Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes

Objective To compare the clinical characteristics and outcomes of patients with acute heart failure (AHF) according to clinical profiles based on congestion and perfusion determined in the emergency department (ED). Methods and results Overall, 11 261 unselected AHF patients from 41 Spanish EDs were classified according to perfusion (normoperfusion = warm; hypoperfusion = cold) and congestion (not = dry; yes = wet). Baseline and decompensation characteristics were recorded as were the main wards to which patients were admitted. The primary outcome was 1-year all-cause mortality; secondary outcomes were need for hospitalisation during the index AHF event, in-hospital all-cause mortality, prolonged hospitalisation, 7-day post-discharge ED revisit for AHF and 30-day post-discharge rehospitalisation for AHF. A total of 8558 patients (76.0%) were warm+ wet, 1929 (17.1%) cold+ wet, 675 (6.0%) warm+ dry, and 99 (0.9%) cold+ dry; hypoperfused (cold) patients were more frequently admitted to intensive care units and geriatrics departments, and warm+ wet patients were discharged home without admission. The four phenotypes differed in most of the baseline and decompensation characteristics. The 1-year mortality was 30.8%, and compared to warm+ dry, the adjusted hazard ratios were significantly increased for cold+ wet (1.660; 95% confidence interval 1.400-1.968) and cold+ dry (1.672; 95% confidence interval 1.189-2.351). Hypoperfused (cold) phenotypes also showed higher rates of index episode hospitalisation and in-hospital mortality, while congestive (wet) phenotypes had a higher risk of prolonged hospitalisation but decreased risk of rehospitalisation. No differences were observed among phenotypes in ED revisit risk. Conclusions Bedside clinical evaluation of congestion and perfusion of AHF patients upon ED arrival and classification according to phenotypic profiles proposed by the latest European Society of Cardiology guidelines provide useful complementary information and help to rapidly predict patient outcomes shortly after ED patient arrival

State of the world’s plants and fungi 2020

Kew’s State of the World’s Plants and Fungi project provides assessments of our current knowledge of the diversity of plants and fungi on Earth, the global threats that they face, and the policies to safeguard them. Produced in conjunction with an international scientific symposium, Kew’s State of the World’s Plants and Fungi sets an important international standard from which we can annually track trends in the global status of plant and fungal diversity

A LabVIEW-based simulator for the activated sludge process

The activated sludge process is the main process in most urban wastewater treatment systems. It is considered complex in nature, and building its mathematical model in practice becomes difficult. A simple and easy way to build the simulation models for the system is needed. In this paper, a LabVIEW based simulator for the system is presented. LabVIEW offers a highly efficient, simple and flexible platform for simulation and control. Building applications in LabVIEW require less coding, and debugging is easy and fast. The proposed simulator utilizes the Benchmark Simulation Model no.1 (BSM 1) for the biochemical reactor and clarification processes. The operation of the simulator is via a graphical user interface (GUI) built in the LabVIEW environment. The simulation results can be displayed in digital and graphical forms. Simulation results obtained were compared with the results from other software simulation packages in which the COST/IWA Simulation Benchmark has been implemented. The developed simulator is very useful due to its efficiency and accuracy in simulating the wastewater process model. The simulator can serve as a training tool for plant operators/students to provide them with better knowledge and understanding of the process

Improvement of activated sludge process using enhanced nonlinear PI controller

Wastewater treatment plant is a large-scale system and highly known with the nonlinearity of the parameters, making them a challenge to be controlled. In this paper, enhanced nonlinear PI (EN-PI) controller is developed for activated sludge process where a sector-bounded nonlinear gain with automatic gain adjustment is cascaded to conventional static-gain PI. The importance in controlling the dissolved oxygen concentration and the improvement of nitrogen removal process are discussed. The effectiveness of the proposed EN-PI controller is validated by comparing the performance of local control loops and the activated sludge process to the benchmark PI under three different weathers. The EN-PI controller is effectively applied in improving the performances of the static-gain PI, hence controlling the dynamic natures of the plant. Itwas proved by significant improvement in effluent violations, effluent quality index and energy saving of the Benchmark Simulation Model No.1

SARS-CoV-2 accessory proteins reveal distinct serological signatures in children

International audienceThe antibody response magnitude and kinetics may impact clinical severity, serological diagnosis and long-term protection of COVID-19, which may play a role in why children experience lower morbidity. We therefore tested samples from 122 children in Hong Kong with symptomatic (n = 78) and asymptomatic (n = 44) SARS-CoV-2 infections up to 200 days post infection, relative to 71 infected adults (symptomatic n = 61, and asymptomatic n = 10), and negative controls (n = 48). We assessed serum IgG antibodies to a 14-wide antigen panel of structural and accessory proteins by Luciferase Immuno-Precipitation System (LIPS) assay and circulating cytokines. Infected children have lower levels of Spike, Membrane, ORF3a, ORF7a, ORF7b antibodies, comparable ORF8 and elevated E-specific antibodies than adults. Combination of two unique antibody targets, ORF3d and ORF8, can accurately discriminate SARS-CoV-2 infection in children. Principal component analysis reveals distinct pediatric serological signatures, and the highest contribution to variance from adults are antibody responses to non-structural proteins ORF3d, NSP1, ORF3a and ORF8. From a diverse panel of cytokines that can modulate immune priming and relative inflammation, IL-8, MCP-1 and IL-6 correlate with the magnitude of pediatric antibody specificity and severity. Antibodies to SARS-CoV-2 internal proteins may become an important sero surveillance tool of infection with the roll-out of vaccines in the pediatric population