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Comorbidity, frailty, and decreased cognitive function lead to a higher risk of death in elderly patients (more than 65 years of age) during acute medical events. Early and accurate illness severity assessment can support appropriate decision making for clinicians caring for these patients. We aimed to develop ELDER-ICU, a machine learning model to assess the illness severity of older adults admitted to the intensive care unit (ICU) with cohort-specific calibration and evaluation for potential model bias.

Compromised light quantity on the seabed affects the composition and resilience of marine forests and the maintenance of ecosystem services. However, the response of macroalgal assemblages to changes in the quality(spectral composition) of light as compared to the quantityalone is poorly understood. Here, we bridge radiative transfer modeling and algal physiology to simulate the underwater light environment and explore macroalgal responses to spectral attenuation by various coastal water constituents. We considered three groups of macroalgal taxa (class Phaeophyceae and, phyla Chlorophyta and Rhodophyta) for which we developed a “synthetic envelope” of spectrally resolved action spectra using 1 million radiative simulations. We found that brown algae were more efficient at harvesting light across the whole spectrum at low attenuation (< 0.2 m−1) when depths were greater than 10 m, whereas green algae dominated shallower depths than 10 m for low to high attenuation values. Finally, red algae made best use of the available light at relatively higher attenuation values (> 0.2 m−1) and deeper depths. We also demonstrated that the brown and green algal taxa showed higher photosynthetic efficiencies when attenuation was dominated by particulate matter rather than by phytoplankton or detrital matter. Our results shed new light on the “Complementary Chromatic Adaptation” hypothesis by confirming that algal pigmentation matters under a subset of scenarios, particularly at the limits of light availability in coastal waters. This study paves the way for identifying competitive thresholds in macroalgal communities by using satellite‐derived ocean color products to identify regions and depths of potential optical transitions.

Background:Aims of this study were to investigate the prevalence and incidence of catheter-related infection, identify risk factors, and determine the relation of catheter-related infection with mortality in critically ill COVID-19 patients. Methods:This was a retrospective cohort study of central venous catheters (CVCs) in critically ill COVID-19 patients. Eligible CVC insertions required an indwelling time of at least 48 hours and were identified using a full-admission electronic health record database. Risk factors were identified using logistic regression. Differences in survival rates at day 28 of follow-up were assessed using a log-rank test and proportional hazard model. Results:In 538 patients, a total of 914 CVCs were included. Prevalence and incidence of suspected catheter-related infection were 7.9% and 9.4 infections per 1,000 catheter indwelling days, respectively. Prone ventilation for more than 5 days was associated with increased risk of suspected catheter-related infection; odds ratio, 5.05 (95% confidence interval 2.12–11.0). Risk of death was significantly higher in patients with suspected catheter-related infection (hazard ratio, 1.78; 95% confidence interval, 1.25–2.53). Conclusions:This study shows that in critically ill patients with COVID-19, prevalence and incidence of suspected catheter-related infection are high, prone ventilation is a risk factor, and mortality is higher in case of catheter-related infection.

Hypotension in the ICU is common, yet management is challenging and variable. Insight in management by ICU physicians and nurses may improve patient care and guide future hypotension treatment trials and guidelines.

The advent of chat generative pre-trained transformer (ChatGPT) and large language models (LLMs) has revolutionized natural language processing (NLP). These models possess unprecedented capabilities in understanding and generating human-like language. This breakthrough holds significant promise for critical care medicine, where unstructured data and complex clinical information are abundant. Key applications of LLMs in this field include administrative support through automated documentation and patient chart summarization; clinical decision support by assisting in diagnostics and treatment planning; personalized communication to enhance patient and family understanding; and improving data quality by extracting insights from unstructured clinical notes. Despite these opportunities, challenges such as the risk of generating inaccurate or biased information “hallucinations”, ethical considerations, and the need for clinician artificial intelligence (AI) literacy must be addressed. Integrating LLMs with traditional machine learning models – an approach known as Hybrid AI – combines the strengths of both technologies while mitigating their limitations. Careful implementation, regulatory compliance, and ongoing validation are essential to ensure that LLMs enhance patient care rather than hinder it. LLMs have the potential to transform critical care practices, but integrating them requires caution. Responsible use and thorough clinician training are crucial to fully realize their benefits.

Aquatic ecosystems can exhibit seasonal variation in resource availability and animals have evolved to cope with the associated caloric restriction. During winter in the NW Mediterranean Sea, the European sardine Sardina pilchardus naturally experiences caloric restriction owing to a decrease in the diversity and quantity of plankton. However, ongoing global warming has had deleterious effects on plankton communities such that food shortages may occur throughout the year, especially under warm conditions in the summer. We investigated the interactive effects of temperature and food availability on sardine metabolism by continuously monitoring whole-animal respiration of groups of control (fed) and food-deprived sardines over a 60-day experiment in winter (12°C) or summer (20°C) conditions under natural photoperiod. In addition, we measured mitochondrial respiration of red muscle fibres, biometric variables and energy reserves of individuals sampled at 30 and 60 days. This revealed that winter food deprivation elicits energy saving mechanisms at whole animal and cellular levels by maintaining a low metabolism to preserve energy reserves, allowing high levels of survival. By contrast, despite energy saving mechanisms at the mitochondrial level, whole animal metabolic rate was high during food deprivation in summer, causing increased consumption of energy reserves at the muscular level and high mortality after 60 days. Furthermore, a 5-day re-feeding did not improve survival, and mortalities continued, suggesting that long-term food deprivation at high temperatures causes profound stress in sardines that potentially impairs nutrient absorption.

