Explore the vast range of titles available.

The “very old intensive care patients” (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

Delirium is a common and serious complication in elderly patients undergoing major abdominal surgery, with significant adverse outcomes. Successful strategies or therapies to reduce the incidence of delirium are scarce. The objective of this study was to assess the role of prehabilitation in reducing the incidence of delirium in elderly patients. A single-center uncontrolled before-and-after study was conducted, including patients aged 70 years or older who underwent elective abdominal surgery for colorectal carcinoma or an abdominal aortic aneurysm between January 2013 and October 2015 (control group) and between November 2015 and June 2018 (prehabilitation group). The prehabilitation group received interventions to improve patients' physical health, nutritional status, factors of frailty and preoperative anaemia prior to surgery. The primary outcome was incidence of delirium, diagnosed with the DSM-V criteria or the confusion assessment method. Secondary outcomes were additional complications, length of stay, unplanned ICU admission, length of ICU stay, readmission rate, institutionalization, and in-hospital or 30-day mortality. A total of 360 control patients and 267 prehabilitation patients were included in the final analysis. The mean number of prehabilitation days was 39 days. The prehabilitation group had a higher burden of comorbidities and was more physically and visually impaired at baseline. At adjusted logistic regression analysis, delirium incidence was reduced significantly from 11.7 to 8.2% (OR 0.56; 95% CI 0.32-0.98; P = 0.043). No statistically significant effects were seen on secondary outcomes. Current prehabilitation program is feasible and safe, and can reduce delirium incidence in elderly patients undergoing elective major abdominal surgery. This program merits further evaluation. Dutch Trial Registration, NTR5932.

Perception is often characterized computationally as an inference process in which uncertain or ambiguous sensory inputs are combined with prior expectations. Although behavioral studies have shown that observers can change their prior expectations in the context of a task, robust neural signatures of task-specific priors have been elusive. Here, we analytically derive such signatures under the general assumption that the responses of sensory neurons encode posterior beliefs that combine sensory inputs with task-specific expectations. Specifically, we derive predictions for the task-dependence of correlated neural variability and decision-related signals in sensory neurons. The qualitative aspects of our results are parameter-free and specific to the statistics of each task. The predictions for correlated variability also differ from predictions of classic feedforward models of sensory processing and are therefore a strong test of theories of hierarchical Bayesian inference in the brain. Importantly, we find that Bayesian learning predicts an increase in so-called “differential correlations” as the observer’s internal model learns the stimulus distribution, and the observer’s behavioral performance improves. This stands in contrast to classic feedforward encoding/decoding models of sensory processing, since such correlations are fundamentally information-limiting. We find support for our predictions in data from existing neurophysiological studies across a variety of tasks and brain areas. Finally, we show in simulation how measurements of sensory neural responses can reveal information about a subject’s internal beliefs about the task. Taken together, our results reinterpret task-dependent sources of neural covariability as signatures of Bayesian inference and provide new insights into their cause and their function.

The ability to perform genomic sequencing on long-dead organisms is opening new frontiers in evolutionary research. These opportunities are especially notable in the case of museum collections, from which countless documented specimens may now be suitable for genomic analysis—if data of sufficient quality can be obtained. Here, we report 25 newly sequenced genomes from museum specimens of the model organism Drosophila melanogaster , including the oldest extant specimens of this species. By comparing historical samples ranging from the early 1800s to 1933 against modern-day genomes, we document evolution across thousands of generations, including time periods that encompass the species’ initial occupation of northern Europe and an era of rapidly increasing human activity. We also find that the Lund, Sweden population underwent local genetic differentiation during the early 1800s to 1933 interval (potentially due to drift in a small population) but then became more similar to other European populations thereafter (potentially due to increased migration). Within each century-scale time period, our temporal sampling allows us to document compelling candidates for recent natural selection. In some cases, we gain insights regarding previously implicated selection candidates, such as ChKov1 , for which our inferred timing of selection favors the hypothesis of antiviral resistance over insecticide resistance. Other candidates are novel, such as the circadian-related gene Ahcy , which yields a selection signal that rivals that of the DDT resistance gene Cyp6g1 . These insights deepen our understanding of recent evolution in a model system, and highlight the potential of future museomic studies.

