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Background: We sought to estimate whether a lower mean arterial blood pressure target, compared with a higher mean arterial blood pressure target, reduced 90-day all-cause mortality among critically ill adult patients with vasodilatory shock. Methods: We conducted an individual patient data meta-analysis of randomized controlled trials that evaluated the effect of distinct thresholds of mean arterial blood pressure to guide vasopressor support among critically ill adults identified in a systematic literature search. The main exposure was a lower mean arterial pressure target compared with a higher mean arterial pressure target (including usual care). The primary outcome was 90-day all-cause mortality. We used a Bayesian random effects log-binomial model to estimate risk ratios with 95% credible intervals (CrIs). Results: Between 2010 and 2019, 3352 patients were randomly assigned in three trials (SEPSISPAM, OVATION pilot trial, and 65-Trial) across 103 hospitals from the United Kingdom, France, and Canada. When compared with a higher mean arterial blood pressure target or usual care, the risk ratio for 90-day all-cause mortality associated with a lower blood pressure target was 0.93 (95% CrI, 0.76 to 1.07; low certainty, posterior probability of benefit 87%). Results were consistent across multiple secondary and sensitivity analyses, including adjustment for prognostically important baseline covariates and alternative modeling techniques. Multiple approaches to evaluate the heterogeneity of treatment effect did not identify any subgroups that may potentially benefit from higher mean arterial blood pressure targets. Conclusions: Targeting a lower mean arterial blood pressure for vasopressor therapy in critically ill patients with vasodilatory shock possibly reduced 90-day all-cause mortality. However, the certainty of evidence is low, and this analysis does not exclude the possibility that lower targets may cause harm overall. [ABSTRACT FROM AUTHOR]

Simple Summary: As the global population continues to grow, the demand for sustainable protein sources is intensifying. Black soldier fly (BSF) larvae are emerging as a promising solution for reducing food waste while producing high-quality proteins for animal feed. This study focused on optimising the growth of BSF larvae by exploring how their feed's nutrient content impacts their growth. By testing various feed formulations and developing a predictive model, we created a prediction formula for balancing protein, fat, and carbohydrates to maximise growth and efficiency. These findings provide a roadmap for creating better feed mixes from diverse organic waste streams, helping reduce waste and dependency on traditional protein sources like soy and fishmeal. This study explores the optimisation of rearing substrates for black soldier fly larvae (BSFL). First, the ideal dry matter content of substrates was determined, comparing the standard 30% dry matter (DM) with substrates hydrated to their maximum water holding capacity (WHC). Substrates at maximal WHC yielded significantly higher larval survival rates (p = 0.0006). Consequently, the WHC approach was adopted for further experiments. Using these hydrated artificial substrates, fractional factorial designs based on central composite and Box–Behnken designs were employed to assess the impact of macronutrient composition on bioconversion efficiency. The results demonstrated significant main, interaction, and quadratic effects on bioconversion efficiency. Validation with real-life substrates of varied protein content, including indigestible feather meal, affirmed the predictive model's accuracy after accounting for protein source digestibility. This research underscores the importance of optimal hydration and macronutrient composition in enhancing BSFL growth and bioconversion efficiency. [ABSTRACT FROM AUTHOR]

On "Blood Pressure Targets for Adults with Vasodilatory Shock". Dr. Rob Mac Sweeney from Critical Care Reviews joins NEJM Evidence executive editor Corey Hardin and author Dr. François Lamontagne to discuss Dr. Lamontagne's recent publication "Blood Pressure Targets for Adults with Vasodilatory Shock." [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPurpose:Pressure injuries (PrI) are a prevalent and serious health issue for wheelchair users. This study aims to identify the personal factors associated with PrI occurrence and their significance by synthesizing existing literature.Materials and methods:We conducted an umbrella review, systematically searching four databases for reviews published from 2007 to May 2024. The search terms were selected by an independent, experienced librarian. To evaluate the risk of bias and methodological quality of the included studies, we applied the ROBIS tool and the GROOVE procedure. Identified risk factors were categorized into relevant groups.Results:After an assessment of 5,797 potential articles, 21 studies met the inclusion criteria. Among these, 43% were systematic reviews, 24% meta-analyses, 19% literature reviews, 9% scoping reviews, and 5% narrative reviews. The findings revealed 33 individual personal factors, categorized into the general health, clinical condition, initial pathology, environment/lifestyle, person-related, and combined risk factor groups. Key individual risk factors frequently encountered among wheelchair users included advanced age, obesity, spinal cord injury (SCI), higher levels of SCI, diabetes, infections, incontinence, immobility, respiratory and perfusion impairments, sensory perception issues, and low physical activity.Conclusions:This study is the first to synthesize literature on internal risk factors associated with PrI among wheelchair users. It confirmed well-established factors such as SCI, diabetes, and aging. The findings provide healthcare professionals and decision-makers with critical information for the prevention and management of PrI in this population, offering new insights into adopting a holistic approach to assessing and addressing individual risks factors.This review provides a holistic view of a person's risk factors for PrI occurrence.Because combined individual risk factors are considered as individual risk factors, it emphasizes the importance of taking an overall view of each wheelchair user when considering PrI prevention.This review provides a holistic view of a person's risk factors for PrI occurrence.Because combined individual risk factors are considered as individual risk factors, it emphasizes the importance of taking an overall view of each wheelchair user when considering PrI prevention. [ABSTRACT FROM AUTHOR]

Background: Exoskeletons are used in rehabilitation centers for people with spinal cord injuries (SCI) due to the potential benefits they offer for locomotor rehabilitation. The acceptability of exoskeletons is crucial to promote rehabilitation and to ensure a successful implementation of this technology. The objective was to explore the acceptability of overground wearable powered exoskeleton used in rehabilitation among people with SCI. Methods: Fourteen individuals with SCI (9 men, mean [SD] age 47 years [14.8], a majority with traumatic and thoracic lesion (T6–T12)) who had utilized an exoskeleton in Canada or in France during their rehabilitation participated in a semi-structured interview. A thematic analysis using the theoretical framework of acceptability was carried out. Results: Participants were motivated to use an exoskeleton during their rehabilitation. They reported several perceived benefits to its use, including better walking pattern, increased endurance, and greater muscle mass. They also experienced mild pain, notable concentration demands, and fatigue. Most participants reported that using exoskeletons in their rehabilitation process was appropriate and relevant to them. Conclusions: Exoskeletons are generally well accepted by participants in this study. Adjustments in their use, such as conducting training sessions in obstacle-free environment and technological improvements to address the device’s restrictive characteristics, heaviness, and massiveness are however still needed.