving an insufficient HD dose; on the other hand, it could help preventing disequilibrium syndrome in patients with very small urea distribution volumes.

Study on Consumption Preference of New Energy Vehicles

The sales volume and sales volume of new energy vehicles in the market reflect the public's use of new energy vehicles. According to the feedback and demand of different people, the purchase proportion of new energy vehicles and new energy vehicles is different. The impact on economic development and the impact on the purchasing economy. The psychological impact of people using new energy vehicles. Consumers' pursuit of new energy vehicle performance (breakthroughs in speed and road use quality. Changes in conventional engine power output and motor output. The psychological impact on the use of new energy vehicles. Consumers' pursuit of new energy vehicle performance. After-sales quality assurance and service, the impact of different age groups on new energy vehicles. And the impact on the economic development of the population and the purchasing population, different age groups have different demands for new energy vehicles. After-sales service has also improved with market changes, and more and more people are pursuing the purchase of new energy vehicles. China's new energy vehicle policy will have an impact on the price of cars and buyers.

Efektifitas SENADA terhadap Peningkatan Fungsi Kognitif Lansia dengan Demensia: Case Report

Older people in Indonesia are experiencing a significant increase in population, often accompanied by a decline in brain function and the risk of dementia. SENADA (Brain Health Exercise) emerges as a potential approach for enhancing cognitive function in older people through simple movements. Further research and information are needed to support its use in elderly healthcare practices. This study employed a case report approach with nursing care to evaluate the effectiveness of SENADA in older individuals with dementia. Interventions were conducted regularly with structured data collection using MMSE. The aim of this research was to assess the effectiveness of SENADA in improving cognitive function in older people with dementia through a case report approach with nursing care. Interventions were given twice daily for five minutes. Data were collected through interviews, interventions, evaluations, and documentation. Results demonstrated that SENADA therapy in patient Ny. A was effective for enhancing cognitive function in older people, as evidenced by the change in MMSE outputs from moderate to no cognitive impairment.

Effects of medical therapy and age on cardiac output changes following balloon pulmonary angioplasty: Implications for combination therapy in chronic thromboembolic pulmonary hypertension

BACKGROUNDSome patients with chronic thromboembolic pulmonary hypertension (CTEPH) exhibit exercise intolerance due to reduced cardiac output (CO) even after successful balloon pulmonary angioplasty (BPA). Medical therapy is a potential option for such cases; however, it is unclear which patients necessitate it even after BPA. METHODSThis study included 286 patients with CTEPH who underwent BPA and right heart catheterization one year after the final BPA and classified them into No-medication and Withdrawal groups. The No-medication group comprised patients without pulmonary hypertension (PH) medications before and after BPA, while the Withdrawal group included patients who received PH medications before BPA and discontinued them after BPA. We assessed differences in the changes in CO after BPA from baseline (ΔCO) between the two groups. Additionally, we evaluated the ΔCO among different age categories within each group: younger (< 60 years), middle-aged (60 to 70 years), and older-adults (≥ 70 years). RESULTSAfter adjusting baseline covariates, overall ΔCO did not differ significantly. However, ΔCO was significantly increased in No-medication group but decreased in Withdrawal group (0.32 and −0.33, difference in ΔCO: −0.65, 95% confidence intervals: −0.90 to −0.40). A significantly positive effect on ΔCO was observed only in younger individuals, with a significant interaction between age and ΔCO in both groups. CONCLUSIONSIncreasing CO with BPA alone may be challenging with age in patients with CTEPH. Given that discontinuation of PH medication after BPA decreased CO more than the effect of BPA, medical therapy might be necessary even after successful BPA.

