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Purpose of Review: Both cardiac and renal dysfunction can lead to water overload - commonly referred to as "congestion". Identification of congestion is difficult, especially when clinical signs are subtle. Recent Findings: As an extension of an echocardiographic examination, ultrasound can be used to identify intravascular (inferior vena cava diameter dilation, internal jugular vein distension or discontinuous venous renal flow) and tissue congestion (pulmonary B-lines). Combining assessment of cardiac structure, cardiac and renal function and measures of congestion informs the management of heart and kidney disease, which should improve patient outcomes. Summary: In this manuscript, we describe imaging techniques to identify and quantify congestion, clarify its origin, and potentially guide the management of patients with cardio-renal syndrome. [ABSTRACT FROM AUTHOR]

Wireless sensor networks (WSNs) are vulnerable to several challenges. Congestion control, the utilization of trust to ensure security, and the incorporation of clustering schemes demand much attention. Algorithms designed to deal with congestion control fail to ensure security and address challenges faced due to congestion in the network. To resolve this issue, a Hybrid Trust-based Congestion-aware Cluster Routing (HTCCR) protocol is proposed to effectively detect attacker nodes and reduce congestion via optimal routing through clustering. In the proposed HTCCR protocol, node probability is determined based on the trust factor, queue congestion status, residual energy (RE), and distance from the mobile base station (BS) by using hybrid K-Harmonic Means (KHM) and the Enhanced Gravitational Search Algorithm (EGSA). Sensor nodes select cluster heads (CHs) with better fitness values and transmit data through them. The CH forwards data to a mobile sink once the sink comes into the range of CH. Priority-based data delivery is incorporated to effectively control packet forwarding based on priority level, thus decreasing congestion. It is evident that the propounded HTCCR protocol offers better performance in contrast to the benchmarked TBSEER, CTRF, and TAGA based on the average delay, packet delivery ratio (PDR), throughput, detection ratio, packet loss ratio (PLR), overheads, and energy through simulations. The proposed HTCCR protocol involves 2.5, 2.3, and 1.7 times less delay; an 18.1%, 12.5%, and 5.5% better detection ratio; 2.9, 2.6, and 1.8 times less energy; a 2.2, 1.9, and 1.5 times lower PLR; a 14.5%, 10.5%, and 5.2% better PDR; a 30.7%, 28.5%, and 18.4% better throughput; and 2.27, 1.91, and 1.66 times lower routing overheads in contrast to the TBSEER, CTRF, and TAGA protocols, respectively. The HTCCR protocol involves 4.1% less delay for the ' C 1 ' and ' C 2 ' RT packets, and the average throughput of RT is 10.4% better when compared with NRT. [ABSTRACT FROM AUTHOR]

