Set Of Units Research Articles

Clinical and histopathological characteristics of acute kidney injury in a cohort of brain death donors with procurement biopsies.

Kidney biopsies are routinely used for diagnostic and prognostic purposes but their utility in the intensive care unit (ICU) setting is limited. We investigated the associations of clinical and histopathological risk factors with ICU-acute kidney injury (AKI) in donors with brain death (DBD) with kidneys of lower quality and procurement biopsies. Overall,221 donors with brain death, 239 biopsies and 197 recipients were included. The biopsies were reread and scored according to the Banff recommendations. Clinical and histopathological data were compared between donors with and without AKI defined by serum creatinine and by urine output. Logistic regression analysis was applied to identify independent clinical and histopathological risk factors for both phenotypes. Lastly, the impact of each AKI phenotype on outcome was explored.AKI was diagnosedbased on the RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease)AKIN (Acute Kidney Injury Network) orKDIGO (Kidney Disease Improving Global Outcomes) criteria. Acute kidney injury occurred in 65% of donorsbased both uponserum creatinine and by urine output. Serum creatinine was able to better discriminate AKI. Multiorgan failure and severe AKI were captured by serum creatinine, and hemodynamic instability by urine output. Donors with serum creatinine-AKI showed lower chronic macrovascular scores, while donors with urine output-AKI had higher chronic microvascular and tubulointerstitial scores. Tubular injury was similar between the subgroups. Except for delayed graft function and one-year death-censored graft survival, the other short-term recipient outcomes were similar for both AKI phenotypes. Serum creatinine is more suitable than urine output for defining AKI in donors with brain death. There are distinct clinical risk factors for each AKI-ICU phenotype. Donor AKI phenotype does not predict the recipient´s prognosis. Kidney biopsies do not seem to confer any tangible benefit in defining AKI indonors with brain death.

Greenhouse gas reduction in a medium-duty compression ignition engine with optimization for B20

Soy-based biodiesel can reduce well-to-wheels greenhouse gas (GHG) emissions per unit energy (i.e., gCO2e/MJ) by 66%–72% as compared to the petroleum-based diesel fuel with currently adopted agricultural and industrial practices. Biodiesel can reduce particulate matter and carbon monoxide emissions with a manageable degree of increase in NOx emissions. From the perspective of GHG emissions reduction per unit travelling distance (i.e., gCO2e/mile), the application of B20 in compression ignition engines without the adjustment in engine control unit (ECU) settings will not extract the best carbon emissions reduction that B20 could achieve. Optimizing the engine control settings permits re-calibration to achieve the maximum brake fuel conversion efficiency (BFE) based on comprehensive understanding on the impact of both “fuel” and “ECU calibration” on BFE and other criteria pollutant emissions. The maximum GHG emissions reduction with B20 application is experimentally measured with the optimized ECU calibration, thus providing the understanding of the combined impact of biodiesel fuel and calibrations on engine performance and emissions. Six steady operating modes were considered, that can be combined to estimate the US federal test procedure BFE and emissions over the Federal Test Protocol (FTP) 75 cycle. Combined with the weight factors to simulate the EPA FTP 75 cycle from these 6 “mini-map” test points, 0.53% improvement in the energy requirement per unit traveling distance (i.e., MJ/mile) is achieved for B20 with the final ECU calibration, in addition to the degree of GHG emissions reduction on a “gCO2e/MJ” basis from the use of B20 blend of soy biodiesel of ∼12.5% reduction in gCO2e/MJ, for a total GHG emissions reduction of 13%.

Essentials of Point-of-Care Ultrasound Coding and Billing at the Neonatal Intensive Care Unit Setting in the United States.

Point-of-care ultrasound (POCUS) has increasingly been used by neonatal providers in neonatal intensive care units in the United States. However, there is a lack of literature addressing the complexities of POCUS coding and billing practices in the United States. This article describes the coding terminology and billing process especially those relevant to neonatal POCUS. We elucidate considerations for neonatal POCUS billing framework and workflow integration. Directions on image storage and supporting documentation to facilitate efficient reimbursement, compliance with billing regulations, and appeal to insurance claim denial are discussed. KEY POINTS: · Code neonatal POCUS procedure precisely allows accurate reimbursement and reduced errors in billing.. · Document details to support medical necessity and reimbursement claims effectively.. · Adhere to regulations to avoid audits, denials, and ensure proper reimbursement..