Cardiac workload study in patients with hypertrophic cardiomyopathy

The relevance of studying the heart load is determined by the need to assess its reserves at different degrees of heart failure for further selection of treatment tactics. The aim of the work is to evaluate the influence of pressure and cardiac output changes on the left and right ventricular workload in patients with hypertrophic obstructive cardiomyopathy. The haemodynamic data of 69 patients divided into two subgroups according to the value of cardiac index greater and less than the mean value were considered. It was found that the change in the left ventricular power of the heart of patients with hypertrophic obstructive cardiomyopathy is determined by the change in both cardiac index and blood pressure. In better-off patients with high cardiac index, the effect of blood pressure is higher and cardiac output is lower. In severe patients with a low cardiac index, the influence of blood pressure is reduced and cardiac index is increased. The formation of right ventricular power, both in patients with high cardiac index and low, is not affected by changes in cardiac output. Changes in the right ventricular power index are determined by variations in pulmonary artery pressure to a greater extent in well patients and to a lesser extent in severe patients. Since there are 23.1% variations in cardiac index and 60% variations in pulmonary arterial pressure, it is assumed that there is a regulatory mechanism that changes cardiac output opposite to pulmonary artery pressure fluctuations. Comparison of left and right ventricular power indices with the data given in the literature showed that both for all examined patients with hypertrophic obstructive cardiomyopathy and divided into groups, the average values of left and right ventricular power indices correspond to the range of power fluctuations in healthy people at rest. The range of left ventricular power index variation by 3.5 times, and right ventricular power index variation by 10 times in patients with hypertrophic obstructive cardiomyopathy is determined by multifunctional relationships of cardiovascular system function indices (pressures and cardiac output), which determines the necessity of personalised therapy selection, taking into account the mechanisms of their formation. The results obtained during the study of the effect of changes in pressure and cardiac index on the power developed by the left and right parts of the heart must be taken into account when choosing therapy in patients with hypertrophic obstructive cardiomyopathy. Practical significance. The results will be used in the choice of treatment in order to optimize the load on the heart in patients with hypertrophic obstructive cardiomyopathy.

Cardiomyocyte Ketone Metabolism Regulates Myocardial Hyperemia

Myocardial perfusion is inextricably coupled to metabolism, with increases in physiologic cardiac demand promoting coronary vasodilation. Despite its wide acceptance, the hypothesis that cardiomyocyte metabolism autoregulates myocardial perfusion lacks mechanistic detail; however, clinical and preclinical studies suggest a signaling role for intermediary metabolites in the vasodilatory response. In particular, the ketone body precursor, β-hydroxybutyrate (3-OHB), enhances myocardial blood flow in humans, but the mechanism by which it does so remains unclear. Here, we determined the extent to which 3-OHB influences myocardial hyperemia in mice. Intravenous 3-OHB infusion (0.5 g/kg) in adult mice (12–24 wks) raised circulating 3-OHB levels (0.5 ± 0.1 to 5.1 ± 0.6 mM; p=0.005) and increased myocardial perfusion (18.6 ± 4.4 to 50.9 ± 10.4 mL/min/g; p=0.024), as measured by myocardial contrast echocardiography. Enhanced perfusion induced by 3-OHB occurred in the absence of changes in cardiac output or systolic performance. Next, to determine if 3-OHB directly dilates the coronary vasculature, we exposed pressurized (80 mmHg), small-diameter (100–260 μm) coronary arteries from mice (C57/Bl6J and 6N) to 3-OHB (0.1–5 mM) but found no significant changes in diameter. Based on these results, we tested whether cardiomyocyte metabolism of 3-OHB is required for the vasodilatory response. We deleted β-hydroxybutyrate dehydrogenase (BDH1) selectively in cardiomyocytes using Bdh1fl/fl mice crossed with tamoxifen-inducible Cre recombinase mice (csBDH1−/−). Although 3-OHB robustly enhanced myocardial perfusion (6.9 ± 1.4 to 21.3 ± 5.6 mL/min/g; p=0.031) at sustained cardiac workloads and peripheral vascular resistance in Cre-negative littermate (control) mice, csBDH1−/− mice completely lacked the 3-OHB-induced hyperemic response (8.0 ± 2.5 to 6.3 ± 2.8 mL/min/g; p&gt;0.999). Together, these data indicate that 3-OHB evokes workload-independent enhancement of myocardial perfusion through a mechanism that requires cardiomyocyte metabolism of 3-OHB. Our results support the general concept that acute changes in metabolic substrate availability may influence oxygen delivery to cardiomyocytes via a cardiomyocyte-vascular signaling nexus. R01HL163818, R01HL142710, R01HL163003, P30GM127607, P30GM127607-05S1, Jewish Heritage Fund for Excellence (JHFE), S10OD025178. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cardiac Surgery-Associated Acute Kidney Injury.