The growing congestion in delivery rooms in Israeli hospitals is the underlying issue of the current study. Aim: The study sought to examine various alternatives for public policy aimed at reducing congestion. The choice of Israel as a case study derives from its conspicuous imbalance between supply and demand in the maternity, resulting from the high demand for prenatal and birthing services on one hand and the low supply, both in absolute terms and relative to OECD countries, of medical resources such as physicians, nurses, and hospital beds. The research combines quantitative research that includes analysis of data related to human resources and hospital beds in Israel compared to other countries on one hand and data on productivity and childbirth in Israel on the other, and qualitative research that includes examination of the different alternatives to hospital-based birth. The research findings present fertility and birth data for Israel in the last decade, which are leading to increased congestion and crowding in delivery rooms and maternity wards at local hospitals. Discussion: Two possible alternatives are proposed for designing and implementing public policy capable of contributing to the regulation of this congestion. One is the home birth, and the second is private birthing centers. The research conclusions indicate that policymakers in Israel must anticipate the increasing congestion in hospital delivery rooms and maternity wards and expedite efforts at designing alternative solutions before the emergence of a crisis situation that will make it essential to identify immediate solutions. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis-associated pulmonary hypertension (SSc-PH) is widely recognized as the most severe subtype of connective tissue disease-associated pulmonary hypertension (CTD-PH), particularly in patients with complicating factors such as interstitial lung disease (ILD) and biventricular failure. This condition is associated with the poorest clinical outcomes among PH subtypes, presenting significant challenges in both management and prognosis. Despite the use of conventional therapies, including intravenous administration of epoprostenol, a promising prostacyclin analogue, treatment outcomes for SSc-PH remain suboptimal. While epoprostenol has demonstrated efficacy in reducing pulmonary arterial pressures, its clinical application is often constrained by the risk of ventilation–perfusion (V-Q) mismatch, particularly at higher doses. Case presentation: We report the case of a 73-year-old woman with SSc-PH complicated by ILD, who experienced progressive hemodynamic deterioration despite receiving optimized therapy with intravenous epoprostenol. Efforts to escalate the dose of epoprostenol were limited by the development of severe V-Q mismatch, precluding further dose increases. In light of these challenges, inhaled treprostinil was introduced as an adjunctive therapy. There were significant improvements in her pulmonary hypertension and hemodynamic parameters, ultimately allowing the discontinuation of intravenous dobutamine and stabilization of her hemodynamics, as well as her respiratory function, exercise capacity, and quality of life. Conclusions: This case highlights the potential clinical utility of combining inhaled treprostinil with intravenous epoprostenol for the treatment of SSc-PH in patients with concurrent ILD. By addressing the limitations associated with high-dose intravenous prostacyclin therapy, this combination approach may represent a promising therapeutic strategy for improving outcomes in this difficult-to-treat patient population. Further investigation is warranted to establish the efficacy and feasibility of this combination therapy in larger cohorts of patients with SSc-PH and associated ILD. [ABSTRACT FROM AUTHOR]

Price promotion is an effective way to capture market share, as consumer sensitivity to price is universal. Yet, consumer satisfaction with services‐such as logistics‐plays a critical role. Deep price discounts can indeed spike demand, but they can also congest systems, thus prolonging delivery times and diminishing consumer satisfaction. Despite observed significant effects of logistics capacity on consumer and firm payoffs in logistics systems in recent years, economic and operational analysis of these effects remains under explored. This study theoretically examines the influence of logistics capacity on competition between two firms using a refined Hotelling model that incorporates system congestion via a BPR‐type congestion function. Our primary findings include: First, the possibility of multiple equilibria emerges with intermediate product values, fueled by either unilateral price reductions to seize greater market share or price increases to enhance marginal benefits. Moreover, a firm with superior logistics capacity may not always set higher prices at equilibrium. Second, we show that equilibrium pricing exhibits a non‐monotonic relationship with logistics capacity and market size. Lastly, we scrutinize firms' long‐term strategic reactions to changes in logistics capacity and the implications of marginal capacity costs, symmetric or otherwise. Our findings provide the following insights. We caution that the equilibrium pricing strategy is ambiguous when the product value is not extreme because both firms are more likely to engage in random price wars. Intriguingly, while augmenting logistics capacity might elevate service satisfaction, it could paradoxically reduce firm revenue or consumer surplus. Our analysis also indicates that higher marginal capacity costs could, counter intuitively, benefit firms or consumers. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) have a strong pathophysiological interrelationship, and their combination worsens prognosis. Summary: This article briefly reviews the bidirectional epidemiological burden and the pathophysiological interplay between HFpEF and CKD. It also discusses some of the controversial aspects regarding the diagnosis and screening of HFpEF in CKD patients and focuses on the most effective therapeutic approaches to improve symptoms and prognosis in this high-risk population. Key Messages: Due to its prevalence and prognostic significance, HFpEF screening should be considered in patients with CKD, with careful use of traditional diagnostic tools in this population. Optimal medical therapy has seen major recent advances in patients with both HFpEF and CKD. SGLT2 inhibitors, finerenone, and semaglutide have consistently demonstrated cardio- and renoprotective effects in both conditions. [ABSTRACT FROM AUTHOR]