Developmental care education in Australian surgical neonatal intensive care units: A cross-sectional study of nurses’ perceptions

BackgroundNurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses’ perceptions of developmental care. ObjectiveTo determine perceptions and attitudes towards developmental care in a specialty neonatal setting. DesignCross-sectional study. SettingsTwo surgical neonatal intensive care units in Australia. ParticipantsRegistered nurses permanently employed at the study sites between May 2021 to April 2022. MethodsA modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses’ perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. ResultsOf 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3–8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1–6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1–6.2]. ConclusionsThe results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Контаминация фразеологизмов как средство речевой характеристики персонажей в романе М.А. Шолохова «Поднятая целина»

This article dwells on the contamination of phraseological units in Mikhail Sholokhov’s works using his novel Virgin Soil Upturned as an example. The writer pays much attention to the choice of language units and the ways of their organization in the context. One of the most striking features of his style is the concentrated use of phraseological units within a short text fragment. Based on semantic identification and component analysis, it is concluded that the created sets of phraseological units are connected by paradigmatic and syntagmatic relations, which determine their interaction and the degree of influence on each other as well as contribute to structural and semantic contamination. The characters’ speech in the novel contains phraseological units that have been contaminated. Sholokhov’s use of contaminated units to describe characters allows us to identify such characteristics as their social status and level of education, as well as emotional state, temperament, etc. The image is being detailed, expanded and refined by shifting accents and adding semes and connotations. Sholokhov combines the features of various phraseological units, thus enhancing the aesthetic function of the text. Such categorical properties of phraseological units as integrity of meaning and constancy of structure as well as imagery and expressiveness of the original phraseological unit are reinterpreted and transformed during contamination, thereby updating the image and intensifying the aesthetic potential of language units in the context and, consequently, in the text as a whole. Contamination of phraseological units, which is a result of their concentrated use, in Sholokhov’s works is nothing other than a conscious departure from the traditional forms of text organization, aimed at achieving creative goals and implementing the author’s idea. Further research in this area may be of interest to specialists dealing with stylistics, text theory, phraseology and the study of linguistic personality.

Classification of acacia, rape and multifloral Hungarian honey types

The composition of honey is mostly determined by the species-specific characteristics of flowering plants, which is reflected in the significant deviations in composition of honey varieties. The high-quality acacia honey is assessed based on both physical-chemical parameters and melissopalynology. The appearance of rape pollen in acacia honey makes the acacia honey be sorted into the multifloral honey category. Over carrying out melissopalynology, the149 samples of various honeys (acacia, rape and multifloral) have also been analysed by using physical-chemical and elemental analysis. Multivariate data analysis revealed that multifloral honey is much closer to acacia honey than to rape honey, as it can be observed from the examined unique parameters. By the PCA (Principal Component Analysis) analysis based on united set of physico-chemical and melissopalynology results the acacia and rape honey samples are entirely separated for each other, while multifloral honey samples are very close to acacia honey group and partially overlap with it. On ignoring the pollen analysis and based on the rest of the results, the multifloral honey category is almost indistinguishable from the declared and verified acacia honey category.

The investigation of phraseology in Karakalpak linguistics

Every country possesses its own unique set of phraseological units, which serve as a valuable repository of language reflecting the history, culture, and lifestyle of its people. These figurative and expansive language units vividly capture the human experience, imbuing the language with distinctiveness and conveying symbolic and associative meanings deeply ingrained in the consciousness of native speakers.

Multicenter comparative study on the usefulness of the optimal electrosurgical unit setting in endoscopic papillectomy for ampullary neoplasms (with video).

Endoscopic papillectomy (EP) is less invasive than surgery but procedure-related adverse events (AEs) still frequently occur. This study compared the benefits of EP using a new optimal endoCUT setting on the VIO (Erbe) electrosurgical unit (VIO-EP) with those using the conventional electrosurgical unit setting (ICC-EP, Erbe). This multicenter, retrospective, comparative cohort study included 57 patients who underwent VIO-EP and 91 who underwent ICC-EP. The primary outcome was occurrence of EP-related AEs. Secondary outcomes were pathological findings (the resection margins, the R0 resection, and residual lesions). Pancreatitis tended to be less common in the VIO-EP group (5.3% vs. 9.9%, p = .248). Evaluation of computed tomography images showed that pancreatitis was confined to the pancreatic head in 77.8% of cases in the ICC-EP group and in 33.3% of those in the VIO-EP group. After exclusion of cases of delayed bleeding, pancreatitis tended to be less common in the VIO-EP group; this finding was not statistically significant (2.3% vs. 8.2%, p = .184). In pathological findings, residual lesions were significantly less common in the VIO-EP group. The risks of pancreatitis and residual lesions after EP may be lower when the VIO electrosurgical unit is used with the optimal setting.