AKI is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (cardiac surgery-associated AKI [CSA-AKI]) on the basis of changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence, and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention, and treatment management.

Microtubules distinctly contribute to the performance of the healthy and pressure-overloaded RV

Introduction: Microtubules (MT) are a key contributor to cardiomyocyte contractility and mechanics. Recently, our group reported that acute depolymerization of MT reduces viscosity and elasticity and alters anisotropy of healthy and pressure-overloaded right ventricular (RV) tissues. While RV free wall viscosity and elasticity are distinctly upregulated with chronic pressure overload, how organ function is affected by viscoelastic contribution of the MT remains unknown. Our aim was to investigate the role of MT polymerization in RV function from its effect on RV tissue viscoelasticity. We hypothesized that the MT differentially contributes to healthy and pressure-overloaded RV function. Methods: All procedures and methods were approved by Colorado State University IACUC. Pulmonary hypertension (PH) was induced in 6-week-old male rats via 3-week monocrotaline treatment. Healthy age- and sex-matched rats served as control. Pressure-volume (PV) relationships were obtained by RV catheterization before and after intramyocardial injections of 0.3mM colchicine (COL) to acutely depolymerize the MT network and reduce tissue viscoelasticity. Functional impacts were evaluated by monitoring changes in RV end-systolic pressure (ESP), cardiac output (CO), stroke volume (SV), ejection fraction (EF), dP/dt max and min, cardiac effciency (CE), and the end-systolic pressure-volume relation (ESPVR). Results: As expected, monocrotaline treatment induced marked PH and RV contractile dysfunction, indicated by a significant elevation of RV ESP with reduced CO and ESPVR. In the healthy RV, COL treatment led to marked reductions in all functional parameters, indicating that the MT network is critical to maintain RV performance and contractile function in the healthy heart. In the pressure-overloaded RV, COL treatment similarly reduced SV, CO, EF, and dP/dt max and min, but increased CE and ESPVR, indicating that MT depolymerization improved mechanical effciency and contractility. To rule out effects caused by bolus injections alone, we administered a similar quantity of saline and observed no effects on the PV parameters in healthy RV. Discussion: Our study is the first to investigate the acute effect of MT depolymerization on RV function in healthy and diseased states. We found distinct contributions of MT to the contractile function and mechanical effciency of healthy and pressure-overloaded RVs. These findings reveal a critical influence of tissue viscoelasticity on RV physiology and dysfunction, emphasizing the importance of considering myocardial viscoelastic behavior in future studies investigating cardiac remodeling and heart failure pathophysiology. This work is partially supported by the National Science Foundation (NSF) grant 2244994. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Long-range surface plasmon hydrogel aptasensor for sensitive, selective, and continuous measurement of vancomycin

This research presents a long-range surface plasmon (LRSP) hydrogel aptasensor designed for precise detection and real-time monitoring of vancomycin (VCM), an antibiotic with a narrow therapeutic range. The aptasensor utilizes a three-dimensional binding matrix of 2-methacryloyloxyethyl phosphorylcholine (MPC) and N-methacryloyl-(L)-tyrosinemethylester (MAT) hydrogel for aptamer immobilization, yielding enhanced sensing capabilities. The hydrogel is coated on Au surface, gelled, and irradiated with light to immobilize peptide aptamers with VCM recognition sites. When exposed to VCM, the sensor displays changes in reflectivity proportional to the VCM concentration, with a dynamic range of 0.06–100 μM. The sensor demonstrated a 13-fold increase in sensitivity compared to an LRSP aptasensor without the hydrogel and showed high selectivity for VCM and high reproducibility with a coefficient of variation of 6.5% across 10 repeated measurements. Furthermore, when the VCM concentration was continuously varied without rinsing, a rapid change in reflectivity and output corresponding to changes in concentration was obtained, suggesting the possibility of real-time monitoring of VCM concentration.