In the spanning tree congestion problem, given a connected graph G, the objective is to compute a spanning tree T in G that minimizes its maximum edge congestion, where the congestion of an edge e of T is the number of edges in G for which the unique path in T between their endpoints traverses e. The problem is known to be N P -hard, but its approximability is still poorly understood, and it is not even known whether the optimum solution can be efficiently approximated with ratio o(n). In the decision version of this problem, denoted K - STC , we need to determine if G has a spanning tree with congestion at most K. It is known that K - STC is N P -complete for K ≥ 8 , and this implies a lower bound of 1.125 on the approximation ratio of minimizing congestion. On the other hand, 3 - STC can be solved in polynomial time, with the complexity status of this problem for K ∈ 4 , 5 , 6 , 7 remaining an open problem. We substantially improve the earlier hardness results by proving that K - STC is N P -complete for K ≥ 5 . This leaves only the case K = 4 open, and improves the lower bound on the approximation ratio to 1.2. Motivated by evidence that minimizing congestion is hard even for graphs of small constant radius, we also consider K - STC restricted to graphs of radius 2, and we prove that this variant is N P -complete for all K ≥ 6 . [ABSTRACT FROM AUTHOR]

Pulmonary congestion is a critical factor influencing the clinical presentation, therapeutic decisions, and outcomes of heart failure (HF) patients. Lung ultrasound (LUS) offers a simple, rapid, and accurate method for assessing pulmonary congestion, surpassing the diagnostic capabilities of traditional clinical evaluation and chest radiography. Due to the wide availability of ultrasound equipment, congestion can be evaluated in multiple settings, ranging from emergency departments to intensive care units, including outpatient settings. A combined cardiopulmonary imaging approach, integrating LUS with other imaging modalities, enhances congestion assessment in both acute and chronic HF. This comprehensive approach provides valuable insights for HF management and risk stratification. However, optimizing the utilization of LUS remains a challenge, as standardized imaging protocols and B-line thresholds may vary across different clinical scenarios and HF phenotypes. Despite the widespread use of LUS in various HF settings, physician adoption and interpretation of LUS findings remain suboptimal. This review aims to provide a practical and clinical overview of LUS in HF, guiding clinicians towards the correct application and interpretation of this valuable tool in diverse HF contexts. [ABSTRACT FROM AUTHOR]

UAVs are flying in the air at different speeds and continuously forwarding the collected information to other UAVs or IoT devices in FANET. UAVs are playing an important role in data collection from places where humans can't reach them easily. The UAVs are intelligent devices, and these devices have sufficient bandwidth and memory for data forwarding and storing. The role of UAVs is specific, and they have the reflexibility to change the battery and control the data interval to control the congestion in network. The IoT devices with FANET can transfer the valuable data to other IoT devices for verification and matching. The proper utilization of bandwidth, memory, energy and processing capability are able to increase the Quality of Service (QoS) in FANET. In this paper, proposed the Memory, channel and Process utilization for Fuzzy based (MCPFB) for congestion detection and avoidance scheme to improve bandwidth utilization, energy consumption in FANET with the IoT network. primarily aims to identify and prevent network congestion, which is crucial for maintaining the QoS requirements and ensuring reliable communication. Congestion is a phenomenon that arises when the volume of data transmitted across a network exceeds its capacity. These factors can lead to disruptions, reduced efficiency, and potential data loss in communication networks such as Flying Ad Hoc Networks (FANETs). To effectively handle congestion in FANET and provide reliable communication in challenging and dynamic environments, it is crucial to employ efficient resource management, intelligent algorithms, and adaptable protocols. The process of designing fuzzy rules for Flying Ad Hoc Networks (FANET) entails developing a set of guidelines that utilize fuzzy logic to make decisions pertaining to different parts of the network. The MCPFB is better than the previous BARS approach in terms of different performance metrics. [ABSTRACT FROM AUTHOR]