While excessive anthropogenic nutrient loads are harmful to coral reefs, natural nutrient flows can boost coral growth and reef functions. Here we investigate if seabird-derived nutrient subsidies benefit the growth of two dominant corals on lagoonal reefs, submassive Isopora palifera and corymbose Acropora vermiculata , and if enhanced colony-level calcification rates can increase reef-scale carbonate production. I. palifera and A. vermiculata colonies close to an island with high seabird densities displayed 1.4 and 3.2-times higher linear extension rates, 1.8 and 3.9-times faster planar area increase, and 1.6 and 2.7-times higher calcification rates compared to colonies close to a nearby island with low seabird densities, respectively. While benthic ReefBudget surveys in combination with average coral growth rates did not indicate differences in reef-scale carbonate production across sites, coral carbonate production was 2.2-times higher at the seabird-rich island when using site-specific linear growth rates and skeletal densities. This study shows that seabird-derived nutrients benefit fast-growing branching as well as previously unstudied submassive coral taxa. It also demonstrates that nutrient subsidies benefit colony-scale and reef-scale calcification rates, which underpin important geo-ecological reef functions. Restoring natural nutrient pathways should thus be a priority for island and reef management.

Making good decisions requires updating beliefs according to new evidence. This is a dynamical process that is prone to biases: in some cases, beliefs become entrenched and resistant to new evidence (leading to primacy effects), while in other cases, beliefs fade over time and rely primarily on later evidence (leading to recency effects). How and why either type of bias dominates in a given context is an important open question. Here, we study this question in classic perceptual decision-making tasks, where, puzzlingly, previous empirical studies differ in the kinds of biases they observe, ranging from primacy to recency, despite seemingly equivalent tasks. We present a new model, based on hierarchical approximate inference and derived from normative principles, that not only explains both primacy and recency effects in existing studies, but also predicts how the type of bias should depend on the statistics of stimuli in a given task. We verify this prediction in a novel visual discrimination task with human observers, finding that each observer’s temporal bias changed as the result of changing the key stimulus statistics identified by our model. The key dynamic that leads to a primacy bias in our model is an overweighting of new sensory information that agrees with the observer’s existing belief—a type of ‘confirmation bias’. By fitting an extended drift-diffusion model to our data we rule out an alternative explanation for primacy effects due to bounded integration. Taken together, our results resolve a major discrepancy among existing perceptual decision-making studies, and suggest that a key source of bias in human decision-making is approximate hierarchical inference.

Background High-pressure injection injuries are rare injuries and are frequently underestimated due to the limited external damage. Because of their association with occupational activities, these injuries are predominantly seen in hands. Facial involvement in such traumas is extremely rare. The difference in facial anatomy compared to the extremities demands careful consideration of both associated complications and treatment options. Case A 6-year-old girl with no significant medical history was presented to the Emergency Department with a high-pressure injection injury to her right eye with a high-pressure cleaner. This resulted in injection of air at a pressure of 8 bar into the eye. She developed significant subcutaneous emphysema in the facial and neck regions. Additionally, intraorbital and intracranial emphysema were identified without any fractures. Treatment consisted of inpatient observation and antibiotic treatment. The patient was discharged after one day of observation for continued antibiotic treatment at home. Two weeks later, the patient had no residual symptoms and there were no signs of secondary infection. Conclusion High-pressure injection injuries to the face are rare and demand a different approach compared to the most common high-pressure injection injuries to the extremities. The nature of the injected material is paramount in choosing the appropriate treatment. This case illustrates that a high-pressure injection injury with air in the facial region, leading to extensive emphysema, can be managed conservatively with antibiotic therapy and inpatient observation.

The Chilean margin is one of the Earth's tectonically most active plate boundaries, and yet, some of its segments are still underexplored. Here, we present amphibious data from the Copiapó region at ∼27°S located within the mature Atacama seismic gap. Combined 2D seismic refraction, multibeam bathymetry, and local seismicity data show a typical oceanic crust thickness of 6–7 km and seismic P‐wave velocities between 3.0 and 7.3 km/s with slightly lower velocities and increased thicknesses underneath the Copiapó Ridge seamounts. The latter is most likely due to predominantly extrusive formation. Elevated velocities underneath one of the seamounts indicate a local region of magmatic underplating, while bending‐related faults visible in the bathymetry and reduced mantle velocities near the trench suggest mantle hydration. The subduction angle of the down‐going Nazca plate smoothly increases from 12° below the marine forearc to 22° at greater depths (40–60 km) with no abrupt change in the dip angle as observed at ∼22°S. The local seismicity off‐ and onshore Copiapó shows three separated bands of earthquakes sub‐parallel to the down‐going plate, and are most likely related to the plate interface, the oceanic Moho and the Double Benioff Zone. The largest event (MW 5.9) during our observation period (December 2022–June 2023) and its aftershocks occurred in the deepest band ∼20 km below the subduction interface. Along the interface, seismicity is most pronounced in areas of high locking offshore, whereas areas of low locking are characterized by previously observed slow slip events and sparse seismicity. Plain Language Summary The Chilean margin is characterized by the collision and subduction of the oceanic Nazca Plate below the continental South American Plate, repeatedly causing large earthquakes. In this study, we investigate the region around Copiapó (∼27°S), which has not been affected by a megathrust earthquake for more than 100 years. By combining different amphibious methods (high‐resolution multibeam bathymetry, wide‐angle seismic refraction and seismological data), we conclude that the Copiapó Ridge seamounts were formed predominantly by extrusive volcanic processes and that the crust underneath some seamounts is thickened due to ascending magma. Compared to ∼22°S, where the subduction angle shows an abrupt steepening, we observe a smooth increase from 12° at shallow depths to 22° at greater depths. Furthermore, our analysis reveals that earthquakes occur in three bands at different depths that are sub‐parallel to the subducting plate. The largest earthquake and its aftershocks occurred in the deepest band and were not related to the interface between the colliding plates. Key Points Multidisciplinary approach using high‐resolution bathymetry, amphibious refraction tomography and shoreline‐crossing seismicity P‐wave velocity model reveals seamounts formed by extrusive volcanism with possible underplating added underneath typical oceanic crust Seismicity occurs in three bands sub‐parallel to the plate interface, with the largest event and aftershocks located ∼20 km below the interface

