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Background: To improve the understanding of the thermodynamics and performance of small passive hygroscopic Heat and Moisture Exchangers (HMEs), a computer model simulating HME function is required. Methods: We developed a numerical HME model to calculate the HME's water and heat exchange. The model was tuned and verified with experimental data and validated by applying it to HME design variations. Results: Verification of the model's results to the experimental data shows that the tuned model yields reliable results. The mass of the core, which determines the HME's total heat capacity, is the most important parameter influencing the performance of passive HMEs. Conclusions: Increasing the HME's diameter is an effective way to improve an HME, as it yields higher performance and lowers breathing resistance. HMEs intended for use in warm or dry climates should contain more and those for use in cold humid climates should contain less hygroscopic salt.

The lipid profile is important in the risk assessment for cardiovascular disease. The lipid profile includes total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglycerides (TGs) and low-density lipoprotein (LDL)-cholesterol (LDL-C). LDL-C has traditionally been calculated using the Friedewald equation (invalid with TGs greater than 4.5 mmol/L and is based on the assumption that the ratio of TG to cholesterol in very- low-density lipoprotein (VLDL) is 5 when measured in mg /dL). LDL-C can be quantified with a reference method, beta-quantification involving ultracentrifugation and this is unsuitable for routine use. Direct measurement of LDL-C was expected to provide a solution with high TGs. However, this has some challenges because of a lack of standardisation between the reagents and assays from different manufacturers as well as the additional costs. Furthermore, mild hypertriglyceridaemia also distorts direct LDL-C measurements. With the limitations of the Friedewald equation, alternatives have been derived. Newer equations include the Sampson-National Institutes of Health (NIH) equation 2 and the Martin-Hopkins equation. The Sampson-NIH2 equation was derived using beta-quantification in a population with high TG and multiple least squares regression to calculate VLDL-C, using TGs and non-HDL-C as independent variables. These data were used in a second equation to calculate LDL-C. The Sampson-NIH2 equation can be used with TGs up to 9 mmol/L. The Martin-Hopkins equation uses a 180 cell stratification of TG/non-HDL-C to determine the TG:VLDL-C ratio and can be used with TGs up to 4.5 mmol/L. Recently, an extended Martin-Hopkins equation has become available for TGs up to 9.04 mmol/L.This article discusses the best practice approach to calculating LDL-C based on the available evidence.

Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, and the International Standard ISO 23162:2021. With these tools, we propose that authors should be instructed to follow these laboratory methods in order to publish studies in peer-reviewed journals, preferable by using a checklist as suggested in an Appendix to this article.

The reference method for low-density lipoprotein-cholesterol (LDL-C) quantitation is β-quantification, a technically demanding method that is not convenient for routine use. Indirect calculation methods to estimate LDL-C, including the Friedewald equation, have been used since 1972. This calculation has several recognized limitations, especially inaccurate results for triglycerides (TG)4.5 mmol/l (400 mg/dl). In view of this, several other equations were developed across the world in different datasets.The purpose of this review was to analyze the best method to calculate LDL-C in clinical practice by reviewing studies that compared equations with measured LDL-C.We identified 45 studies that compared these formulae. The Martin/Hopkins equation uses an adjustable factor for TG:very low-density lipoprotein-cholesterol ratios, validated in a large dataset and demonstrated to provide more accurate LDL-C calculation, especially when LDL1.81 mmol/l (70 mg/dl) and with elevated TG. However, it is not in widespread international use because of the need for further validation and the use of the adjustable factor. The Sampson equation was developed for patients with TG up to 9 mmol/l (800 mg/dl) and was based on β-quantification and performs well on high TG, postprandial and low LDL-C samples similar to direct LDL-C.The choice of equation should take into the level of triglycerides. Further validation of different equations is required in different populations.

The modular DAQ development projects Caribou (for silicon detectors) and SRS-VMM3 (for gas detectors) provide common open-source platforms with reusable hardware, firmware and software. This document reports on the design of the two readout boards, which constitutes MS11 in month 23.