In heart failure (HF), congestion is a key pathophysiologic hallmark and a major contributor to morbidity and mortality. However, the presence of congestion is often overlooked in both acute and chronic settings, particularly when it is not clinically evident, which can have important clinical consequences. Ultrasound (US) is a widely available, non-invasive, sensitive tool that might enable clinicians to detect and quantify the presence of (subclinical) congestion in different organs and tissues and guide therapeutic strategies. In particular, left ventricular filling pressures and pulmonary pressures can be estimated using transthoracic echocardiography; extravascular lung water accumulation can be evaluated by lung US; finally, systemic venous congestion can be assessed at the level of the inferior vena cava or internal jugular vein. The Doppler evaluation of renal, hepatic and portal venous flow can provide additional valuable information. This review aims to describe US techniques allowing multi-organ evaluation of congestion, underlining their role in detecting, monitoring, and treating volume overload more objectively. [ABSTRACT FROM AUTHOR]

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In the recent era of communication technology, flying ad hoc networks are gaining popularity because of their flexibility and broad area of application to gather data from environmental sources with limited infrastructure. FANET nodes, or unmanned aerial vehicles (UAVs), are heterogeneous devices, and coordination between the UAVs is an important part of communication with limited battery power sources. In ad hoc networks, devices have limited battery power, so proper battery utilization is critical to maintaining network connectivity. In order to establish a network without congestion, it is vital to have inter-UAV and IoT wireless communication for cooperation and collaboration among many UAVs. UAV connections may experience frequent disconnections. Another obstacle is the limited distance allowed between the stations. The routing algorithm selects only the nodes that are specifically requested by the source node based on its requirements and maintains the source node no longer needs the route until it. IoT devices have limited processing capability and memory. A single mobile device controls the IoT devices, or users can use the concept of automation to control the functioning of smart IoT devices. This research proposes a fuzzy-based congestion control scheme (MCPFB) to control the congestion between UAVs and IoT devices. UAVs are faster, and IoT devices can collect information from UAVs and forward it to other devices. The UAV's can store limited and sufficient types of information, but during routing, only a single path is available, which causes congestion in the FANET-IoT network. The fuzzy based load prediction and balancing routing is able to handle the problem of congestion in FANET-IoT. In order to overcome the problem of congestion with improper energy utilisation, this paper presents fuzzy rule-based congestion control techniques for a flying ad hoc network. We focus on the efforts to reduce congestion in the FANET-IoT network. Routing is a critical issue in FANET-IoT and hence the focus of this research is on the performance improvement of routing in FANET-IoT. Packets dropping on the nodes show congestion occurrence in the network, and the possibility of lost connectivity with other nodes is high. Unlike the aforementioned works, the proposed MCPFB routing shows better performance compared to the conventional BARS scheme in FANET-IoT. [ABSTRACT FROM AUTHOR]

Abstract Aims Incomplete decongestion due to lack of titration of diuretics to effective doses is a common reason for readmission in patients with acute decompensated heart failure (ADHF). The natriuretic response prediction equation (NRPE) is a novel tool that proved to be rapid and accurate to predict natriuretic response and does not need urine collection. However, the NRPE has not been externally validated. The goal of this study was to externally validate the discrimination capacity of the NRPE in patients with ADHF and fluid overload. Methods and results Patients admitted with ADHF who required intravenous loop diuretics were included. A spot urine sample was obtained ~2 h following diuretic administration, and a timed 6‐h urine collection by study staff was carried out. Urine sodium and urine creatinine from the spot urine sample were used to predict the 6‐h natriuretic response using the NRPE. The primary goal was to validate the NRPE to discriminate poor loop diuretic natriuretic response (sodium output