Labor linkages and flow paths of industry in China

As economic power increases and market patterns adapt, labor becomes an increasingly significant factor of production. However, there is a dearth of discourse regarding the structural changes that have occurred in the correlation of the labor force across industries, as well as a visual representation of the labor force's movement across industries. To quantify and analyze the correlation effect with greater precision, it is necessary to establish an input-output model as the foundation of analysis, comparing the changes in the total output of the economic system prior to and subsequent to the exclusion using the vertical integration algorithm. By decomposing the path structure, the average propagation distance of the labor force population's demand for each industry can be determined. By employing labor force population data from the corresponding years and China's input-output tables published by the National Bureau of Statistics of China (NBS) from 2005 to 2020, this study conducts a quantitative analysis of the correlation effect between labor force population and the trend of its transfer across 19 industries. The findings indicate that the correlation effect between labor force and population is most pronounced in the manufacturing sector. Furthermore, the construction sector faces an especially critical requirement for labor force personnel from other industries. The article culminates with a recommendation that the government enhance its macro-control endeavors to address labor market risk shocks and take an active stance in response to labor market fluctuations.

Quantification of sectoral impact of COVID-19 on Indian economy: an application of economy-wide accounting framework

PurposeCOVID-19 has affected the economies adversely from all sides. The sudden halt in production has impacted both the supply and demand sides. It calls for analysis to quantify the impact of the reduction in economic activity on the economy-wide variables so that appropriate steps can be taken. This study aims to evaluate the sensitivity of various sectors of the Indian economy to this dual shock.Design/methodology/approachThe eight-sector open economy general equilibrium Global Trade Analysis Project (GTAP) model has been simulated to evaluate the sector-specific effects of a fall in economic activity due to COVID-19. This model uses an economy-wide accounting framework to quantify the impact of a shock on the given equilibrium economy and report the post-simulation new equilibrium values.FindingsThe empirical results state that welfare for the Indian economy falls to the tune of 7.70% due to output shock. Because of demand–supply linkages, it also impacts the inter- and intra-industry flows, demand for factors of production and imports. There is a momentous fall in the demand for factor endowments from all sectors. Among those, the trade-hotel-transport and manufacturing sectors are in the first two positions from the top. The study recommends an immediate revival of the manufacturing and trade-hotel-transport sectors to get the Indian economy back on track.Originality/valueThe present study has modified the existing GTAP model accounting framework through unemployment and output closures to account for the impact of change in sectoral output due to COVID-19 on the level of employment and other macroeconomic variables.

Are We Always Right? Evaluation of the Performance and Knowledge of the Passive Leg Raise Test in Detecting Volume Responsiveness in Critical Care Patients: A National German Survey.

Background: In hemodynamically unstable patients, the passive leg raise (PLR) test is recommended for use as a self-fluid challenge for predicting preload responsiveness. However, to interpret the hemodynamic effects and reliability of the PLR, the method of performing it is of the utmost importance. Our aim was to determine the current practice of the correct application and interpretation of the PLR in intensive care patients. Methods: After ethical approval, we designed a cross-sectional online survey with a short user-friendly online questionnaire. Using a random sample of 1903 hospitals in Germany, 182 hospitals with different levels of care were invited via an email containing a link to the questionnaire. The online survey was conducted between December 2021 and January 2022. All critical care physicians from different medical disciplines were surveyed. We evaluated the correct points of concern for the PLR, including indication, contraindication, choice of initial position, how to interpret and apply the changes in cardiac output, and the limitations of the PLR. Results: A total of 292 respondents participated in the online survey, and 283/292 (97%) of the respondents completed the full survey. In addition, 132/283 (47%) were consultants and 119/283 (42%) worked at a university medical center. The question about the performance of the PLR was answered correctly by 72/283 (25%) of the participants. The limitations of the PLR, such as intra-abdominal hypertension, were correctly selected by 150/283 (53%) of the participants. The correct effect size (increase in stroke volume ≥ 10%) was correctly identified by 217/283 (77%) of the participants. Conclusions: Our results suggest a considerable disparity between the contemporary practice of the correct application and interpretation of the PLR and the practice recommendations from recently published data at German ICUs.