The RD51 collaboration maintains a common infrastructure at CERN for its R & Dactivities, including two beam telescopes for test beam campaigns. Recently, one of the beamtelescopes has been equipped and commissioned with new multi-channel and charge-sensitivefront-end electronics based on the ATLAS/BNL VMM3a front-end ASIC and the RD51 Scalable ReadoutSystem (SRS). This allows to read out the detectors at high rates (up to the MHz regime) withelectronics time resolutions of the order of 1 ns and the ability to handle different detectortypes and sizes, due to a larger dynamic range compared to the previous front-end electronicsbased on the APV25 ASIC. Having studied and improved the beam telescope's performance over thecourse of three test beam campaigns, the results are presented in this paper. The RD51 collaboration maintains a common infrastructure at CERN for its R & D activities, including two beam telescopes for test beam campaigns. Recently, one of the beam telescopes has been equipped and commissioned with new multi-channel and charge-sensitive front-end electronics based on the ATLAS/BNL VMM3a front-end ASIC and the RD51 Scalable Readout System (SRS). This allows to read out the detectors at high rates (up to the MHz regime) with electronics time resolutions of the order of 1 ns and the ability to handle different detector types and sizes, due to a larger dynamic range compared to the previous front-end electronics based on the APV25 ASIC. Having studied and improved the beam telescope's performance over the course of three test beam campaigns, the results are presented in this paper.

Wastewater (WW) is considered a source of antibiotic-resistant bacteria with clinical relevance and may, thus, be important for their dissemination into the environment, especially in countries with poor WW treatment. To obtain an overview of the occurrence and characteristics of carbapenem-resistant Gram-negative bacteria (CR-GNB) in WW of Belgrade, we investigated samples from the four main sewer outlets prior to effluent into international rivers, the Sava and the Danube. Thirty-four CR-GNB isolates were selected for antimicrobial susceptibility testing (AST) and whole-genome sequencing (WGS). AST revealed that all isolates were multidrug-resistant. WGS showed that they belonged to eight different species and 25 different sequence types (STs), seven of which were new. ST101 K. pneumoniae (blaCTX-M-15/blaOXA-48) with novel plasmid p101_srb was the most frequent isolate, detected at nearly all the sampling sites. The most frequent resistance genes to aminoglycosides, quinolones, trimethroprim-sulfamethoxazole, tetracycline and fosfomycin were aac(6′)-Ib-cr (55.9%), oqxA (32.3%), dfrA14 (47.1%), sul1 (52.9%), tet(A) (23.5%) and fosA (50%), respectively. Acquired resistance to colistin via chromosomal-mediated mechanisms was detected in K. pneumoniae (mutations in mgrB and basRS) and P. aeruginosa (mutation in basRS), while a plasmid-mediated mechanism was confirmed in the E. cloacae complex (mcr-9.1 gene). The highest number of virulence genes (>300) was recorded in P. aeruginosa isolates. Further research is needed to systematically track the occurrence and distribution of these bacteria so as to mitigate their threat.

International audience; We describe the development of a position-sensitive Gas Electron Multiplier detector prototype, providing for each ionizing event three coordinates: the cartesian X and Y, and U at 45°. Simultaneous recording of the three projections permits ambiguity-free reconstruction of multiple tracks, and aims at operation in very high intensity radiation fields.

Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality.We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates.Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083).In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico.For the Portuguese translation of the abstract see Supplementary Materials section.

Albumin, a vital protein in cell culture systems, is derived from whole blood or blood products. The culture of human gametes and developing embryos for assisted reproductive technology (ART) uses albumin of human origin. Human serum albumin (HSA) is derived from expired blood obtained from blood banks. This blood has been stored in polyvinyl chloride bags made clear and flexible with di-2-ethylhexyl phthalate (DEHP). However, DEHP can leach from the bags into stored blood and cofractionate with HSA during albumin isolation. DEHP and its metabolite, mono-ethylhexyl phthalate, are known endocrine disruptors that are reported to have negative effects when directly supplemented in media for in vitro fertilization using gametes from a variety of animals. Therefore, the contamination of ART media with DEHP and mono-ethylhexyl phthalate through HSA supplementation may affect the outcomes of ART procedures. Although the embryology laboratory is strictly monitored to prevent a wide variety of contaminations, phthalate contamination of HSA has not been broadly examined. This review outlines the function of HSA in ART procedures and the production of HSA from whole blood. Finally, the review highlights the effects of acute phthalate exposures on gametes during in vitro procedures. Phthalates found in human serum albumin are present in media used for ART at levels that impair developmental endpoints in model species.