A prospective assessment of readiness to implement an early detection of cerebral palsy pathway in a neonatal intensive care setting using the PARIHS framework

BackgroundEarly detection of cerebral palsy (CP) is possible through targeted use of assessment tools. Changes in practice are needed to facilitate this shift towards earlier diagnosis of CP in New Zealand. The aim of this study was to prospectively evaluate readiness to implement an early detection of CP pathway within a level 3 neonatal intensive care unit (NICU) setting prior to any implementation taking place. The PARIHS (Promoting Action on Research Implementation in Health Services) framework was engaged to assess readiness by highlighting determinants that influence implementation outcomes as either barriers or enablers.MethodsA mixed methods approach was used. Firstly, an online staff survey assessed PARIHS sub-elements using Likert scores and free text with the intent to develop a baseline understanding of staff views. Secondly, focus groups were conducted to gain deeper understanding of barriers and enablers to implementation. Participants included health professionals involved in the first 6 months of life. Data were analysed to outline the barriers and enablers of implementation under the Evidence and Context constructs of the PARIHS framework.ResultsTwenty-seven participants completed the survey, and 20 participants participated in eight focus groups and two individual interviews. Quantitative (survey) findings found 65% agreement around the usefulness of research evidence on early CP detection; however, ≤ 45% felt current resources (i.e. human, financial and IT) were sufficient for implementation. Qualitative findings (survey and focus groups) highlighted key staff concerns around resources, family impact (creating unnecessary stress), and equity (barriers to participation). Staff wanted information regarding how international evidence translates to the local context and availability of timely follow-up services. Sub-elements within the Evidence and Context constructs were rated as either mixed or low (except for Evidence - Research, rated as high), overall indicating that Auckland NICU is at the early stages of readiness to implement the early CP detection pathway.ConclusionThis work may resonate with other neonatal services preparing to implement CP early detection pathways. Resourcing has a major role in facilitating implementation of pathways and uncertainty about resources is a barrier to implementation. Ongoing focus on building consensus and funding is required to ensure optimal uptake.

Research on Vibration Accumulation Self-Powered Downhole Sensor Based on Triboelectric Nanogenerators.

In drilling operations, measuring vibration parameters is crucial for enhancing drilling efficiency and ensuring safety. Nevertheless, the conventional vibration measurement sensor significantly extends the drilling cycle due to its dependence on an external power source. Therefore, we propose a vibration-accumulation-type self-powered sensor in this research, aiming to address these needs. By leveraging vibration accumulation and electromagnetic power generation to accelerate charging, the sensor's output performance is enhanced through a complementary charging mode. The experimental results regarding sensing performance demonstrate that the sensor possesses a measurement range spanning from 0 to 11 Hz, with a linearity of 3.2% and a sensitivity of 1.032. Additionally, it exhibits a maximum average measurement error of less than 4%. The experimental results of output performance measurement indicate that the sensor unit and generator set exhibit a maximum output power of 0.258 μW and 25.5 mW, respectively, and eight LED lights can be lit at the same time. When the sensor unit and power generation unit output together, the maximum output power of the sensor is also 25.5 mW. Furthermore, we conducted tests on the sensor's output signal in conditions of high temperature and humidity, confirming its continued functionality in such environments. This sensor not only achieves self-powered sensing capabilities, addressing the power supply challenges faced by traditional downhole sensors, but also integrates energy accumulation with electromagnetic power generation to enhance its output performance. This innovation enables the sensor to harness downhole vibration energy for powering other micro-power devices, showcasing promising application prospects.

A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit

IntroductionNoninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making. MethodsThis study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the “gold standard” brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings. ResultsVitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and “gold standard” clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the “gold standard.” DiscussionTaken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.

Abundant 2480 Ma Detrital Zircons in ∼1740 Ma Vishnu Schist in Northwestern Arizona: Derivation From the Matachewan Large Igneous Province?