Accurate and actionable diagnosis of Acute Kidney Injury (AKI) ahead of time is important to prevent or mitigate renal insufficiency. The purpose of this study was to evaluate the performance of Kinetic estimated Glomerular Filtration Rate (KeGFR) in timely predicting AKI in critically ill septic patients.

L’étude du cas de la frontière franco-italienne en Isère sous la Restauration et la Monarchie de Juillet permet d’analyser les spécificités, les contraintes et les méthodes de l’administration « de frontière », avec d’autant plus de légitimité que c’était l’une des frontières les plus difficiles à administrer à cette période. La proximité du royaume de Piémont-Sardaigne, soutenu par les Autrichiens après 1815, en fait une zone stratégique pour la défense du territoire national. La frontière est aussi une zone de circulation et d’échanges. Les fonctionnaires et administrateurs de ces régions doivent inspecter les échanges légaux (de marchandises et de voyageurs) et empêcher les échanges illégaux (contrebande, passages clandestins de personnes). Cette surveillance est cependant, sur l’ensemble de la période étudiée, peu efficace. L’impossibilité d’une surveillance locale sans faille oblige les fonctionnaires et administrateurs dauphinois à trouver des méthodes administratives originales, et notamment la coopération transfrontalière avec les autorités de Piémont-Sardaigne.

Some hypoxia-tolerant species, such as goldfish, experience intermittent and severe hypoxia in their natural habitat, causing them to develop multiple physiological adaptations. However, in fish, the metabolic impact of regular hypoxic exposure on swimming performance in normoxia is less well understood. Therefore, we experimentally tested whether chronic exposure to constant (30 days at 10% air saturation) or intermittent hypoxia (3 h in normoxia and 21 h in hypoxia, 5 days a week) would result in similar metabolic and swimming performance benefits after reoxygenation. Moreover, half of the normoxic and intermittent hypoxic fish were put on a 20-day normoxic training regime. After these treatments, metabolic rate (standard and maximum metabolic rates: SMR and MMR) and swimming performance [critical swimming speed (Ucrit) and cost of transport (COT)] were assessed. In addition, enzyme activities [citrate synthase (CS), cytochrome c oxidase (COX) and lactate dehydrogenase (LDH)] and mitochondrial respiration were examined in red muscle fibres. We found that acclimation to constant hypoxia resulted in (1) metabolic suppression (−45% SMR and −27% MMR), (2) increased anaerobic capacity (+117% LDH), (3) improved swimming performance (+80% Ucrit, −71% COT) and (4) no changes at the mitochondrial level. Conversely, the enhancement of swimming performance was reduced following acclimation to intermittent hypoxia (+45% Ucrit, −41% COT), with a 55% decrease in aerobic scope, despite a significant increase in oxidative metabolism (+201% COX, +49% CS). This study demonstrates that constant hypoxia leads to the greatest benefit in swimming performance and that mitochondrial metabolic adjustments only provide minor help in coping with hypoxia.

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Aerobic metabolism of aquatic ectotherms is highly sensitive to fluctuating climates. Many mitochondrial traits exhibit phenotypic plasticity in response to acute variations in temperature and oxygen availability. These responses are critical for understanding the effects of environmental variations on aquatic ectotherms' performance. Using the European seabass, Dicentrarchus labrax, we determined the effects of acute warming and deoxygenation in vitroon mitochondrial respiratory capacities and mitochondrial efficiency to produce ATP (ATP/O ratio). We show that acute warming reduced ATP/O ratio but deoxygenation marginally raised ATP/O ratio, leading to a compensatory effect of low oxygen availability on mitochondrial ATP/O ratio at high temperature. The acute effect of warming and deoxygenation on mitochondrial efficiency might be related to the leak of protons across the mitochondrial inner membrane, as the mitochondrial respiration required to counteract the proton leak increased with warming and decreased with deoxygenation. Our study underlines the importance of integrating the combined effects of temperature and oxygen availability on mitochondrial metabolism. Predictions on decline in performance of aquatic ectotherms owing to climate change may not be accurate, since these predictions typically look at respiratory capacity and ignore efficiency of ATP production.

Although hypotension in ICU patients is associated with adverse outcome, currently used definitions are unknown and no universally accepted definition exists.

Dosing of vancomycin is often guided by therapeutic drug monitoring and population pharmacokinetic models in the intensive care unit (ICU). The validity of these models is crucial, as ICU patients have marked pharmacokinetic variability.