Cardiorespiratory fitness, adiposity and incident asthma in adults

Available large-scale prospective studies on adiposity and asthma used body mass index as an indicator of adiposity. Studies involving more accurate measures of adiposity, such as body fat percentage (BF%), are needed to confirm or contrast body mass index - related results. Cardiorepiratory fitness is a strong predictor of morbidity and mortality, and the available literature suggests that moderate-high cardiorespiratory fitness reduces many of the health hazards associated with obesity. The present study aimed: 1) to examine whether cardiorespiratory fitness and/or BF% are associated with subsequent acquisition of asthma in adults; and 2) to test the hypothesis that a high cardiorespiratory fitness level can reduce the risk of incident asthma in individuals with excess adiposity

The EHA Research Roadmap : Malignant Lymphoid Diseases

Peer reviewe

Gluons and the quark sea at high energies: distributions, polarization, tomography

This report is based on a ten-week program on "Gluons and the quark sea at high-energies", which took place at the Institute for Nuclear Theory in Seattle in Fall 2010. The principal aim of the program was to develop and sharpen the science case for an Electron-Ion Collider (EIC), a facility that will be able to collide electrons and positrons with polarized protons and with light to heavy nuclei at high energies, offering unprecedented possibilities for in-depth studies of quantum chromodynamics. This report is organized around four major themes: i) the spin and flavor structure of the proton, ii) three-dimensional structure of nucleons and nuclei in momentum and configuration space, iii) QCD matter in nuclei, and iv) Electroweak physics and the search for physics beyond the Standard Model. Beginning with an executive summary, the report contains tables of key measurements, chapter overviews for each of the major scientific themes, and detailed individual contributions on various aspects of the scientific opportunities presented by an EIC.Comment: 547 pages, A report on the joint BNL/INT/Jlab program on the science case for an Electron-Ion Collider, September 13 to November 19, 2010, Institute for Nuclear Theory, Seattle; v2 with minor changes, matches printed versio

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Energy Efficiency and Demand-Response: Tools to Address Texas' Reliability Challenges

Texas has recently experienced major electric reliability problems, as illustrated by large load shedding during Winter Storm Uri in February 2021. This event reflected the extraordinarily high demand for electric home heating (from inefficient homes and equipment) combined with the loss of 50% of the state's generation fleet (due to freezing weather, fuel supply, and equipment failures). The Electric Reliability Council of Texas (ERCOT), the power system serving 90% of Texans, also faces summer supply challenges, as illustrated by calls for power conservation in June 2021. In that case, the shortage was driven by a large number of plants being out of service for unplanned repairs. ERCOT's energy-only wholesale market design and evolving generation resource mix are widely viewed as complicating the task of maintaining reliability as the power supply mix changes.Numerous solutions have been proposed to address these problems, including subsidized winterization of existing power plants and critical grid infrastructure, and construction of many new power plants. This paper looks at seven residential retrofit measures selected for their proven capability to reduce summer or winter peak electricity demand. We also considered the impacts of a planned federal phaseout of incandescent lamps on energy demand in Texas. This paper estimates these measures' potential to improve ERCOT's system reliability by cutting summer or winter peak loads or delivering grid flexibility services

The changing utility industry and opportunities to improve energy efficiency : insights from the U.S., Germany and Australia

The electric utility sector in Australia, Germany and the U.S. are all going through major changes driven by declining sales, increasing use of distributed energy sources and policy responses to global climate change. This paper discusses efforts in each of these countries to reform their electric industries, address climate change and promote energy efficiency. Going forward, we see a role for government, utilities and private market energy efficiency efforts in all three countries, although the emphasis will vary by country and will evolve over time. Where all three parties can work together with a common vision, reform efforts are likely to be more successful and more sustained. In all three countries the future is uncertain. In the face of this uncertainty, energy efficiency supporters need to keep abreast of these changes, and find more flexible and nimble policy strategies for energy efficiency to prosper, as the future is likely to unfold in unexpected ways

Utility DSM: Off the Coasts and into the Heartland

Utility demand-side management efforts began on the coasts but have recently spread to the "heartland." The authors review efforts to develop DSM programs and policies in states that are now ramping up programs, identifying key practices that are often linked with progress in states that are new to DSM and discussing the implications for the 18 states that currently lack significant DSM programs.