Detrital zircon grains in the ∼1740–1750 Ma Vishnu Schist and similar rock units in northwestern Arizona consist of up to 30% grains dated by U-Pb isotopic analysis at 2470–2490 Ma. These zircon grains are distributed over ∼40,000 km2 and define an age peak at 2480.0 ± 27.3 Ma (2SE). These grains have yielded unusually consistent 207Pb/206Pb dates, with generally smaller analytical uncertainty and greater concordance to ideal U-Pb evolution than grains of other ages. A weighted mean age of 2480 ± 0.9 Ma (2SE) for this zircon population reflects consistent analytical results and high analytical precision but not the accuracy of the age. The source of these zircons has not been identified. To better characterize the unidentified source, we analyzed 45 of these grains for trace and rare-earth elements by laser-ablation mass spectrometry and scanned 16 grains with an electron microprobe to identify mineral inclusions. Mass spectrometer determinations of Sc/Yb and Nb/Sc support derivation from an oceanic-island igneous source. Electron microprobe scans revealed quartz in 5 of 16 grains, indicating a felsic source. The low variability in 207Pb/206Pb dates and a generally linear relationship between U and Th support zircon derivation from a single igneous unit or closely related set of units without xenocrystic zircons. A literature search for other zircon populations with similar age and U/Th ratios identified ∼2480 Ma zircons in a Mesoproterozoic(?) metapsammite and conglomerate in southwestern Montana. This sandstone was deposited near the margin of the Wyoming craton and contains almost entirely 2400–3600 Ma zircons, unlike zircon grains in Vishnu Schist which include a large population of 1730–1900 Ma zircons. From this relationship we infer that the 2480 Ma zircons in both areas were derived from a source in the Wyoming craton. We conclude that the 2480 Ma Vishnu zircons were derived from a felsic batholith that formed above and from hotspot magma related to the ∼2450–2480 Ma Matachewan Large Igneous Province, that this batholith formed by mixing between a mantle-derived hotspot magma and assimilated Archean continental crust, and that the source rock was emplaced during initial rifting between the Wyoming craton and the Superior province.

E-Commerce Data Mining Analysis based on User Preferences and Assiciation Rules

Improving the sales of e-commerce platforms is the primary goal of this paper. This paper studies the data of e-commerce product recommendations from the perspective of user preference and association rules. The characteristics of positive and reverse association rules in data mining are analyzed. Then, a multi-dimension association rule calculation method is proposed. Create a data attribute unit set. By analyzing each attribute's weighted coefficient and similarity, the attribute confidence degree is obtained, and the data is preprocessed. An example is given to verify the effectiveness of the proposed method. The recommendation engine based on user preferences and association rules significantly improves the accuracy, recall rate and prediction coverage of e-commerce recommendation systems.

Before, during, and irrespective of the pandemic: leisure constraints and urban national park visitation

ABSTRACT Urban and urban-proximate national park sites provide diverse leisure opportunities for residents, yet potential barriers and constraints for visitation exist. We examined constraints prior to, during, and regardless of the COVID-19 pandemic in the Washington, D.C. Metro area at Rock Creek Park and Chesapeake and Ohio Canal National Historical Park. Visitors and non-visitors (n = 840) responses were assessed for differences in their (1) demographic characteristics and leisure activities, (2) perceived constraints, and (3) the (a)temporal dimensions of these constraints (i.e. considering or despite COVID-19). Findings illustrate constraints were largely similar for both populations, but non-visitors reported significantly more physical limitations during the pandemic; overall, this demographically diverse group reported significantly less knowledge related to national park site visitation. Findings help point park managers towards information, outreach, and social support as potential tools to improve the visitor experience in these and other national park unit settings.

Strategies for nursing care of critically ill multicultural patients: A scoping review.