CO2 gap changes compared with cardiac output changes in response to intravenous volume expansion and/or vasopressor therapy in septic shock.

The difference in partial pressure of carbon dioxide (PCO2) between mixed or central venous blood and arterial blood, known as the ∆PCO2 or CO2 gap, has demonstrated a strong relationship with cardiac index during septic shock resuscitation. Early monitoring of the ∆PCO2 can help assess the cardiac output (CO) adequacy for tissue perfusion. To investigate the value of ∆PCO2 changes in early septic shock management compared with CO. This observational prospective study included 76 patients diagnosed with septic shock admitted to Cairo University Hospital's Critical Care Department between December 2020 and March 2022. Patients were categorised by initial resuscitation response, initial ∆PCO2 and 28-day mortality. The primary outcome was the relationship between the ∆PCO2 and CO changes before and after initial resuscitation, with secondary outcomes including ICU length of stay (LOS) and 28-day mortality. Peri-resuscitation ∆PCO2 changes predicted a ≥15% change in the cardiac index (CI) (area under the curve (AUC) 0.727; 95% CI 0.614 - 0.840) with 66.7% sensitivity and 62.8% specificity. The optimal ∆PCO2 change cut-off value was <-1.85, corresponding to a <-22% threshold for a 15% cardiac index increase. The PCO2 gap ratio (gap/gap ratio of T1- PCO2 gap to T0 -PCO2 gap) also predicted a ≥15% change in cardiac index (AUC 745; 95% CI 0.634 - 0.855) with 63.6% sensitivity and 79.1% specificity. The optimal CO2 gap/gap ratio cut-off value was <0.71. A significant difference in 28-day mortality was noted based on the gap/gap ratio. Peri-resuscitation ∆PCO2 and the gap/gap ratio are useful non-invasive bedside markers for predicting changes in CO and preload responsiveness. The current study provides an insight to the PCO2 gap changes during and after early resuscitation of septic shock patients, which correlate to cardiac output changes and might also serve as a fluid responsiveness indicator.

Marginal abatement cost of CO2: A convex quantile non-radial directional distance function regression method considering noise and inefficiency

By purchasing emission reduction equipment or reducing production scale, it is possible to effectively decrease CO2. Therefore, understanding the marginal abatement cost (MAC) associated with these methods is crucial for making decisions. However, previous studies using the directional distance function (DDF) approach often mis-specified production functions and neglected data noise. They also assumed decision-making units (DMUs) to be on the production frontier and used proportional changes in inputs and outputs as abatement paths. This paper addresses these limitations by developing the convex quantile non-radial directional distance function (CQR-NDDF) method, which estimates the MAC of CO2 and determines optimal abatement paths for DMUs without assuming a specific production function, employing linear programming techniques. Applying this method to 30 provinces in mainland China from 2011 to 2019, the study finds that China's CO2 MAC increased from 182 to 247 yuan/ton. The lowest-cost abatement path varies by province and time. The club convergence and ordered probit model are employed to conclude that the second industry and urbanization increase the MAC of CO2, while factors such as foreign direct investment, openness level, and human capital decrease the MAC. Moreover, the CQR-NDDF method yields significantly lower MAC estimates than the NDDF method. In conclusion, this paper provides new insights into China's CO2 MAC, emphasizing the importance of considering inefficiency and data noise in MAC estimation. We anticipate that utilizing CO2 MAC as a benchmark for carbon trading market prices could lead to an increase in prices within China's carbon trading market.