Coral growth is an important metric of coral health and underpins reef-scale functional attributes such as structural complexity and calcium carbonate production. There persists, however, a paucity of growth data for most reef-building regions, especially for coral species whose skeletal architecture prevents the use of traditional methods such as coring and Alizarin staining. We used structure-from-motion photogrammetry to quantify a range of colony-scale growth metrics for six coral species in the Mexican Caribbean and present a newly developed workflow to measure colony volume change over time. Our results provide the first growth metrics for two species that are now major space occupiers on Caribbean reefs, Agaricia agaricites and Agaricia tenuifolia . We also document higher linear extension, volume increase and calcification rates within back reef compared to fore reef environments for four other common species: Orbicella faveolata , Porites astreoides , Siderastrea siderea and Pseudodiploria strigosa . Linear extension rates in our study were lower than those obtained via computed tomography (CT) scans of coral cores from the same sites, as the photogrammetry method averages growth in all dimensions, while the CT method depicts growth only along the main growth axis (upwards). The comparison of direct volume change versus potential volume increase calculated from linear extension emphasizes the importance of assessing whole colony growth to improve calcification estimates. The method presented here provides an approach that can generate accurate calcification estimates alongside a range of other whole-colony growth metrics in a non-invasive way.

Estimating glomerular filtration (eGFR) after Continuous Renal Replacement Therapy (CRRT) is important to guide drug dosing and to assess the need to re-initiate CRRT. Standard eGFR equations cannot be applied as these patients neither have steady-state serum creatinine concentration nor average muscle mass. In this study we evaluate the combination of dynamic renal function with CT-scan based correction for aberrant muscle mass to estimate renal function immediately after CRRT cessation. We prospectively included 31 patients admitted to an academic intensive care unit (ICU) with a total of 37 CRRT cessations and measured serum creatinine before cessation (T1), directly (T2) and 5 h (T3) after cessation and the following two days when eGFR stabilized (T4, T5). We used the dynamic creatinine clearance calculation (D3C) equation to calculate eGFR (D3C GFR ) and creatinine clearance (D3C creat ) between T2-T3. D3C creat was corrected for aberrant muscle mass when a CT-scan was available using the CRAFT equation. We compared D3C GFR to stabilized CKD-EPI at T5 and D3C Creat to 4-h urinary creatinine clearance (4-h uCrCl) between T2-T3. We retrospectively validated these results in a larger retrospective cohort (NICE database; 1856 patients, 2064 cessations). The D3C GFR was comparable to observed stabilized CKD-EPI at T5 in the prospective cohort (MPE = − 1.6 ml/min/1.73 m 2 , p30 = 76%) and in the retrospective NICE-database (MPE = 3.2 ml/min/1.73 m 2 , p30 = 80%). In the prospective cohort, the D3C Creat had poor accuracy compared to 4-h uCrCl (MPE = 17 ml/min/1.73 m 2 , p30 = 24%). In a subset of patients (n = 13) where CT-scans were available, combination of CRAFT and D3C Creat improved bias and accuracy (MPE = 8 ml/min/1.73 m 2 , RMSE = 18 ml/min/1.73 m 2 ) versus D3C Creat alone (MPE = 18 ml/min/1.73 m 2 , RMSE = 32 ml/min/1.73 m 2 ). The D3C GFR improves assessment of eGFR in ICU patients immediately after CRRT cessation. Although the D3C Creat had poor association with underlying creatinine clearance, inclusion of CT derived biometric parameters in the dynamic renal function algorithm further improved the performance, stressing the role of muscle mass integration into renal function equations in critically ill patients.