In society, people live in a social reality where multiculturalism is an increasingly relevant and prevalent topic in their contexts. Facing this, caring for multicultural patients in an emergency service or intensive care unit setting requires a high level of cultural competence due to the complexity, vulnerability of the patient, rapid changes in hemodynamic status, involvement of the family, their informational needs. To map the strategies for nursing care of critically ill multicultural patients. A Scoping Review was conducted following the Joanna Briggs Institute's recommendations, with the research question: What are the strategies for nursing care of critically ill multicultural patients? The study was guided by PRISMA. The research was conducted through the EBSCOHost platform, SciELO, Portugal's Open Access Scientific Repository, the Virtual Health Library and a search in grey literature. This was achieved by combining the descriptors DECS/MESH: cultural competence; critical care; emergency room; intensive care; and natural words: cultural care; nurs* interventions; nurs* strategies; within the time frame from 2012 to 2024. The study screening was performed by three independent reviewers through the reading of titles, abstracts and full texts, applying exclusion criteria. The study results were then subjected to content analysis, from which categories emerged. The selected articles highlight various strategies that contribute to the improvement of nursing care for critically ill multicultural patients, focusing on care practice and cultural diversity training for both nurses and nursing students. Nurses with cultural competence possess more knowledge and strategies to provide tailored care for multicultural critically ill patients, thereby enhancing the quality of care delivered and contributing to the humanization of healthcare. Nurses need to have knowledge of existing strategies for caring for multicultural critically ill patients. No direct patient or public contribution to the review.

Inflammaging in Multidrug-Resistant Sepsis of Geriatric ICU Patients and Healthcare Challenges.

Multidrug-resistant sepsis (MDR) is a pressing concern in intensive care unit (ICU) settings, specifically among geriatric patients who experience age-related immune system changes and comorbidities. The aim of this review is to explore the clinical impact of MDR sepsis in geriatric ICU patients and shed light on healthcare challenges associated with its management. We conducted a comprehensive literature search using the National Center for Biotechnology Information (NCBI) and Google Scholar search engines. Our search incorporated keywords such as "multidrug-resistant sepsis" OR "MDR sepsis", "geriatric ICU patients" OR "elderly ICU patients", and "complications", "healthcare burdens", "diagnostic challenges", and "healthcare challenges" associated with MDR sepsis in "ICU patients" and "geriatric/elderly ICU patients". This review explores the specific risk factors contributing to MDR sepsis, the complexities of diagnostic challenges, and the healthcare burden faced by elderly ICU patients. Notably, the elderly population bears a higher burden of MDR sepsis (57.5%), influenced by various factors, including comorbidities, immunosuppression, age-related immune changes, and resource-limited ICU settings. Furthermore, sepsis imposes a significant economic burden on healthcare systems, with annual costs exceeding $27 billion in the USA. These findings underscore the urgency of addressing MDR sepsis in geriatric ICU patients and the need for tailored interventions to improve outcomes and reduce healthcare costs.

The Relationship Between Serum Albumin Levels and Sepsis in Patients Admitted to a Tertiary Care Center in India.

Introduction Sepsis poses a significant threat in Indian hospitals, with high mortality rates and complications. This study explores the correlation between serum albumin levels and sepsis outcomes in an intensive care unit (ICU) setting. The challenges of diagnosing tropical infections further complicate sepsis management in India. Methodology A longitudinal study was conducted at Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, India. Adult patients admitted between July 2020 and March 2021 with sepsis were included. Serum albumin levels, demographic data, and clinical outcomes were analyzed. The study used a convenient sampling technique with a sample size of 102 patients. Results Among the 102 patients in the ICU, 22 have expired and the mortality rate in the study was 21.6%. Hypoalbuminemia was present in 56.9% (n = 58) of the patients. The mortality rate is higher among the sepsis patients with the occurrence of hypoalbuminemia (29.3%) compared to patients without hypoalbuminemia (11.4%) and the difference in proportion between the two groups was statistically significant (p-value = 0.029). The requirement of vasopressor support is higher among sepsis patients with the occurrence of hypoalbuminemia (56.9%) compared to patients without hypoalbuminemia (27.3%). The chi-square test reveals that the difference in proportion between the two groups was statistically significant (p-value = 0.005). No substantial impact on systemic inflammatory response scores, readmission to ICU, or progression to chronic illness was observed based on albumin levels. Conclusion This study underscores the predictive value of hypoalbuminemia in sepsis outcomes. Patients with decreased albumin levels showed higher mortality rates and increased vasopressor usage. While albumin levels did not significantly influence certain parameters, hypoalbuminemia may serve as an indicator of severity and adverse prognosis in sepsis, emphasizing the need for further research and tailored interventions.