Differential protective impact of peptide vaccine formulae targeting the lung- and liver-stage of challenge Schistosoma mansoni infection in mice

The study aimed to elicit protective immune responses against murine schistosomiasis mansoni at the parasite lung- and liver stage. Two peptides showing amino acid sequence similarity to gut cysteine peptidases, which induce strong memory immune effectors in the liver, were combined with a peptide based on S. mansoni thioredoxin peroxidase (TPX), a prominent lung-stage schistosomula excretory-secretory product, and alum as adjuvant. Only one of the 2 cysteine peptidases-based peptides in a multiple antigenic peptide construct (MAP-3 and MAP-4) appeared to adjuvant protective immune responses induced by the TPX peptide in a MAP form. Production of TPX MAP-specific IgG1 serum antibodies, and increase in lung interleukin-1 (IL-1), uric acid, and reactive oxygen species (ROS) content were associated with significant (P < 0.05) 50 % reduction in recovery of lung-stage larvae. Increase in lung triglycerides and cholesterol levels appeared to provide the surviving worms with nutrients necessary for a stout double lipid bilayer barrier at the parasite-host interface. Surviving worms-released products elicited memory responses to the MAP-3 immunogen, including production of specific IgG1 antibodies and increase in liver IL-33 and ROS. Reduction in challenge worm burden recorded 45 days post infection did not exceed 48 % associated with no differences in parasite egg counts in the host liver and small intestine compared to unimmunized adjuvant control mice. Alum adjuvant assisted the second peptide, MAP-4, in production of IgG1, IgG2a, IgG2b and IgA specific antibodies and increase in liver ROS, but with no protective potential, raising doubt about the necessity of adjuvant addition. Accordingly, different vaccine formulas containing TPX MAP and 1, 2 or 3 cysteine peptidases-derived peptides with or without alum were used to immunize parallel groups of mice. Compared to unimmunized control mice, significant (P < 0.05 to < 0.005) 22 to 54 % reduction in worm burden was recorded in the different groups associated with insignificant changes in parasite egg output. The results together indicated that a schistosomiasis vaccine able to entirely prevent disease and halt its transmission still remains elusive.

Planned expansion of transportation infrastructure in Brazil has implications for the pattern of agricultural production and carbon emissions

High transportation costs have been a barrier to the expansion of agriculture in the interior of Brazil. To reduce transportation costs, Brazil launched the National Logistics Plan, aiming to expand its railway network by up to 91 % by 2035. Such a large-scale infrastructure investment raises concerns about its economic and environmental consequences. By combining geospatial estimation of transportation cost with a grid-resolving, multi-scale economic model that bridges fine-scale crop production with its trade and demand from national and global perspectives, we explore impacts of transportation infrastructure expansion on agricultural production, land use changes, and carbon emissions both locally and nationally in Brazil. We find that globally, the impacts on output and land use changes are small. However, within Brazil, the plan's primary impacts are impressive. PNL2035 results in the reduction of transportation costs by 8–23 % across states (depending on expansion's extent) in the interior Cerrado biome. This results in cropland expansion and increases in terrestrial carbon emissions in the Cerrado region. However, the increase in terrestrial carbon emissions in the Cerrado is offset by spillover effects elsewhere in Brazil, as crop production shifts away from the Southeast-South regions and accompanying change in the mix of transportation mode for farm products from roadway to more emission-efficient railway. Furthermore, we argue that the transportation infrastructure's impact on the enhanced mobility of labor and other agricultural inputs would further accentuate the regional shift in agricultural production and contribute to carbon emission mitigation. Upon its completion, PNL2035 is expected to result in the reduction of net national emissions by 1.8–30.7 million metric ton of CO2-equivalent, depending on the impacts on labor and purchased input mobility. We conclude that the omission of spillover effects due to infrastructure expansion can lead to misleading assessments of transport policies.