The gold standard for measuring LDL-C is impractical for routine use while direct measurements have numerous shortcomings. This study investigated the correlation of predictive equations with currently used enzymatic assays in populations where these have historically proven unreliable to determine whether equations may be used interchangeably. No reference measure was available for comparison in this study.We examined two analytical datasets from different platforms to evaluate the correlation of predictive equations for LDL-C (Friedewald, Sampson-NIH2, Martin-Hopkins, Extended Martin-Hopkins, Hattori and Anandaraja) with direct LDL-C assays in a large paediatric (n = 7598) and an adult cohort with uncontrolled diabetes (n = 57165). Non-parametric statistics were used for comparison.In the paediatric cohort, the Sampson-NIH2 equation correlated best with the direct LDL-C assays with the most values falling within desirable bias (35.9-44%) and TEDifferent measurement platforms influence the results of predictive equations and directly measured LDL-C. We propose utilising the Martin-Hopkins equation as an alternative to dLDL-C assays in adults with diabetes and for screening purposes in paediatric populations to avoid underestimating cardiovascular risk.

Background: Due to the heat and moisture exchanger's (HME) breathing resistance, laryngectomized patients cannot always use an (optimal) HME during physical exercise. We propose a novel HME cassette concept with adjustable “bypass,” to provide adjustment between different breathing resistances within one device. Methods: Under standardized conditions, the resistance and humidification performance of a high resistance/high humidification HME (XM) foam in a cassette with and without bypass were compared to a lower resistance/lesser humidification HME (XF) foam in a closed cassette. Results: With a bypass in the cassette, the resistance and humidification performance of XM foam were similar to those of XF foam in the closed cassette. Compared to XM foam in the closed cassette, introducing the bypass resulted in a 40% resistance decrease, whereas humidification performance was maintained at 80% of the original value. Conclusions: This HME cassette prototype allows adjustment between substantially different resistances while maintaining appropriate humidification performances.

In this paper, we propose a sparse decomposition of the heart rate during sleep with an application to apnoea–RERA detection. We observed that the tachycardia following an apnoea event has a quasi-deterministic shape with a random amplitude. Accordingly, we model the apnoea-perturbed heart rate as a Bernoulli–Gaussian (BG) process convolved with a deterministic reference signal that allows the identification of tachycardia and bradycardia events. The problem of determining the BG series indicating the presence or absence of an event and estimating its amplitude is a deconvolution problem for which sparsity is imposed. This allows an almost syntactic representation of the heart rate on which simple detection algorithms are applied.

International audience; The main purpose of this contribution is to describe the new features of the latest version 7.4 of the CONtinuous-Time System IDentification (CONTSID) toolbox for Matlab. The main addition is a new Graphical User Interface (GUI), which allows the user in a friendly and easy way to perform data analysis, model parameter estimation as well as model validation. The recent additions for MISO time-delay transfer function model identification are also briefly introduced.

Introduction The focus on paediatric radiation dose reduction supports reevaluation of paediatric imaging protocols. This is particularly important in the neonates where chest radiographs are frequently requested to assess respiratory illness and line placement. This study aims to assess the impact of neonatal chest radiographic protocols on patient dose in four hospitals in different countries. Methods Exposure parameters, collimation, focus to skin distance (FSD) and radiation dose from 200 neonatal chest radiographs were registered prospectively. Inclusion criteria consisted of both premature and full-term neonates weighing between 1000 and 5000 g. Only data from the examinations meeting diagnostic criteria and approved for the clinical use were included. Radiation dose was assessed using dose area product (DAP). Results The lowest DAP value (4.58 mGy cm2) was recorded in the Norwegian hospital, employing a high kVp, low mAs protocol using a DR system. The Canadian hospital recorded the highest DAP (9.48), using lower kVp and higher mAs with a CR system, including the addition of a lateral projection. The difference in the mean DAP, weight, field of view (FOV) and kVp between the hospitals is statistically significant (p Conclusion Use of non-standardised imaging protocols in neonatal chest radiography results in differences in patient dose across hospitals included in the study. Using higher kVp, lower mAs and reducing the number of lateral projections to clinically relevant indications result in a lower DAP measured in the infant sample studied. Further studies to examine image quality based on exposure factors and added filtration are recommended. Implications for practice Reevaluation of paediatric imaging protocols presents an opportunity to reduce patient dose in a population with increased sensitivity to ionising radiation.