Correlation between Cardiac Output and Disease Severity in Intubated COVID-19 Patients: Insights from Ultrasonic Cardiac Output Monitoring in Intensive Care Unit Settings

Abstract Background: The COVID-19 pandemic has affected millions globally, and still continues to do so. Regarding the cardiovascular influences of COVID-19, this study aimed to investigate the relationship between cardiac indices, particularly cardiac output (CO), and severity of disease. Methods: This retrospective cohort study was conducted on intubated COVID-19 patients admitted to the intensive care unit (ICU). The study involved analyzing data from mechanically ventilated patients, excluding those with preexisting cardiovascular or pulmonary comorbidities. Hemodynamic parameters were evaluated by ultrasonic cardiac output monitoring (USCOM), and the severity of disease was evaluated by acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scoring systems. Results: The study included 41 patients, predominantly male with an average age of 63.1 years. Hemodynamic parameters and scores were reported for 6 days. This showed significant changes in CO, SOFA, and APACHE II over time (with P = 0.02, 0.04, 0.03, respectively). A negative correlation was found between CO and both SOFA and APACHE II scores (P < 0.05), indicating that as CO increased, the severity scores decreased. Conclusion: This study emphasizes the importance of continuous hemodynamic monitoring in ICU settings for COVID-19 patients. The correlation between CO and severity scores suggests that USCOM, along with APACHE II and SOFA, can be crucial in assessing the dynamic clinical state of patients, contributing to better management and potentially improving outcomes.

Correlation and collective behaviour in Adler-type locally coupled oscillators at the edge of chaos

Dynamical systems can be analysed as computational devices capable of performing information processing. In coupled oscillators, enlarged capabilities are expected when the set of units is formed by subsets with collective behaviour within them but weak correlation between the subsets. A system of non-linear oscillators weakly coupled in the phase approximation is studied. The informational distance maps show different regimes of collective behaviour, ranging from independent, local, and global, as the control parameters of the system are changed. This rich set of behaviours happens despite the simple nature of the model used. Complex hierarchies between oscillators can be identified near the edge of chaos region in the informational distance dendrograms. We identify the emergence of local collective regimes, further corroborated by the spatiotemporal maps. Correlation diagrams also exhibit non-trivial dependence for the system at the edge of chaos.

Transition to Weight-Based High-Flow Nasal Cannula Use Outside of the ICU for Bronchiolitis

Most children's hospitals have adopted weight-based high-flow nasal cannula (HFNC) bronchiolitis protocols for use outside of the intensive care unit (ICU) setting. Whether these protocols are achieving their goal of reducing bronchiolitis-related ICU admissions remains unknown. To measure the association between hospital transition to weight-based non-ICU HFNC use and subsequent ICU admission. This multicenter retrospective cohort study was conducted with a controlled interrupted time series approach and involved 18 children's hospitals that contribute data to the Pediatric Health Information Systems database. The cohort included patients aged 0 to 24 months who were hospitalized with a diagnosis of bronchiolitis between January 1, 2010, and December 31, 2021. Data were analyzed from July 2023 to January 2024. Hospital-level transition from ICU-only to weight-based non-ICU protocol for HFNC use. Data for the ICU-only group were obtained from a previously published survey. Proportion of patients with bronchiolitis admitted to the ICU. A total of 86 046 patients with bronchiolitis received care from 10 hospitals in the ICU-only group (n = 47 336; 27 850 males [58.8%]; mean [SD] age, 7.6 [6.2] years) and 8 hospitals in the weight-based protocol group (n = 38 710; 22 845 males [59.0%]; mean [SD] age, 7.7 [6.3] years). Mean age and sex were similar for patients between the 2 groups. Hospitals in the ICU-only group vs the weight-based protocol group had higher proportions of Black (26.2% vs 19.8%) and non-Hispanic (81.6% vs 63.8%) patients and patients with governmental insurance (68.1% vs 65.9%). Hospital transition to a weight-based HFNC protocol was associated with a 6.1% (95% CI, 8.7%-3.4%) decrease per year in ICU admission and a 1.5% (95% CI, 2.8%-0.1%) reduction per year in noninvasive positive pressure ventilation use compared with the ICU-only group. No differences in mean length of stay or the proportion of patients who received invasive mechanical ventilation were found between groups. Results of this cohort study of hospitalized patients with bronchiolitis suggest that transition from ICU-only to weight-based non-ICU HFNC protocols is associated with reduced ICU admission rates.